National Nurses United

NewsBriefs Texas Ratio Bill Introduced upport among RNs across Texas is growing for a CNA/NNOC-sponsored, bipartisan bill introduced Feb. 21 that assures nurses the legal guarantee to serve as patient advocates, sets minimum RN-to-patient staffing ratios, and protects RNs who expose unsafe conditions. "Now it's for real right here," said Evelyn Posas, a Texas RN for 22 years. "We can fight for this. Let's go and let's do this. California worked for this for 10 years. I'm hoping it won't take 10 years because this is long, long due. I would like to retire and be a patient one day and not have this problem." Following the path forged by California and also recently in Illinois and Maine, Texas is the fourth state to introduce staffing ratio legislation mandating RN-to-patient staffing ratios, the Texas Patient Protection Act of 2007. "The bill would improve patient safety. It would certainly improve patient conditions, decrease readmission rates, decrease medical errors, decrease patient adverse events," said RN Mary Brunn. The bill will prohibit nurses from being assigned more patients than can be safely monitored. According to one study published 2002 in the Journal of the American Medical Association, for every patient above four assigned to a nurse, the mortality rate rises 7 percent. Being forced to float to other units in which nurses have little expertise is also another major problem. The crisis over staffing has come to a head in Texas. Just when nurses are handling more patients, Posas said, the acuity level of patients is rising, as more patients without insurance arrive with already-advanced stages of sickness. With nurses balancing more patients and handling more challenging cases, patients run a higher mortality rate. "We're pushing for the ratio because the hospitals will allow what is not right for the patient if the ratio is not mandated," said Posas. "The ratio is the only actual protection for the patient. We need the ratio so we can do something before [unsafe] things happen." Nurses who have tried to expose unsafe conditions in the past have not been able to make significant changes to prevent the same situations from reoccurring. Management typically takes a long time to process com- S Above: Mary Brunn, an Austin RN, speaks about the need for a ratio law. Right: Staff and RNs from Houston and Beaumont meet with Texas State Rep. Joe Deshotel (center) plaints, said Posas, and they act as the review board. Nurses can invoke the current Safe Harbor law, intended to protect nurses for 48 hours after the investigation from employer retaliation. But Posas believes nurses run the risk of being fired for speaking up. The Texas Patient Protection Act includes whistle-blower protection, with the enforcement of ratios over management. "I really support [the bill]; it's something that's needed in the hospital setting," said RN Diana Pirzada, who left her hospital in Dallas, Texas, and now works in a pediatric clinic because she was overwhelmed by her high patient load when her unit was understaffed. "I hope nurses will support it and the people will support it." If the bill passes, many nurses who have left the field because of unsafe practice environments for their patients have said that they will return, relieving the medical field's nursing shortage, said Pirzada. After RNpatient ratios passed in California, the number of registered nurses per year seeking licensure rose from 3,200 per year to 10,000. TEXAS 4 REGISTERED NURSE W W W. C A L N U R S E S . O R G Brunn predicts Texas nurses will likewise return, and more people will be drawn to the nursing profession. While the Texas Hospital Association predictably argues that passage of the bill would cost too much and cause hospitals and medical units to close, nurses argue that their view is short sighted. Without the bill, hospitals will lose money as nurses leave and turnover increases. Lack of experienced nurses can prolong patient stays and lead to complications when problems are not detected immediately. Posas also wants the bill to pass because she has a practical concern as a potential patient. She doesn't want to be the one in the hospital bed, pushing the help button and receiving no response because the nurses are too busy. "It doesn't matter if we win or don't win, I won't stop because the patients need it," said Posas. "I won't lessen my enthusiasm and it won't hinder me from going forth no matter how long it takes." —bonnie ho MARCH 2007

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