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NJ Public Wants Beefed Up Staffing, More Hospital Inspections, Nurses Contend

But healthcare execs say requiring more nurses per patient would reduce needed flexibility, defend current mechanism for checking hospital quality

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New Jersey hospitals should have more nurses working each shift – and the state should inspect those hospitals yearly.

That’s what people in the state want, at least according to a poll commissioned by the state’s largest nurses’ union, which is using the results to bolster its case for changing state laws and regulations.

Of 400 registered voters polled last month, 73 percent said they supported having a law that would set a maximum number of patients per nurse, while 20 percent opposed the idea.

In the same poll, 81 percent of those asked said the state Department of Health should be required to conduct annual hospital inspections, while 9 percent opposed it.

“The public connects quality of care to the number of nurses that provide the care, and that’s a crucial issue for us,” said Ann Twomey, president of the Health Professionals and Allied Employees (HPAE). “You hear about (how) people trust nurses. Well, this poll verified that fact as well.”

In fact, 69 percent of those polled said they “trust nurses a lot when it comes to healthcare policy in New Jersey,” according to the survey conducted by Anzalone Liszt Grove Research.

A bill, S-1183/A-647, that would increase minimum staffing levels for nurses recently had its first public hearing after 10 years of lobbying by Garden State nurses.

Hospital officials and nursing executives suggested that the issues are more complex than the poll results suggest.

The Organization of Nursing Executives, which represents the senior nursing officials at hospitals, issued a statement saying that hospital staffing shouldn’t be one-size-fits-all.

“While it is interesting to learn voters’ opinions on nursing issues, there are many complex factors that go into determining nurse staffing levels,” the group said in the statement. “In fact, recent data shows New Jersey's hospitals have made great advances in patient outcomes over the past several years, in areas ranging from reduction of infections to hospital readmissions.”

Union officials argue that raising the state-mandated staffing levels – which were last changed in 1987 -- would give nurses the flexibility needed to meet patient needs.

“Some places provide more consistent staffing, but there’s no guarantee,” which is why the bill is needed, said Twomey.

But Aline Holmes, senior vice president of clinical affairs for the New Jersey Hospital Association, said hospitals have more flexibility if they can base staffing levels on patient needs, rather than government-set minimums, and are able to vary those staffing levels based on the experience of the nurses.

“There are all kinds of mechanisms in place to meet what the patients needs and to meet the care needs on the floor,” she said.

“I am sure if you ask the question (in a poll), ‘Should hospitals provide one-to-one nursing care in the hospital?’ I’m sure they would all say yes,” Holmes added.

NJHA officials pointed to an estimate that increasing staffing to the levels sought by the HPAE would cost hospitals $159 million.

“That comes at a time when healthcare providers are under major pressure from policymakers and employers to reduce healthcare costs,” said NJHA spokeswoman Kerry McKean Kelly.

But the HPAE poll indicated the people might be willing to pay more to have more nurses: A total of 69 percent disagreed that requiring more nurses “would make the cost of healthcare go up so much, it would not be worth it.”

In addition to public support on the staffing issue, Twomey said the public also understands the importance of hospital inspection. Inspections required for hospitals to keep their licenses were reduced in frequency, then eliminated in February 2011. Hospitals are now simply required to submit an annual statement saying they are complying with state regulations.

Department of Health officials noted that New Jersey is one of 48 states that recognize federally approved accrediting agencies such as the Joint Commission, instead of having routine state inspections, “which allows the department to use our resources on incident or complaint investigations,” according to a statement.

HPAE Chief of Staff Jeanne Otersen countered that the Joint Commission doesn’t check to ensure that hospitals are complying with state laws. In addition, she said, state inspectors who visit hospitals due to complaints are focused on the complaints, rather than the broader focus of state inspections in the past.

“I don’t think people realized that the department doesn’t play that role of enforcement,” she said.

But hospital industry representatives said that visits from the Joint Commission and other accrediting bodies, as well as from state officials in response to complaints, ensure that hospitals are safe. Holmes pointed to several measures, including steps taken in the past few years to reduce hospital-acquired infections and pressure sores, as evidence that the state’s current approach to inspections and staffing is working.

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