LICENSING STANDARDS: Staffing, Duties Under Review in NJ
New Jersey's plan for a "massive" overhaul of hospital licensing standards has sparked heated debate among hospitals, doctors, nurses and the unions that represent them, the Asbury Park Press reports. One of the most hotly contested provisions is the push to change how hospitals set adequate staffing levels. Observers note that the staffing situation has worsened as managed care has added volumes of paperwork to nurses' workloads. Currently, staffing mix is based on patient acuity -- how sick patients are. The state Department of Health and Senior Services' new regulations would change the determinants to an amalgam of factors including length of stay, staff competency, unit size and "access to home health services upon discharge."
What the Nurses Want
Nurse advocates are worried that hospitals would use the new, multi-dimensional standards "to further erode staffing levels, already stretched thin because of high health care costs and an impending nursing shortage." Jean Oterson, spokesperson for Health Professionals and Allied Employees AFT/AFL-CIO, calls the new regulations "a real mistake" and is lobbying for a bill that would limit the ratio of patients to nurses on medical/surgical floors to 6:1. The union's vice president, Bernie Gerard, said, "This should be a time when more regulation takes place because there is so much grand experimentation taking place."
What the Doctors Don't Want
Physicians oppose the portion of the proposed amendments that would grant clinical nurse specialists, nurse practitioners and physicians' assistants "the right to perform some of the duties now limited to doctors." The Medical Society of New Jersey, in a letter to John Calabria, director of certificate of need and acute care licensing at the state health department, strongly objected to giving nurses "overall responsibility" in some cases.
Hospitals Want Compromise
Taking the middle road, the New Jersey Hospital Association supports expanding nurses' roles, but opposes abandoning acuity-based staffing regulations. The proposed rules, which affect cardiac, emergency medicine, obstetrics, patient rights, medical records and the roles of nurse practitioners and physician assistants, have been subject to public comment for several months. The state Health Care Administration Board is expected to take them up soon, and approval could mean they go into effect as soon as this fall (McEnery, 5/9).