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
No matter what indicator you use, Russian President Vladimir Putin is winning in the energy markets. Moscow is milking its oil cash cow, earning hundreds of millions of US dollars every day to bankroll the invasion of Ukraine and buy domestic support for the war. Once European sanctions against Russian crude exports kick in from November, the region’s governments will face some tough choices as the energy crisis starts to bite consumers and companies. Electricity costs for homes and businesses are set to soar from October, as the surge in oil income allows Putin to sacrifice gas revenue and squeeze supplies to
In an August 12 Wall Street Journal report, Chinese sources contend that in their July 28 phone call, United States President Joe Biden was told by Chinese Communist Party (CCP) leader Xi Jinping (習近平) that “he had no intention of going to war with the US” over House of Representatives Speaker Nancy Pelosi’s then upcoming visit to Taiwan. However, there should be global alarm that Xi did use that visit to begin the CCP’s active war against democracy in Taiwan and globally, and that the Biden Administration’s response has been insufficient. To hear CCP officials, People’s Liberation Army (PLA) spokesmen, and a
Much of the foreign policy conversation in the US over the past two weeks has centered on whether US House of Representatives Speaker Nancy Pelosi ought to have visited Taiwan. Her backers pointed out that there was precedent for such a visit — a previous House speaker and US Cabinet members had visited Taiwan — and that it is important for officials to underscore the US’ commitment to Taiwan in the face of increasing Chinese pressure. Critics argued that the trip was ill-timed, because Chinese President Xi Jinping (習近平) would likely feel a need to respond, lest he appear weak
United Microelectronics Corp (UMC) founder and former chairman Robert Tsao (曹興誠) on Friday last week pledged to donate NT$3 billion (US$100 million) to help Taiwan protect itself from the Chinese Communist Party’s (CCP) aggression. While still UMC chairman, Tsao gained a reputation for supporting unification with China and backing parties such as the Chinese Nationalist Party (KMT), the New Party and the People First Party, which have similar leanings. During a TV show on Monday, host Clara Chou (周玉蔻) asked Tsao which politicians he now supported. Tsao said he had supported the New Party when it formed, had become disappointed by People First