National Nurses United

PHOTO COURTESY OF NEW SOUTH WALES NURSES��� ASSOCIATION Ratios around the world establish ratios. In 2002, the group issued a report titled ���Stop Telling Us to Cope.��� NSWNA waged a long and comprehensive campaign involving the commissioning of reports and studies, lobbying politicians, and using print, TV, and radio ads to inform the public. Despite Nurses everywhere understand minimum staffing this and the public pressure that followed, the government remained intransigent. NSWNA then stepped up its campaign and took a vote ratios are a critical safety standard in 2010 among members on whether to strike over the ratios issue. The 10-year legislative and regulatory struggle to enact ratios in Cal- The members said yes, and the vote further galvanized the campaign. In an innovative move that attracted a lot of public and media attenifornia was actually not the first instance of nurse-to-patient staffing tion, the nurses rented a train and quickly renamed it the strike train. ratios developed and won by nurses. This pressure by NSWNA improved its bargaining position with After intense lobbying and political pressure from the Australian the government, and in 2010, RNs won ratios in surgical Nursing Federation (ANF) Victorian Branch, the Vicmedical wards, palliative care, and in patient acute mental torian Ministry for Health, which is responsible for the RNs in the Australian health units in 2010. operation of acute-care hospitals in that state, adopted state of New South As with the California ratios, there is aggressive opposithe union-backed nurse-to-patient ratios effective Wales held a massive tion from conservative political groups, the hospital indusDec. 1, 2000. For medical/surgical units, those ratios rally for ratios try, and even the government against ratios in Australia. varied from 1:4 to 1:6, with more patients permitted In March 2012, after a well-crafted nine-month campaign, Victorian on the night shift. For emergency departments, the ratio was 1:3 at all nurses and midwives stopped the Victorian government from replactimes, and triage and charge nurses were not counted in the ratios. ing nurses with health assistants as part of the ratios, saved the state���s The Victorian government also committed to and funded reentry unique nurse/midwife patient ratios, and achieved some improveand refresher programs for nurses who wished to return to the ments to the ratios. Australian Nursing Federation (ANF) Victorian workforce. The results were impressive. In 1999, Victoria���s hospitals Branch Secretary Lisa Fitzpatrick proudly announced that patients had approximately 20,000 full-time-equivalent nursing positions, admitted to rehabilitation wards would now benefit from an improved with 1,300 of those positions vacant. By October 2001, there were nurse-to-patient ratio of 1:7 on the evening shift to 1:5 in recognition of an additional 2,650 full-time-equivalent nurses employed in Victothe enormity of nurses��� workloads in this specialty. ANF also secured ria���s hospitals���with half that number filling the vacancies and the annual funding to work towards a 1:3 ratio in day oncology units. other half as additional staff to meet the ratio requirements. In the United Kingdom, nurse-to-patient ratios have been disThe result of the mandated, fixed nurse-to-patient ratios have been similar to the results in California: Improved recruitment and retention cussed for a number of years, mainly on an academic level. Prior to 2012, there had been no real push from organizations representing of nurses, reduced reliance on expensive agency staff, improved patient care, increased job satisfaction for nurses, more workplace stability, and the nursing profession to pursue mandated nurse-to-patient ratios. 2012 was the year that all changed. reduced stress (ANF Victoria Work/Time/Life Survey, 2003). The Royal College of Nurses (RCN), with 400,000 members, is Bolstered by the success of the ANF in Victoria, the New South the largest organization of registered nurses in the world. At its 2011 Wales Nurses��� Association (NSWNA) began its own campaign to NOVEMBER 2012 W W W. N AT I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 11

• Cover