National Nurses United

Books.FINAL:FINAL 2 8/21/08 11:04 PM Page 16 can distract us from our work, and prop up the current failing system.—shum preston Safety in Numbers: Nurse-to-Patient Ratios and the Future of Healthcare By Suzanne Gordon, John Buchanan, and Tanya Bretherton; Cornell University Press, 272 pp. n a sunny, summer day in September 1999, more than 2,000 RNs from across California swarmed the steps of the state Capitol in Sacramento to send an emphatic message inside. It was the day of what was expected to be a tough vote in the state Senate on a bill written and sponsored by the California Nurses Association to require every acute-care hospital in the state to maintain minimum, specific, numeric RN-to-patient ratios in all units at all times. Inside the building, hospital and insurance industry lobbyists, walking arm in arm with lobbyists from the Service Employees International Union, crawled into legislative offices urging them to kill the bill. To no avail. The bill passed. In early October, thenGov. Gray Davis again shocked the lobbyists by signing the bill, the first in the nation and the world, mandating RN staffing ratios. Enactment of the law, featured on the front page of the New York Times, captured the notice of RNs, patients, and healthcare activists around the U.S. and the world. Within a year, Australia's second largest state, Victoria, had also adopted ratios, helping spur the movement started in California that has inspired similar efforts by RNs from Massachusetts to Japan—mostly sponsored by CNA/NNOC. The Sacramento rally, and ongoing actions to encourage Gov. Davis to sign the bill, were organized, mobilized, and led by CNA, the culmination of years of work. It included legislation, an initiative, a public pressure campaign uniting nurses and patients, hospital floor actions, petitions, letters, phone calls, and political campaigns, helping elect legislators who supported the ratios and worked to defeat those who did not. While the hospital industry in particular united to block passage of similar bills in at least 14 other states, CNA had to continue the fight to implement and defend the California law, especially following the election of Arnold Schwarzenegger as governor. At the behest of the hospitals, Schwarzenegger tried to roll back the law in November 2004 only to face a year of CNA protests, a O 16 REGISTERED NURSE successful CNA lawsuit challenging his authority to override the bill, and a labor coalition inspired by CNA's 107 protests against Schwarzenegger that led to a crushing defeat in a series of initiatives he sponsored. The California and Victoria fights for safe staffing are chronicled in Safety in Numbers, an important new book by John Buchanan, Tanya Bretherton, and lead author Suzanne Gordon, who has written a series of books on RNs and nurse activism. Gordon meticulously dissects the unfolding of the ratio campaigns in both states, examines and debunks the opposition arguments, and provides documentation on the need for ratios and the salutary consequences of their enactment. Gordon's surest footing, and probably the centerpiece of the book, is her analysis of the ratio fight in Victoria and the nurses' ongoing campaign to defend them. For U.S. readers unfamiliar with the subject, Gordon describes how the Victorian system works, and the spirited efforts of the Australian Nursing Federation's Victoria branch. The heart of their campaign was a strategy built around the slogan of "Nursing the System Back to Health" which united professional concerns with deteriorating workplace standards, and a program of industrial action, which involved "closing beds," by shutting down portions of hospital units. She attributes their success as well to deeply rooted public support, the nursing shortage, and the fortuitous ascension of a labor government elected on a program of social renewal. Personal, public testimony by overwhelmed RNs was especially effective, Gordon writes, recounting stories that could be told by RNs in understaffed units around the globe—stories so compelling that "even employers began to acknowledge the need to address the issue of workload and its influence on nurse professionalism and patient safety." Such admissions from administrators would be harder to come by in the U.S. Gordon identifies the crucial difference, Australia's national, publicly-funded healthcare system in which private industry, while present, plays a clearly subservient role. The consequence is the availability of more public funding for essential patient reforms, such as ratios, and greater public accountability. Gordon's comfort level with the Victoria case study is probably heightened by her ability to give exclusive credit to the ANFVictoria, while in California, perhaps for political reasons, she somewhat understates the role of CNA, the architect of the law and the sole reason it was achieved. Most notably, Gordon misstates the position of the Service Employees International What Not to Read If you did a double take to understand this book's cover, you're not alone. At first I thought this book was about patients helped by the Doctors Without Borders organization, but then realized just how wrong I was. Yes, they are now producing professional travel guidebooks for patients who are leaving the United States for medical procedures and treatment—what's been coined as medical tourism. Get a heart valve replaced, and sneak in a visit to the Taj Mahal—all in the same trip! This particular edition, which focuses on Singapore, discusses planning your "health travel journey," how to budget, dos and don'ts, and provides lists of Singapore medical centers, health travel agents, and hotels. Patients Beyond Borders pretty much sums up everything that's wrong with the U.S. healthcare system and the warped American mentality of healthcare as a product that consumers with the means to do so should "shop around" to purchase. Those who still think healthcare can't be outsourced need look no farther than this book.—lucia hwang W W W. C A L N U R S E S . O R G J U LY | A U G U S T 2 0 0 8

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