Commonwealth may require better IDs for hospitals

In a move that will probably have little effect on the Hospital of the University of Pennsylvania but raises a number of important health care issues, Pennsylvania State Treasurer Barbara Hafer last week announced her support for legislation to mandate better identification for hospital workers. Hafer -- who is also a nurse -- endorsed House Bill 402, which if passed would require caregivers to wear distinct identification so patients could easily identify the credentials of the person treating them. "The issue is not nurses, the issue is patients," Hafer said at a rally in Harrisburg. "Too many others in health care have become so focused on costs that they have forgotten the patient." Hafer and others have criticized hospitals across the nation for failing to clearly distinguish between registered nurses -- who are the highest-trained of all nurses and provide the most specialized care -- and other lesser-trained care providers. In order to provide the best possible care for its patients, HUP recently adopted a system of identification whereby staff members wear badges with their photograph, name and credentials. "HUP believes that all patients have a right to know who's taking care of them and what their credentials are," Nursing Practice Clinical Director Eileen Haller said. The hospital therefore does not fall into the realm of health care providers that Hafer and others have criticized for vagueness. But critics charge that the similar titles given to workers with different training may confuse patients. For example, registered nurses -- known as RNs -- "assess the patient's needs, plan the patient's plan of care in the hospital? [and] perform a fairly sophisticated level of treatment," according to Haller. Additionally, hospitals employ certified nursing assistants, or CNAs, to provide personal care for patients, and licensed practical nurses -- LPNs -- to follow the care plan that higher-ups create and administer some forms of medication. According to a press release issued by the State Treasurer's office, some hospitals simply give non-registered nurses tags that say "NRN," which could easily confuse patients who see the "RN" and assume they are dealing with registered nurses. Part of the problem stems from the changing world of health care in which costs have become a major concern for hospitals as they struggle to maintain a high standard of patient care while paying ever-increasing bills. As an effect of the resulting structural shifts, many hospitals have begun hiring non-registered nurses and other personnel to complete low-level tasks previously performed by registered nurses. Hafer also addressed this issue in her speech, arguing that nurses should fight for the lowest possible nurse-patient ratio. But Haller and Nursing Professor Kathy McCauley noted that legislating nurse-patient ratios would probably be ineffective due to the fact that the ratio has to differ depending on the type of patient being treated. HUP, for instance, serves as an acute care facility -- dealing with "some of the sickest patients in the city" -- and therefore has a very low overall nurse-patient ratio, whereas a rehabilitation center needs less nurses per patient and therefore has a higher ratio, Haller explained. But the real issue is how to ensure that hospitals do not hire fewer registered nurses and instead assign unqualified personnel to tasks that necessitate high levels of training. "What I'm afraid of and what I think Barbara Hafer is afraid of is that? we have so few RNs that we have real clinical judgements being made by people who don't have the clinical training to do that," McCauley said. "HUP has really tried to get a handle on the credentials of people in these roles," she added.