HEALTH CARE STAFFING

WHEREAS, many health care facilities are responding to the pressure to cut their costs by reducing the number of staff assigned to patient care and by instituting experimental new work arrangements that rely on the use of unlicensed support staff to perform duties previously assigned to licensed health care personnel; and

WHEREAS, there are currently no national standards and often no state standards for determining appropriate minimum staffing levels in health care facilities, so that decisions about the number and type of staff on duty at any given time are left to the discretion of management at a time in which cost cutting is the primary yardstick by which such decisions are measured; and

WHEREAS, there are no national and often no state standards for training of those support staff nor are there mechanisms to determine their levels of competency to perform the tasks to which they are assigned; and

WHEREAS, the patient population that is the subject of these experiments in staffing redesign is likely to be suffering from more serious and more complex illnesses because of the trend to treat all but the most serious illnesses on an outpatient basis; and

WHEREAS, there are no data and there has been no evaluation of the effects of these organizational decisions on patient outcomes, quality of care or patient injuries, nor is there evidence of any systematic monitoring of these issues at the facility level; and

WHEREAS, patients and their families have no way of knowing when they enter a health care facility whether the personnel assigned to their care have been given adequate training and are competent to perform the tasks they are being asked to do, nor do they have any way of knowing what the staffing policies of that facility are and whether sufficient staff will be available to care for their needs; and

WHEREAS, the injury and illness rate among health care workers has been increasing steadily since 1980 and the probability of sustaining treatment-related accidents, injuries and infections among patients and staff is likely to continue to increase as the number and training of staff decreases; and

WHEREAS, every effort should be made to eliminate excessive spending, duplication and unnecessary expenditures in the provision of health care services, staffing decisions that affect the quality of patient care must not be governed solely or even predominantly by the desire to lower costs and maximize profits:

RESOLVED, that standardized job titles, job descriptions and minimum education or training requirements should be developed at the national or state level for all health care personnel to whom patient care duties may be assigned; and

RESOLVED, that health care facilities and managed care networks should be required to disclose publicly¾ according to a uniform and universal standard¾ data concerning staff numbers and skill mix in relation to patient population as well as their criteria for determining and adjusting those numbers; and

RESOLVED, that the appropriate governmental bodies should provide research funds to determine the relationship between health care staffing and quality of patient care; and

RESOLVED, that staffing numbers, skill mix and other issues affecting quality of care be designated mandatory subjects for collective bargaining so that nurses and other health care personnel are able to more effectively protect their patients, their working conditions and their professional interests; and

RESOLVED, that a national agency should be established to conduct ongoing evaluations of staffing and quality standards, collect and disseminate data and serve as a clearinghouse for the investigation of complaints regarding the safety and quality of patient care by hospitals, managed care networks and other providers.