National Nurses United

so wisely observed, would be an attack of the ratios themselves. Nurses and patients everywhere in America deserve guaranteed nurse-to-patient ratios.�� At a time when RNs and patients everywhere in America desperately need��improved staf���ng to save lives, the growing movement to win ratios nationally is critically important.�� Nurses are the last line of defense in safeguarding the public health, safety, and well-being against ongoing attacks aimed at deregulation and elimination of safe staf���ng and other important, long-standing public health and safety laws. As scholar and nurse educator Adelaide Nutting observed, ���The hospitals where we work are in a real sense battle���elds where men and women and children are ���ghting for their lives. In their struggle and their dire need of help they have come to us, trusting us to throw our strength and skill in upon their side, to ���ght with them the unseen enemy.��� Implications of the California Safe Nurse Staf���ng Mandate for the People of the United States The CNA/NNOC/NNU professional practice and patient advocacy model de���nition of ���quality��� in nursing practice is as follows: Competent, safe, therapeutic, and effective care provided in the exclusive interest of the patient. This model ensures that RNs always acts in their patients��� best interests. This is not only the moral obligation of the nurse, inherent within the social contract between the public and the profession of nursing, but it is also an RN duty and right. As direct-care nurses, we have a vested interest, on behalf of our patients and our profession, to be accountable for the provision of care according to the true art and science of nursing as described by ���orence Nightingale. Evidence-based practice can be de���ned as the conscientious integration of best research evidence with clinical expertise and patient values and needs in the delivery of healthcare. The best research evidence is produced by the conduct and synthesis of numerous, highquality studies. Improved staf���ng has a signi���cant and positive correlation with improved patient outcomes; research has shown quality of care is improved when staf���ng is adequate. The most critical barrier to the health, welfare, and safety of patients in acute-care settings is the lack of a uniform, mandated safe staf���ng standard, based on individual patient acuity with minimum, numerical and speci���c direct-care registered nurse-to-patient ratios, including the lack of a protected right to advocate in the exclusive interest of the patient without fear of retaliation. RN Template for Problem Solving NNU contracts have created new standards for RNs and patient protection. A crucial part of quality patient care is ensuring adequate hospital staf���ng to avoid putting patients at risk and driving nurses out of the profession. Union representation provides RNs with the tools to have a real voice in patient care decisions, which we use to create safer healthcare facilities to protect our patients, our licenses, and ourselves. The professional practice/performance committee (PPC) is a staff RN-controlled committee with the authority to research, analyze, and document unsafe practice issues. The PPC has the authority to recommend speci���c actions to management to resolve problems and power to make real changes. The PPC is an elected, staff-RN committee with representatives from every major nursing unit that meets in the facility on paid time and tracks conditions of NOVEMBER 2012 concern to RNs through an independent documentation system called the Assignment Despite Objection (ADO). The PPC is a forum through which nurses and nursing concerns can be translated into effective action. If your facility does not have a PPC, you should discuss your concerns with your peers, provide education, develop a written action plan, and organize collectively to hold your facility accountable for maintaining safe RN-to-patient ratios at all times. The National Nurses United Action Plan The California experience with establishing strict numerical minimums for RN to patient staf���ng, with mandated staf���ng up with additional staff based on the patient���s severity of illness and complexity of care needs, is an evidence-based and validated strategy for reducing adverse patient outcomes and improving the quality of care. The fact remains that the quality of our nation���s healthcare system remains under scrutiny and an enormous research base has emerged documenting the link between increased RN staf���ng levels and better patient outcomes achieved by having effective ratios of RNs present and available to perform vital surveillance functions. Researchers have established the connection between organizational context of care, failure-to-rescue, nurse, and patient outcomes. The nurse surveillance function is heavily dependent upon human resource decisions made by hospital management, so safe staf���ng cannot be left to chance; it must be guaranteed by law. The importance of enacting SB 992 (Boxer), the United States Nursing Shortage Reform and Patient Advocacy Act, and HR 2187 (Schakowsky), the Nurse Staf���ng Standards for Patient Safety and Quality Care Act, so that all patients will have a universal standard of access to safe, therapeutic, and effective nursing care, and all RNs will be protected in the exercise of their rights and duties as patient advocates, cannot be overemphasized. If our nation is serious about cost-effectiveness, improved outcomes, equal opportunity, and equal protection rights, then safe RN staf���ng becomes an imperative. Healthcare is a human right, and it is a responsibility of our government, led by the nation���s direct-care nurses, to ensure that right by working to enact an improved and expanded Medicare for All healthcare system. References AB 394, Chapter 945, Statutes of 1999. California, (1999). Aiken, L. H., Clarke, S. P. & Sloane, D. M. (2002). Hospital Staf���ng, Organizational Support and Quality of Care: Cross-National ���ndings. International Journal of Quality in Healthcare 14 (1): 5���13. Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake, E. T. & Cheney, T. (2008). Effects of Hospital Care Environments on Patient Mortality and Nurse Outcomes. Journal of Nursing Administration. 38 (5): 220���6. Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., Busse, R., Clarke, H., Giovannetti, P., Hunt, J., Rafferty, A. M., & Shamian, J. (2001). Nurses��� reports of hospital quality of care and working conditions in ���ve countries. Health Affairs. 20 (3): 43���53. Aiken, L.H., Clarke, S.P., Sloan, D.M., Sochalski, J., Silber, J.H. (2002) Hospital nursing staf���ng and patient mortality. Nurse burnout, and job dissatisfaction. Journal of the American Medical Association 288(16); 1987-1993. Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., ���ynn, L., Seago, J. A. , Spetz, J. , & Smith, H. L., (2010). Implications of the California nurse staf���ng mandate for other states. Health Services Research, 45 (4). 904-21. California Code of Regulations, Title 22, Section 70217 Nursing Service Staff. (2005). 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 33

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