National Nurses United

If you build it, they will come After ratios took effect, RNs returned to the bedside One of the claims by the hospital industry in its attempts to block the introduction of ratios was that there were not enough nurses to fulfill the staffing mandates of the ratio, so what was the point of having an unrealistic law? California registered nurses knew differently; they had seen their colleagues leave the bedside in droves, citing the heavy workload and stress as their reasons for doing so. Direct-care RNs were convinced that if ratios were set by law, that their colleagues would return to the acute-care hospital setting. In fact, after the ratios were introduced, California increased its number of actively licensed RNs by more than 120,000 RNs ��� tripling the average annual increase prior to its enactment. The total number of RNs in California in April 2010 was 357,209 compared with 246,068 in 1999. This increase in numbers was seven times more than the total number state health of���cials said would be needed to ful���ll the ratios for general medical and surgical units. RNs who had let their licenses become inactive changed their status to active, citing the ratios and attendant decreased workload as the primary reason for returning to the nursing workforce. The picture in California prior to ratios was not pretty. According to the Joint Commission for Accreditation of Hospitals, ���Higher acuity patients plus fewer nurses to care for them is a prescription for danger.��� As acuity of patients and complexity of care increased during the 1990s, the hospital industry failed to increase the number of RNs in the acute-care setting. RNs, frustrated with the lack of support and respect from administration, and burnt out with excessive workloads, NOVEMBER 2012 were leaving the profession, citing overwork and the inability to provide the type of care they were educated and wished to provide as the main reasons for leaving. A study conducted in 2001 by Peter D. Hart Research Associates showed that the majority of nurses, some 74 percent, said they would stay at their jobs if changes were made. Top among the identi���ed desirable changes were: increased staf���ng, less paperwork, and fewer administrative duties. Other common reasons cited for leaving the profession were to ���nd work that was less stressful and less physically demanding. There is consensus amongst researchers on the topic that insuf���cient staf���ng raises the stress level of nurses, impacting job satisfaction, and driving many nurses to leave the profession. This re���ected the situation in California. Rapid turnover of RNs was common, leaving patients with fragmented care and further stress for RNs remaining in the acute-care setting. Ratios were also expected to dramatically reduce nursing turnover, which is very costly both in terms of quality of care and the bottom line of hospitals. According to PriceWaterhouseCoopers in 2007, the average hospital is estimated to lose about $300,000 per year for each percentage increase in annual nurse turnover. Given, as reported in 2008 by the Sacramento Business Journal, that the RN vacancy rate for California���s major hospital chains fell below 5 percent after the introduction of ratios, it would appear that the hospital industry in California had cause for celebration. Compare this 5 percent rate in California with Texas, a state with no mandated ratios, where the turnover rate hovers around the 20 percent mark. The national average ranges from about 15 to 25 percent. As direct care RNs predicted, the ratios brought their colleagues back to the bedside, improved quality of care and nurses��� morale, and, far from bankrupting hospitals, actually improved their bottom lines. Everybody gained, not least of which were the patients, who are always the RNs��� ���rst concern. 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 21

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