This is from Labor Notes. This sounds as if it is a real problem. I have heard some stories of Canadian nurses moving to the U.S. but then returning because of working conditions. Having mandatory ratios would improve working conditions and attract more nurses to help the shortage.
Battles Over Nurse Staffing Ratios Spread Across NationMischa GausLabor NotesFebruary 2008Faced with insufficient staffing, nurses in a number of states are pushingfor legislation that would specify the number of patients each nurse cansafely care for. Photo: Jim West.After a patient quietly died in registerednurse Danielle Magaña's hospital hallway, she decided she'd had enough.Although an autopsy later said the woman had died of natural causes, Magañasaid the incident was waiting to happen at her chronically short-staffedhospital, San Antonio's Baptist Medical Center.Intensive-care nurses like her were assigned up to five patients per shift,including two in the hallways who weren't hooked into monitoring equipmentthat warns when a patient's vital signs slip away. Magaña still questionswhether the woman could have been rescued if the nurses on her floor weren'tcarrying such heavy patient loads.Hospital management, she said, "do not give us the right to say, you need tocall in another nurse."So Magaña became one of the 40,000 Texas registered nurses the NationalNurses Organizing Committee (NNOC) estimates have left the hospital bedside,largely they argue because hospitals cut staff in the 1990s and quickenedthe pace of nursing work to intolerable levels. In a national study releasedin September, 42 percent of newly licensed RNs said they would like to leavebedside nursing.ENTRY POINT Magaña is at the forefront of a push to write into law thenumber of patients to which each nurse can safely attend. Active in Texas,Ohio, Maine, Illinois, Massachusetts, Pennsylvania, Arizona-and soon to bein Kentucky and Nevada-the drive operates on many levels, pulling nursesinto the political process, spreading the gospel that understaffed hospitalsare unsafe, and channeling overworked nurses' outrage into hospital-basedorganizing committees.The ratio law is an entry point to shopfloor agitation for nurses, who payabout $50 a month in dues to join NNOC as an associate member. These membersmake up the foundation of NNOC's non-majority unions, which start asadvocacy committees that raise staffing issues with management as soon as ameaningful number of nurses-generally around 10-join at a hospital.The push for ratios in the states exists sometimes uncomfortably alongsidethe Service Employees' promotion of a national law to establish staffingratios. NNOC organizers complain SEIU didn't back their landmark Californiaratio law, and at times undermine their efforts by seeking alliances withhospital chains. SEIU didn't respond to requests for comment.TROJAN HORSES One of the newest battlegrounds is Ohio, where nurses expecttheir ratio law to be introduced in February. Hospital trade groups in thestate have attempted to head off the ratio movement by introducing competinglegislation-a move copied from health care industry lobbies in Illinois.Their proposals oblige hospitals to publicly release staffing plans.Ed Bruno, NNOC's national organizing coordinator, calls that an industry figleaf because it doesn't mandate specific numbers of patients per nurse. Thedebate boils down to whether public disclosure of staffing conditions willsway hospitals to regulate themselves, said Sean Clarke, a nursing professorat the University of Pennsylvania.Unwilling to cede control over employment policy, the hospital industryargues ratios are a blunt, inflexible regulation. Terry Gallagher is an RNwho's worked for 11 years as a travel nurse at more than 16 hospitals innortheast Ohio. He said current staffing practices fail to account for thecomplex, constantly shifting demands placed on nurses-and that "flexibility"is code for forcing nurses to work on foreign terrain."A hospital can float a nurse into critical or emergency situations withabsolutely no experience or expertise," he said. "It is unconscionable and Ihave witnessed it."He began to refuse work in some hospitals after chancy encounters stackedup. Once he found himself sitting on a patient, trying to apply enoughpressure to stop his bleeding as he waited to wheel him into the operatingroom."I had to make choices as to who I had time to intervene with," Gallaghersaid. "This was not a battlefield."SAFETY IN NUMBERS California's early experience with ratios sets the bar forother state campaigns. After a decade of pressure, the California NursesAssociation won mandatory minimum staffing levels in 1999, only to later seeGovernor Arnold Schwarzenegger repay his hospital industry supporters bydelaying and attacking the law.As journalist Suzanne Gordon details in her upcoming book on ratios, Safetyin Numbers, the nurses fought back with studies, lawsuits, and highlyvisible protests, successfully defending the ratios, which limit each nurseto two patients in intensive care. Other California ratios vary, and thosein specialty units were lowered in January from five to four patients to anurse.Ratios became a fact of life. Jan Rodolfo, an oncology nurse at Alta BatesSummit Medical Center in Oakland, California, said they allow nurses toeducate patients and their families about their course of care, and reducemedication snafus and response times during emergencies.They also became a topic of constant scrutiny. Researchers began to confirmthat ratios improved patient care along with nurses' job satisfaction andwork conditions, all of which brought 52,000 more nurses into the workforceby 2006 than California had anticipated, an unexpected boon in an industryfacing a massive nurse shortage.Clarke said the associations between quality of patient care and staffinglevels only stand to reason."You can't put 50 students in a classroom and expect the teacher to performwell," he said.Winning a state law is hard enough-Massachusetts nurses have been trying for11 years-but it isn't sufficient.MORE THAN LAW "Even if you have a great law, if you don't have organizationyou can't enforce it," said Meredith Schafer, an NNOC organizer in Texas.California nurses warmed to that lesson quickly. Their law shifted thebalance of power in hospitals, Rodolfo said, and hospital-by-hospitalcommittees allowed nurses to identify and respond to management'scost-shifting tactics after they were required to increase RNs to meet theratios.Managers often force nurses to pick up a colleague's patients during mealsand breaks, a tactic they employ because there's no financial penalty ifhospitals fail to meet the ratios."They play the numbers game," said Genel Morgan, an intensive-care nurse atMills Peninsula hospital in San Mateo, California.But missing a meal or break is punishable by an hour each in penalty pay,which led nurses to coordinate the filing of hundreds of individualcomplaints. At one hospital, Alta Bates Summit, the campaign produced $1.9million in penalty pay last year-a pressure tactic nurses say is necessaryto convince hospitals not to cut corners on staffing."Patients don't always call before they stop breathing," Rodolfo said.RIGHT TO BETTER WORK Only 15 percent of nurses nationally belong to unions,Bruno said. That opens wide opportunities to turn nurses' dissatisfaction atthe bedside into motivation to change industry standards throughorganization.A powerful example to draw from is the nurses in Australia's Victoria state,who won staffing ratios in 2000 and defended them against a conservativegovernment's backlash through vigorous (and illegal) job actions. Byconstantly educating nurses and linking improvements in care to ratios,"they became like antibiotics," Gordon told Labor Notes. "Who would opposeit?"Most surprising to U.S. nurses is the fact that Victoria is an open-shopstate, despite which almost three-quarters of public sector nurses belong tothe union.In Texas, where nurses have rallied for two years for ratios, making inroadsis slow work. Nurses are taught to think their professional status willdecline if they ally with blue-collar institutions like unions. DanielleMagaña fills a notebook with the misunderstandings nurses have-that unionsare illegal, for instance-and has counted 35. She got a reminder of hospitalconditions when she gave birth in July."As a patient, you remember what it's like on the other side," she said,shuddering.http://labornotes.org/node/1510