H.C.R. NO.



H.D. 1





supporting patient safety in health care facilities by REQUESTING THAT THE CENTER FOR NURSING make recommendations on the nursing shortage, nurse staffing, acuity systems, and other factors affecting patient safety.



WHEREAS, there is increasing concern about the effect of inadequate nurse staffing on patient care; and

WHEREAS, studies show that the health of patients is directly proportionate to the number of registered nurses working in the hospital or health care facility, with inadequate nurse staffing resulting in poor patient outcomes; and

WHEREAS, a study published in the Journal of the American Medical Association showed that for each additional patient above four that a nurse on a medical-surgical unit must care for, there is a corresponding seven percent increase in the death rate; and

WHEREAS, assessment and timely intervention by skilled registered nurses is so critical to patient's well-being that it has led to the introduction of a new term called "failure to rescue"; and

WHEREAS, Hawaii also suffers from a nursing shortage that is expected to become critical in the next decade, particularly because of our ever-increasing population of patients over 80 years-of-age; and

WHEREAS, there is already a critical worldwide shortage of registered nurses making it more difficult for Hawaii to recruit registered nurses from abroad, a strategy it has used in the past; and

WHEREAS, the average age of a registered nurse in Hawaii is currently 48.7 years with 79.2 percent over 40 years, higher than the continental United States where 68.3 percent of all nurses are over the age of 40, and in 1980, the average age of a nurse was 47.1; and

WHEREAS, it is critical that the nursing professional replace nurses who retire because the number of nurses under the age of 30 is extremely low and has continued to decrease; and

WHEREAS, in 1999, the population of nurses under 30 years old in the United States was 9.1 percent, compared to 25.1 percent in 1980; and

WHEREAS, Hawaii's situation is even more alarming considering the statistics for nurses under the age of 30 in 2001, were 6.3 percent dropping in 2001 to 5.7 percent; and

WHEREAS, one effect of the shortage may be unsafe staffing levels in hospitals and health care facilities; and

WHEREAS, the retirement of many nurses, restructuring of the workforce (which has led to patient safety concerns and high dissatisfaction levels among nurses in the workforce), the lack of interest in the professional, decreasing reimbursements to health care facilities, high patient acuity, and a negative image and lack of respect for the profession are some of the numerous factors affecting the ability of the profession to recruit and retain nurses; and

WHEREAS, as a payer for inpatient and outpatient hospital services for individuals entitled to benefits under medicaid and as the entity responsible for the inspection and licensing of health care facilities, the State has a compelling interest in ensuring adequate numbers of nurses to provide safe patient care; now, therefore,

BE IT RESOLVED by the House of Representatives of the Twenty-second Legislature of the State of Hawaii, Regular Session of 2004, the Senate concurring, that the Center for Nursing (Center) be requested to address issues related to safe staffing based on the principles developed by the American Nurses Association, and considering cultural factors unique to the State; and

BE IT FURTHER RESOLVED that the Center examine various acuity systems for reliability and validity and make recommendations based on positive patient outcomes; and

BE IT FURTHER RESOLVED that the Center may create a pilot project to test various staffing systems and is requested to make recommendations and the accompanying rationale available to the legislature, health care facilities, and the general public; and

BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Director of Health, President of the Hawaii Nurses Association, President of the Hawaii Government Employees Association, President of the Health Care Association, Dean of the University of Hawaii School of Nursing and Dental Hygiene, President of A-ONE, and the President of the Healthcare Association of Hawaii.



Report Title:

Patient Safety; Nursing Shortage