Ratios aren't just numbers

Hospital staffing levels and nurse-patient ratios are more complicated than I thought. Right now, all the people in health care are saying, "well, duh!" But I write for the rest of us. (And can I say that this is what I love, love, love about my job? The exposure to interesting ideas!)  About a week ago, I was covering a City Hall rally held by the healthcare professionals on strike at Temple University. It was a beautiful day and I was sort of avoiding going back to the office by doing more "reporting." 

Anyway, I was chatting with Patricia Eakin, the head of the union, the Pennsylvania Association of Staff Nurses and Allied Professionals, and she explained how complicated these staffing issues can be. I know you are now thinking that of course she would say this because she leads a union that's on strike. But this conversation didn't have that feel to it -- it was more about the kinds of issues nurses routinely face at hospitals.

Eakin works in the emergency room at Temple. Part of the emergency room area is devoted to critical care. These are the real serious cases that come in. I'm not sure precisely how critical care relates to the trauma area, but it is certainly not the part of the ER where people come with sprained ankles or flu symptoms. If someone ends up in the ER's critical care area, they are in the hospital because they need medical help badly.

She said that Temple is considering allowing the use of propofol, the same intense sedative implicated in Michael Jackson's death, in the emergency room's critical care areas. And, she said, it worries the ER nurses.

"It's a great drug," she said, but patients on it need to be carefully watched. Hospitals typically assign one nurse to every two patients admitted to intensive care units. That ratio, she said, allows enough supervision for propofol. But in the ER's in critical care area, nurses are staffed at a four to one ratio, generally a reasonable ratio. But it may not enough if propofol is used, she said. In other words, ratios aren't just about numbers.

This is the kind of issue, she said, that nurses routinely discuss with hospital management and many hospitals have nursing committees that address these topics in a collegial way with the normal amount of pull and tug. Today the union is finishing its annual meeting at the Sheraton Center City (ironically the same hotel where Temple's replacement workers are bunking). You can read my article about it in the Wednesday's Philadelphia Inquirer. One workshop at the convention addresses how nurses can form and participate in safety committees.