National Nurses United

Registered Nurse March 2009

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RAD:May 3/16/09 7:37 PM Page 9 Rose Ann DeMoro Executive Director, CNA/NNOC Ratio Reflections How the safe staffing movement started, and where it's going it's becom e a familiar sight in state capitols from Arizona to Maine. RNs standing shoulder to shoulder in rallies, in legislative hearings, in public forums, in press conferences, with a common call, "safe staffing saves lives," and a common solution – RN-topatient staffing ratios for every hospital for every patient. Ratios are such a pervasive, unifying goal for direct-care RNs, it's worth recalling the sentinel event that made the national movement for ratios possible, a moment that also happens to mark the birth of the modern patient advocacy movement for direct-care RNs. It was 1993. Hospitals, increasingly operating like big businesses, had launched a major restructuring wave across the nation to transform the workplace and cut costs. Their major target was displacing RNs through a combination of layoffs, replacing RNs with unlicensed or lesser-licensed staff, and eroding the ability of RNs to exercise their professional judgment in protecting and advocating for patients. The hospitals had their helpers, nurse executives and managers who controlled the American Nurses Association and its state affiliates across the United States, including CNA. But over the winter of 1992 to 1993, everything changed. Fed up with the leaders of their own association, who sounded a lot like their managers at the bedside advising them that the new "change" was inevitable and they should accept it as "better for patient care," CNA's staff nurses rebelled. When the CNA board of directors tried to silence their voices by firing staff leadership (including yours truly) and suspending the staff nurse leaders of the then-segregated collective bargaining board, staff nurses built a movement that swept out the tainted old guard, and for the first time in history put staff nurses in charge of an RN union. MARCH 2009 The rest as they say is history. The new corporate lobbyists, and their ever-helpful board and staff created a powerful force for assistants in the ANA, always ready to propatient advocacy that challenged the hospi- pose alternative staffing bills, ones that don't tal industry and fought for patients from the threaten the economic power of the hospital halls of the hospitals to the corridors of leg- industry because they don't work. And because they leave all control of patient care islative power. High on that agenda was RN staffing ratios, delivery in the hands of the same managers premised on the crucial understanding that and executives who created unsafe condihospitals driven by economic incentives, not tions in the first place. But the tide is running against them. quality care, would never bestow safe staffing The ratio movement has become like a standards on the floors. It was a hard fight, and it took several years and the unified and prairie fire, scorching the earth from coast to coast, opening the inspired power of door for RN advocaCNA's elected leaders, cy movements and staff, and the nurses CNA/NNOC in state and patients of CaliHigh on that agenda after state. fornia forcefully was RN staffing ratios, Ratios are also a pressing state legislapremised on the crucial major founding printors and the governor understanding that ciple of the new nato enact our historic hospitals driven by tional RN union we ratio law. economic incentives, are forming with the The culminating not quality care, would Massachusetts Nurses event was the presnever bestow safe Association and Unitence of thousands of staffing standards on ed American Nurses. RNs on the Capitol the floors. It was a hard What ratios represteps the day the Legfight, and it took several sent for direct-care islature was taking its years and the unified RNs is the fullest exfinal vote on the law. and inspired power of pression of why they As hospital and HMO CNA's elected leaders, became a registered lobbyists swarmed staff, and the nurses and nurse, and their ability the Capitol offices, patients of California to safely practice and the legislators were forcefully pressing state protect their patients. streaming outside to legislators and the It's why committalk to the nurses. We governor to enact our ment to ratios has call it Passing Legishistoric ratio law. always been a surelation 101. It took fire way to differenmany similar mobitiate between the lizations, of course, to ensure proper ratios were adopted, and then advocates of patients and RNs and the apologists and handmaidens of the industry. to defend the law. And why, even where the challenges and But passage of the law in California thrilled RNs and patients in other states and hurdles to enactment of ratios in other states countries, and created a model for how to and nationally remain high, we know the overcome the entrenched opposition of the power and commitment of unified, directhospital industry and the influence its eco- care RNs and the fundamental alliance with nomic power reaches in legislatures, acade- patients will inevitably prevail. I mia, and among some allies in their thrall. Along the way, we continue to meet the Rose Ann DeMoro is executive director of usual adversaries, the big hospital chains, CNA/NNOC. W W W. C A L N U R S E S . O R G REGISTERED NURSE 9

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