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A bill citing the correlation between higher nurse staffing levels and reduction in adverse patient outcomes — including risk of infection — has been introduced in Congress. If approved, the Nurse Retention and Quality of Care Act of 2001 would provide health care facilities and other eligible institutions with special project grants to establish models and best practices promoting the retention and job satisfaction of professional nurses.
The proposed law cites "the correlation between higher nurse staffing levels and reduction in adverse patient outcomes, including risk of infection, shock, upper gastrointestinal bleeding, and increased length of stay."
Infection control professionals have been pointing out for years that health care staffing fluctuations can spark nosocomial outbreaks if rising patient census or acuity outstrip nursing resources. (See Hospital Infection Control, June 1999, under archives at www.HIConline.com.) The general consensus is that staffing problems — particularly if they occur in conjunction with an increase in patient acuity — may undermine aseptic technique, catheter care, and hand washing compliance by harried health care workers.1-4
The proposed law would amend Title VIII of the Public Health Service Act (42 U.S.C. 296 et seq.) by adding a requirement for "initiatives to improve nurse retention, the nursing workplace, and the quality of care."
The secretary of Health and Human Services would award grants to carry out demonstrations of models and best practices in nursing care. The grants would be eligible to health care facilities or any partnership or coalition containing a health care facility and a collegiate, associate degree, or diploma school of nursing.
The projects would include those that promote nurse involvement in clinical decision making and allow them to achieve educational and career advancements. The bill calls for $40 million in grant projects to be awarded over a five-year period. Introduced by U.S. Sen. Hillary Rodham Clinton (D-NY), the bill cites the following problems about the growing nursing shortage:
1. The current nurse work force is aging, with the average age of a practicing registered nurse at 43.3 years. That represents an increase of 5.9 years since 1983.
2. The nursing work force is aging at twice the rate of other occupations in the United States, and the enrollment in nursing programs has decreased in the past five years.
3. Many hospitals around the country are reporting vacancy rates for nursing positions.
4. Retention problems are contributing to the nursing shortage problem. Roughly half of nurses say they have recently considered leaving the nursing profession for reasons other than retirement.
5. A majority of those individuals who are considering leaving nursing express a low level of overall job satisfaction, and their lack of participation in decision making is a major factor contributing to dissatisfaction.
1. Calfee DP, Cage EG, Farr BM. Secular trends in nosocomial infections during the era of managed care. Abstract 59. Presented at the Conference of the Society for Healthcare Epidemiology of America. San Francisco; April 1999.
2. Taylor G. Nosocomial blood stream infections (NBSI): Ten year trends in one institution. Abstract K-60. Presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy. San Diego; September 1998.
3. Taylor G, McKenzie M, Kirkland M, et al. Nosocomial blood stream infections (NBSI) in a restructured hospital. Abstract K-63. Presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy. San Diego; September 1998.
4. Fridkin SK, Pear SM, Williamson TH, et al. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996; 17:150-158.