National Nurses United

In May, healthcare researchers pubembarking on an online campaign to help "I can't imagine in this lished a report in the journal BMJ Quality nurses reach out to, educate, and mobilize day and age not having & Safety which found that the more pediother nurses and the public in order to win ratios. With the acuity atric patients added to nurses' assignments staffing ratios legislation in their states and federally. The campaign will use a mix of of our patients all across above the average number, the higher the risk of readmission. And children treated in social media platforms, such as Facebook the country increasing, hospitals with pediatric staffing ratios of and Twitter, and online web resources, such ratios boil down to one one nurse for four or fewer patients were as a revamped section of the NNU website thing: better outcomes significant less likely to be readmitted withthat provides information on all things ratio, in 15 to 30 days. acts as a clearinghouse for all good ratios for our patients." Though the California hospital industry bills, and teaches nurses how to differentiate fought tooth and nail against passage of AB 394, the staffing ratios between good legislation and bad legislation. law, in 1999, and against the lower numbers the California Nurses "All nurses care about their patients, so all nurses want ratios," Association proposed during the regulatory process of establishing said Bonnie Castillo, RN and director of government relations for the numerical ratios; and then against the law as it went into effect, NNU. "This campaign is about casting a broader net of unity and trying to undermine the "at all times" rule in the courts and working including nurses throughout the United States." with then-Gov. Arnold Schwarzenegger in 2004 to roll back ratios, Currently, nurses in the District of Columbia and in Massachueven the California Hospital Association has admitted that hospitals setts are the farthest along in their struggle to win ratios. The DC have adapted to ratios. Ratios in California are here to stay. nurses have a bill pending before the District of Columbia City "We don't fight this issue now," said Jan Emerson-Shea, a spokesperCouncil and recently successfully lobbied to hold a hearing on the son for the California Hospital Association, in an April 24, 2013 Kaiser bill in November. The Massachusetts Nurses Association, which has Health News article. "It's the law of the state…It's over. It's done." many times proposed ratios legislation to the state legislature, is For NNU nurses in other states, however, the fight is just beginning. now striving to put the matter before voters through a ballot initiative while simultaneously pursuing state legislation. At the federal level, NNU has introduced, with the help of U.S. hough it has been 10 years since California nurses have been Sen. Barbara Boxer and U.S. Rep. Jan Schakowsky, two national working with the protection of minimum staffing ratios, the bills, S. 739 and H.R. 1907, that would establish minimum RN-tomemories of working without that safety net are still fresh in patient staffing ratios for all hospitals in the country, among other nurses' minds. They are also a sobering lesson for nurses who startimprovements of nursing rights. Nurses from around the country ed their nursing practice after 2004 and have no basis of comparivisited Congressional representatives on Capitol Hill at the end of son for understanding the significance of the law. October and urged them to support mandating safe patient ratios. "Before we had the patient ratios, I felt like I was working in a factoWith 26 cosponsors in the House, H.R. 1907, the Nurse Staffing ry on an assembly line," said Michael Jackson, an emergency departStandards for Patient Safety and Quality Care Act of 2013, continues ment RN at UC San Diego Medical Center who is also clinical faculty to receive growing support among members of Congress, particular- and sits on the California Board of Registered Nursing. "Remember ly from California. Golden State representatives play a pivotal role in Lucille Ball and Ethel in the chocolate factory? There you go." generating new cosponsors since they are able to speak convincingly Jackson said he used to take care of anywhere from six to eight about the positive impacts of California's landmark state law. patients at one time. He ran around being a "chaos manager" instead Having helped elect new senators who support RN-to-patient of a "care manager." He remembers being disciplined for not escortratios, RNs in key states have been pushing hard to get other sponsors ing a patient who was being transported to the radiology department for Boxer's S. 739. Additional support in the Senate would signal new because he had to make a decision not to leave an even sicker patient momentum, especially important as the 2014 election cycle begins. back in the emergency department. "You were forced to triage who This expanded lobbying effort in Congress invokes the new studcould get your already thin-stretched time," said Jackson. ies about the positive effects of ratios and the new quality of care Today, Jackson cares for three to four patients at most—which is requirements under the Affordable Care Act, as well as the penalties still difficult given their often very high acuity levels. But, still, it is for readmissions and hospital-acquired infections. Mandating more manageable. Jackson said he simply has more time to spend improved RN staffing is the best way to meet those ACA requireon the patients, including developing what he calls a therapeutic ments and achieve quality of care improvements, say nurses. relationship with each person. "You only have a few minutes of time As for California, in the decade since ratios went into effect, the to establish a connection to a patient who is going to hand over their only news that surfaces these days about ratios is how the research most valuable possession to you: their body, their lives, and their continues to confirm that minimum, numerical staffing ratios have a loved ones," he said. positive effect on patient outcomes. The most important to date has Jackson notes that even researchers at UC San Diego Medical been University of Pennsylvania School of Nursing researcher Linda Center have documented positive effects of nurse staffing ratios. In Aiken's landmark study, published in 2010 by Health Services 2010, the center's medical director's research found that wait times Research, which found that New Jersey hospitals would have 14 perwere quicker for the emergency department when staffing levels cent fewer deaths and Pennsylvania hospitals 11 percent fewer deaths stayed within mandated staffing ratios. if they adopted the same staffing ratios as California hospitals. "In Kathy Dennis, the RN from Mercy General Hospital, remembers these two states alone, 468 lives might have been saved over a twohaving anywhere from eight to 10 patients assigned to her, with only year period just among general surgery patients if the California a licensed vocational nurse to help. "It was crisis management, not nurse staffing levels were adopted," said Aiken in a statement. really nursing," said Dennis bluntly. She said she never had any time T o C to b e R 2 01 3 w w w. 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