More than 500 striking nurses at Mt. Clemens General Hospital are raising a question that medical centers across the country are struggling to answer: How many patients can one nurse care for? As financially strapped hospitals try to cut costs by cutting jobs, nurses like those at Mt. Clemens are demanding limits on how many patients they must supervise - and they want those limits written into their union contracts. "As a nurse, my ability to keep a patient safe is directly related to my ability to see the patient," says Cheryl Johnson, who has worked in the intensive care unit at the University of Michigan Medical Center for 29 years and is president of the United American Nurses, the bargaining arm of the 100,000-member American Nurses Association. "If you can't see them, you can't keep them safe," says Johnson, who also serves as president of UAN affiliate the Michigan Nurses Association. Hospitals like Mt. Clemens say they have standards that ensure excellent care, but that those standards shouldn't be negotiated with unions, written into labor contracts, or dictated by state or federal laws - something California has done and Michigan is considering. "You can't have a set number for nurse-to-patient ratios because there are maybe a dozen different units, and they have different requirements," says Jim Perpich, director of marketing and community relations at Mt. Clemens. "It's something management needs flexibility to change, and it should be based on patient acuity and not a mandated level." Perpich said nursing managers at Mt. Clemens use a computer program that takes into account how sick each patient is and how much care he or she may need todetermine how many nurses each unit must have. That is a crucial calculation not only for the nurses, but for the patients, reports Detroit Free Press. According to HAARETZ, a senior Health Ministry official told staff at Abarbanel Mental Health Center that suicidal patients should be put in restraints. The suggestion by the official from the ministry's mental health department was made a week ago to a senior staff member at Abarbanel in Bat Yam, the largest psychiatric facility in the country, in answer to claims that nurses there have difficulty functioning because of a shortage of some 50 nurses and nursing aides. The senior member of the nursing care staff told Haaretz that when he told the Health Ministry official that suicidal patients were in danger of harming themselves because there were not enough nurses to monitor them, the ministry official also said doctors should be asked to do extra duty monitoring suicidal patients. The Health Ministry official told Haaretz that no proposal had been made to put suicidal patients in restraints. However, he explained that the situation at Abarbanel was partly the result of management problems and faulty supervision by the Health Ministry. He also said the ministry has located alternative beds for a few dozen Abarbanel patients, however, hospital management is delaying their transfer. Yehudit Bornstein, chief nurse in the Health Ministry's mental health department, visited Abarbanel yesterday to examine the institution's claims of a nursing shortage. According to the senior hospital official, the staff shortage at Abarbanel raises concerns that patients' lives may be in danger and has brought about a "simply terrible" situation. The situation had improved since the letter was written, with the total number of patients dropping from 50 to 41 or 42, informs STUFF. The board had committed extra money to help agencies set up other treatment options to reduce the number of patients needing hospital care. A new unit is also planned, but no timeline has been decided. Meanwhile, the hospital has rejected nurses' claims that there were now fewer nurses working in the emergency department than when meningococcal victim Nileema Sharan waited almost three hours to be seen in June last year. Capital and Coast District Health Board dismissed the figures as untrue. Last year the board overspent its nursing budget by more than $7.2 million. Nurses Organisation chief executive Geoff Annals said there was the equivalent of 29.8 fulltime nurses on the current ED roster, compared with 31.4 when Nileema Sharan went there. These included agency and casual nurses not trained in emergency medicine. This went against the coroner's clear recommendation to increase staffing, he said. Nurses believed there should be at least 38 staff. Capital and Coast said it had increased budgeted staff numbers to 36.4, but recruiting had not been easy. Efforts continued and three new recruits were due shortly. In the meantime, vacancies were filled with casual and agency staff.
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