At issue: Nursing staff levels

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Memorial Health System’s nurse staffing levels, among the highest in the nation, could be at risk if the three-hospital network is sold to a for-profit hospital.

Experts say higher nurse-patient ratios help prevent deaths in hospitals and generally yield better patient health outcomes. Patients tend to suffer more complications such as pressure-related ulcers and hospital-acquired infections when they stay in hospitals with lower nurse staffing levels.

HealthOne, the largest for-profit hospital owner in Colorado, has been identified as a potential suitor interested in Memorial.

A citizens commission began meeting earlier this year to explore whether Colorado Springs should sell Memorial.

While it doesn’t release staffing levels, HealthOne admits it doesn’t use the industry-recognized gold standard: California’s legislatively mandated staffing ratios. Memorial, on the other hand, does.

Patient satisfaction surveys at hospitalcompare.hhs.com show that patients are more satisfied with their nursing care at Memorial (70 percent) than they were at HealthONE’s largest Denver hospital, Presbyterian/St. Luke’s Medical Center (66 percent).

More than 55 percent of Memorial’s patients reported always receiving help when they needed it, while only 51 percent of Presbyterian’s patients said the same thing. Memorial also received higher levels of recommendations from its patients.

The site, operated by the U.S. Department of Health and Human Services, reported that both hospitals had mortality rate that were at the national average for hospitals.

HealthOne defended its approach to staffing.

“I don’t think it’s much different than what everyone else is doing,” said spokeswoman Linda Kanamine. “We’ve found that those California standards are hard to put into place in hospitals.”

HealthONE is part of HCA, a national network of hospitals, which Kanimine said allows it to gauge its nursing levels against other HCA hospitals.

Linda Goodwin, chief nursing officer for Memorial, said that beyond following California guidelines, her hospital also has a committee dedicated to the issue.

In some cases, Memorial’s standards for certain units are higher than those in California. For instance, Memorial staffs one nurse for every two patients in its critical care unit, while California’s minimums are one nurse for every three patients.

Memorial’s leaders decided to use California’s ratios, adopted by that state in 2004, because research done by the University of Pennsylvania showed that those ratios were more effective at saving lives than hospitals in states with no laws at all.

The study showed that the death rate after common surgeries in nursing units with lower staffing levels was 7 percent higher than in hospitals where the levels were higher.

Getting a clear view into staffing levels isn’t easy. For-profit hospitals jealously guard their staffing level information. Even nonprofits don’t like releasing specific information they use to decide staffing.

Hospitals such as Memorial tend to be more transparent about staffing levels because they rely more on federal money, which requires them to be more upfront about the question.

For-profit hospitals tend to be more focused on the bottom line, which sometimes influences their nurse-patient ratios, said Megan Finnegin, a spokeswoman for the Service Employees Industry of America, the largest nurses union in the country.

Colorado has no state mandate for nursing levels, so each hospital is left to its own devices when planning how best to use its nurses.

Fran Ricker, executive director of the Colorado Nursing Association, said ratios have their downside.

“We don’t support ratios,” she said, “because the minimum often becomes the maximum for hospitals struggling with their bottom lines. The important thing is to include nurses in whatever decisions the hospital is making about staffing. They are the ones that know best.”

The ANA and SEIU joined forces last year to introduce federal legislation that would require hospitals to establish committees populated by nurses and others to decide staffing levels at the unit and hospital level.

That legislation never got off the ground, Sachs said.

“We’re going to introduce it again; we’re refining it,” he said. “There’s no doubt there should be a standard. … Lack of nursing staff is related to complications, things like falls in the hospital, pressure ulcers, hospital-acquired infections. So having a committee, the strategy we support, can only boost those outcomes.”