At 4:36am on Monday last week, a fire was reported in the hospice on the seventh floor of the Ministry of Health and Welfare’s Taipei Hospital in New Taipei City’s Sinjhuang District (新莊). Because only one nurse was on duty at the time, the fire resulted in nine deaths and injured 16 people, despite the alarm, emergency evacuation, fire extinguishing and fire prevention systems all being activated.
Every time something similar happens, officials apologize and say that they will identify the causes, but what happens after that? All the reviews and discussions fizzle out until the whole thing is repeated following the next disaster.
It must be stressed that a shortage of nurses means that emergency rescues cannot be swift and that this is a cause of many unnecessary deaths and injuries.
When will policymakers understand this and look at the problem from the perspective of patients and their families?
The fire is a reminder of the 2012 fire in the Beimen Sinying branch of Tainan Hospital, also run by the ministry, which resulted in 12 deaths. At the time, nighttime staffing needs were also discussed, but to this day, staffing regulations remain unchanged.
There have already been two big fires. How many more accidents affecting patient safety caused by staff shortages are needed before the ministry is willing to stipulate reasonable staffing regulations?
Deputy Minister of Health and Welfare Hsueh Jui-yuan (薛瑞元) and Department of Nursing and Healthcare Director-General Tsai Shu-feng (蔡淑鳳) were quick to state that staffing at the hospital met requirements.
There were also reports that an assessment of the nursing home had just been passed by the hospital.
According to the regulations for staff at nursing homes, the installation standard is at least one nurse per 15 beds and one carer per five beds. Special attention should be given to the fact that the standard specification says “installation standard” and “nurse-to-bed ratio.”
These are two standards that the Taiwan Nurses Union are strongly opposed to, because the installation regulations only evaluate the initial installation at a medical institution and bases the need for nurses on the number of beds. At ward 7A at Taipei Hospital, there were 32 patients, and so only three nurses were required.
How does such an allocation allow for three shifts? This does not reflect the changes in the actual situation for frontline workers following the admission of a patient when one patient requires around-the-clock care, and one bed requires three different shifts every day.
In contrast to the installation standard and the nurse-to-bed ratio, the union has for many years called on policymakers to adopt a nurse-to-patient ratio as a benchmark. The concept means that the nurses on each shift care directly for a number of patients and that patients and their condition make up the framework for staff allocation, rather than determining the need for nurses based on the number of beds.
The ratio is the internationally recognized standard for nursing staff needs. An empirical study published in the US in 2002 of patients in need of acute care found that the addition of a single nurse lowered the death rate 30 days after surgery by 7 percent.
California and the Australian states of Victoria and Queensland have enshrined the nurse-to-patient ratio in law, making it an important policy for helping save lives.
As a result of cost cutting, hospitals have minimized staff on night shifts. The evaluation criteria only require an average based on all three shifts: day, evening and night. The day shift might be well-staffed, but staff are reduced during the evening and night shifts, and it even happens when monthly averages are submitted for evaluation.
When patients are close to death and their condition can and often does change constantly, that is not the time to play with numbers, even less with averages.
Regular nursing home fire drills test each detail of the standard procedure for reporting and responding in case of a fire. The question is how can the execution of such procedures be guaranteed when there is a shortage of staff?
Nurses are an asset, not a cost, and hospital operators must value the lives of patients.
The union is calling on the ministry to urgently enshrine the nurse-to-patient ratio in law, draw up a patient and nursing staff safety act, and abandon the installation standard and nurse-to-bed ratio, which are putting the safety and lives of patients at risk.
It calls instead for a focus on a mechanism to control nursing needs.
The nurse-to-patient ratio is of crucial importance to patients.
Lu Tzu-yen is a member of the Taiwan Nurses Union board. Chang Yu-an is president of Taiwan Nurses Union.
Translated by Perry Svensson
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