Should You be Concerned about Facility Staffing Ratios and Do the States take Patients into Account?
There has been a lot of debate throughout the year about what the proper staffing for an out-patient hemodialysis clinic should be. California’s Senate Bill 349, called the Dialysis Patient Safety Act, has brought this to the forefront again.
California Nurses Union Supports New Senate Bill
The bill that is making its way through the California legislature would make the following staffing requirements mandatory
- At least one nurse must provide direct care for every eight patients. A nurse only counts toward this ratio if he/she has no other responsibilities other than direct patient care. A nurse manager or charge nurse does not count toward this ratio.
- At least one technician is providing direct care for every three patients. A technician only counts toward this ratio during periods in which the technician has no responsibilities other than direct care. Trainees and nurses included in the nurse ratio do not count toward this ratio.
- The bill would also require a minimum 45-minute transition time between patients
This is being supported by the California Nurses Union and opposed by the California Dialysis Council (which is a group of dialysis providers in California). The CDC says that will be a financial hardship on dialysis clinics and will put smaller and less profitable clinics out of business. The California Nurses say that they are overworked and underappreciated.
The Patient is What This Should all be About
All of us who work in dialysis know that we are expected to do more with less resources. We all know that our patients are sick and in need of more of our time. What gets lost in all of these discussions is the “patient”. The Patient is what this should all be about.
If we have the time to give excellent care, time to talk with patients, time to educate them on a daily basis, they will have a better quality of life, be more involved with their care and most likely live longer. This will in the long run increase the clinic revenue.
If the dialysis staff is less stressed and more content, there will be a greater focus on patient care and safety. This will reduce legal costs and improve patient outcomes. If dialysis professionals are given the time to give excellent care, they will be more fulfilled in their career and less likely to leave. This will reduce clinic costs to constantly retrain. It will increase the quality of people we can retain.
At present, many clinics have more openings than they have applicants. They are so stressed that they hire people that they know do not have the personality to take care of dialysis patients. Let’s admit it! Dialysis patients are difficult to take care of. With what they have lost (ability to support themselves, marriages, family, ability to take care of themselves, etc.), our patients have every right to be difficult. I applaud our patients that manage to persevere and have a full life. I don’t know if I could.
A number of states have established staffing ratios, including Texas and Oregon. But, they still do not take in to account the needs of the patients.
Let’s Have a National Discussion on This Topic!
I am calling for a National discussion about appropriate dialysis staffing that would include all stakeholders, including American Nephrology Nurses Association (ANNA), National Association of Nephrology Technicians (NANT), Renal Physicians Association (RPA), Renal Administrators Association (RAA) and most importantly our patients!
Click here to read previous Letters from the President.