First, I find Mr. Blumstein's statement extremely difficult to follow; therefore, I will not try to respond to all aspects of it. However, I personally object to the inclusiveness of the language in the second sentence of this statement that says "… most all committee members disagree with certain statements. …" It is my belief that the committee worked very hard to have consensus in this important report. Any compromises I may have made related to what I might have desired to add to the report, not with what is in the report.
I do not believe that a dissenting statement of one member of the committee should suggest that there was disagreement by other members as well, and I strongly urge that this statement be limited to the author and not include any reference to the opinions of other committee members.
It also concerns me that the statement suggests that recommendation 6-1 was made without "careful consideration of evidence. …" This recommendation was not made lightly, and it was not made without recognition of the financial burden that it might incur. Mr. Blumstein suggests that registered nurses could be on-call rather than on the premises of a facility. This suggestion is totally unacceptable as a means of providing minimum professional protection and care for very ill and disabled individuals, who frequently have complex nursing and medical care needs, as well as medical emergencies, that require immediate skilled nursing attention.
I voted for this recommendation because it was the right thing to do in light of the increasing acuity of care needs in nursing homes, the knowledge that we do have about the relationship of quality and staffing, and my own 30 years of experience in developing, implementing, and evaluating nurse staffing in hospitals.
Joyce C. Clifford, RN, MSN, FAAN
Vice President, Nursing and Nurse-in-Chief
Beth Israel Hospital
Boston, MA 02215