Front-line nurses have had enough

The ratio of nurses to patients in this country is a battleground. It is such a life or death problem that it has spilled over into the state legislatures around the United States. The concept of “safe-staffing,” rather than “more pay” has now become the rallying cry for nurses and non-nurses alike nationwide. It should be.

Owing to the combination of a huge nursing shortage and massive cost-cutting by our nation’s health facilities, nurses feel they have been overworked to the point that they can no longer safely do the jobs they have been assigned. “Safely” is the key word here.

Make no mistake—I love nurses. Over the past few years, I owe my life to them and the care they have given me while in the hospital. In addition, I get to see and visit with nurses all the time because many of the local nursing staff are my clients. I manage their 403(b) s for them. I get to see their daily stress, the dark-circles under their eyes, and the trembling in their hands when they sign papers or use the keyboard.

At the moment, these 800-plus heroes of mine are deciding whether or not to strike Berkshire Medical Center. I hope that doesn’t happen, but if it does, I will be here for them. My universe of nurses is dedicated, highly-experienced, and totally overworked and they are not alone. Nationwide, nurses are experiencing the same thing. They are through waiting for legislatures or hospital auditors to change what they see as an out-of-control trend, towards reducing nursing staffs further in an effort to contain costs at our nation’s hospitals and nursing homes.

On the picket line, I caught up with David Schildmeier, a spokesperson for 1,200 striking nurses, who are at the moment picketing Tuft’s Hospital in Boston, MA. “This is truly a nationwide issue,” says Schildmeier, “it’s not just my opinion, there are dozens and dozens of national studies that point to the same thing and it has been going on since the Nineties.”

I checked. There are hundreds of studies that bear out his and the nurses’ arguments. Patient mortality is directly linked to the ratio of nurses to patients. It has been proven in study after study. As such, nurses in Massachusetts and other states have been lobbying for legislation that would mandate safe nurse-to-patient staffing ratios for hospitalized patients. Back in 1999, California mandated a one-to-five RN-to-patient load (on surgical floors) and one-to-four on specialty floors like oncology.

Researchers then compared patient outcomes in “no-ratio” states like New Jersey and Pennsylvania. The results indicated that there would have been over 10% fewer deaths in PA and almost 14% fewer in New Jersey with California–style rations. Of course, the Massachusetts Hospital Association (MHA) insists the California ratios have not helped patients and that the public should not support similar staffing bills in other states.

Evidently, Pennsylvania isn’t listening to the MHA. Earlier this year legislatures introduced a bill that would require hospitals to reveal staffing levels on a daily basis, including that most important nurse-to-patient ratios, and post them publically in hospital patient care areas. In February, Ohio legislatures are mandating their own nurse-patient ratios on hospitals. Their proposal is even more drastic, insisting on one-to-one ratios in intensive care units.

So why should you care about the nurse’s plight? In my next column I will examine the cost to you the reader and the costs to our hospitals. Stay tuned, and stay active!

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  1. Yes indeed there is an Rn shortage. There is also a major shortage of Medical Technologists, and without the MT’s to run the lab tests, crossmatch the blood needed, the MD cannot/will not be able make a diagnosis. The Surgeon can’t operate without a Blood banker in house nor can the Heme/Onc Pt get the blood required to continue their treatment. The cost of the four year degree these days vs the salary paid and the stress of short staffing is quickly making this a unwanted Career path choice. As you know, hospitals are a 7/24 job and emergency/trauma patients arrive around the clock yet the Off-Shifts and Weekends are even shorter staffed. In an effort to increase profits hospital management contracts with Dr. Offices and Clinics to have even more samples sent by off site and these generally arrive in batches after the day shift ends. I agree fully experienced Nurses are vital along with a proper and sane ratio of Rn to patients. This holds true for the Lab also. We are all equal and vital partners in providing the best possible care to our patients.

  2. THANK YOU so much for addressing this issue from a measured and rational perspective. Most people are not aware that, from a hospital accounting point of view, nurses are considered a cost. Back in the day, it was decided that nursing services should be lumped in with the room rate. That created a perverse economic incentive: on a balance sheet, fewer nurses reduces costs. This has not changed over time, even though the scope and complexity of the work bedside nurses do has grown dramatically. As our responsibilities has expanded, the measurement of our value has not adjusted accordingly. Additionally, the metrics used to justify business based staffing decisions use short term and easy to extract data, rather than long range and less convenient data that would tell a truer story- a phenomenon commonly known as “the streetlight effect.”

    Here are some little known but independently verifiable facts that are also key to this discussion…
    The American Nurses Association and it’s state affiliates conspicuously claim to “speak for all nurses,” yet only about 5% of nurses nationwide belong to this, or any other, professional nursing organization. In Ohio where I work, the Ohio Nurses Association has aligned with the Ohio Hospital Association to OPPOSE the safe staffing bill you mention in your post. (SB55) Ditto for the ANA regarding national ratio mandates. They’ve opted instead for “nurse led staffing committees” – meaningless exercises in political theater without transparency, oversight or penalty for non-compliance. It’s a “solution” the Hospital Associations and their ilk absolutely love. The vast majority of nurses do not belong to any professional organization, and those of us who do have been poorly served. 35,000 nurses marched on Washington DC to protest unsafe hospital staffing practices in 1995, and yet here we are, 22 years later, and conditions are more dangerous than ever.

    Have I had enough? Apparently not.

    • Love your post! Can I share it?

      • sure

  3. I practice as a nurse in Oregon. In 2001 we were the first state to pass an acuity based staffing law. We have upgraded that law since then most recently in 2014-15. We struggle constantly with hospital administrators that tell us that the law doesn’t mean what it says. Nurses throughout our state are consistently overworked. On the job injuries are on the rise and there appears to be no end in sight. Nursing professors are grossly underpaid, colleges cut funding for programs and the requirements to get into the programs are frequently so rigid people give up trying. The nursing shortage in this country is very real and is multi faceted. Thank you for writing your columns, keeping this issue public and supporting nurses!

  4. I wish I had Norse g work. Here in Ohio we are low on work and nurses cannot get full time hours. We are being sent home daily.


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