- Contact the Committee

November 3, 2003

The Honorable Steve Buyer
Chairman, House Veteran’s Affairs
Subcommittee on Oversight and Investigations
337A Cannon House Office Building
Washington, DC 20515

Dear Chairman Buyer:

On the behalf of the 100,000 staff nurses of the United American Nurses, AFL-CIO (UAN), I would like to thank you for the opportunity to address your follow-up questions to the testimony that I presented at the hearing to review the impact of the current and future nursing shortage on the Department of Veterans Affairs held on October 2, 2003. As you requested, I have included each of your questions, followed by my reply.

Question 1

You stated in your testimony that the number of “unique patients” treated in the VA is up by 55 percent and that VA nurses are caring for more patients, who are often sicker with fewer nurses at the bedside. It appears that more patients are being seen and many are sicker. However, would you not agree that most patients are actually being seen on an outpatient basis?

Answer 1

As I stated in my testimony, VA statistics show that between 1996 and 2002 the number of full-time equivalent RNs went down 8.4 percent. During the same time period, the number of “unique patients” treated at VA went up by 55 percent. While I understand the VA has increased its reliance on out-patient care, the role of VA’s inpatient services has not decreased, but has become more focused. Advances in medical technology and research have allowed the treatment of diseases and conditions that were not treatable just a few years ago. As a result, patients are sicker at the bedside. The veteran population is also aging, which means patients will need more critical care provided by registered nurses. At the same time, the VA continues to decrease the length of stay for patients and discharges them sooner. This means that there are more patients on the floor that used to be in the ICU. Another factor in the staff nurse shortage in the VA is senior experienced RNs are moving to outpatient facilities, leaving new inexperienced nurses to provide inpatient care. While very qualified, new nurses are unable to provide the same level of inpatient care as senior experienced nurses.
Question 2

Do we need more “bedside” or inpatient professional nursing staff, or do we need more care nurses? How many in your estimation?

Answer 2

In UAN’s opinion, the VA needs to increase the number of register nurses to take care of patients’ critical needs. While it is difficult to give you an exact number of nurses that are needed, the UAN strongly supports minimum direct-care nurse-to-patient ratios. The UAN suggests the following minimum direct-care nurse-to-patient ratios:


(1) 1 nurse to 1 patient in operating room and trauma emergency units;

(2) 1 nurse to 2 patients in all critical care units, including emergency critical care and all intensive care units, labor and delivery units and postanesthesia units;

(3) 1 nurse to 3 patients in antepartum, emergency room, pediatrics, step-down, and telemetry units;

(4) 1 nurse to 4 patients in intermediate care nursery, medical/surgical and acute care psychiatric units;

(5) 1 nurse to 5 patients in rehabilitation units; and

(6) 1 nurse to 5 patients in postpartum (3 couplets) and well-baby nursery units.

Similar nurse staffing ratios have been enacted in California (AB395).

Research backs-up the need for the VA to implement minimum direct-care nurse-to-patient ratios. In her landmark study on nurse-to-patient ratios, Linda Aiken concludes, “In hospitals with high patient-to-nurse ratios, surgical patients experienced higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burn-out and job dissatisfaction.” The Aiken study also suggests that;

“results suggest that the California hospital nurse staffing legislation represents a credible approach to reducing mortality and increasing nurse retention in hospital practice, if it can be successfully implemented. Moreover, our findings suggest that California officials were wise to reject ratios favored by hospital stakeholder groups of 10 patients to each nurse on medical and surgical general units in favor of more generous staffing requirements of 5 or 6 per nurse.”

I have attached a copy of Linda Aiken’s study for your review.

Question 3

Given the success of the magnet recognition program, is the UAN in support of this program? If not, why not?

Answer 3

The UAN supports any system that would improve care to patients, elicit nurse input, and produce better patient outcomes. Specifically, the UAN supports the magnet recognition program when it is properly implemented, with strong nurse representation and input. Since its inception, the Magnet Program has had significant growth in the private sector. To address some of the issues that have arisen from member states whose hospitals have undergone the Magnet process, the UAN has developed and has submitted a list of labor standards to the Magnet Program. The UAN is currently working cooperatively with the Magnet program to reach an agreement. We hope these standards will be incorporated in the Magnet Program to ensure nurse representation and increase patient safety. Major emphasis should be placed on the Magnet program’s continued work with the state nurses associations who can provide the program confidential information from registered nurses at the on-site magnet hospitals.

The UAN supports the criteria and culture of the Magnet Program. We believe that the program will be successful if the Magnet program implements the UAN labor standards and works closely with state nurses associations. While the UAN feels that the Magnet Program is a positive step forward, we believe that it should not be a substitute for the legal voice of nurses brought through their unions.

Thank you again for the opportunity to address your questions. The UAN looks forward to working with you and your staff to address the important issue of VA’s nurse staffing shortage. If you have any further questions or need additional information, please let me know.


Sincerely,


Ann Converso, RN
Vice President
United American Nurses, AFL-CIO