Healing our Health Care System

Unsafe nurse-to-patient staffing levels are a key cause of 98,000 preventable deaths each year.

By Deborah Burger

The vast scale of America's health care system is daunting. Maternity wards, emergency rooms, and other facilities operate around the clock at most of the nation's 4,000 hospitals. Registered nurses form the backbone of this system, providing triage and treatment.

But this spine is being stretched to the breaking point. As the president of the nation's largest professional RN union, I've seen hospital nurses left responsible for too many patients in nearly every state — and this problem is only getting worse. Today's unsafe nurse-to-patient staffing levels are a key cause of 98,000 preventable deaths each year, according to the Institute of Medicine.

And RNs are leaving the bedside in droves. Unsafe patient staffing is the impetus behind this exodus.

Fortunately, there's a proven solution. In California, my home state, reasonable RN-to-patient staffing ratios are required by law, thanks to the determined efforts of the California Nurses Association. After 2004, when the law we fought for went into effect, hospitals across the state hired nearly 130,000 additional actively licensed RNs. Dramatic improvements to patient outcomes followed.

Minimum staff-patient ratios are common-sense minimum safety standards. After all, we expect specific standards for classroom sizes, airline crews, day care centers, and nursing homes. Why not for our hospitals?

The hard scientific evidence offers conclusive proof of the effectiveness and cost-savings of this approach. A 2010 landmark research project, the most comprehensive study done on the law, proved what California's RNs have long known — safe ratios are the single most effective nursing reform to protect patients and keep experienced RNs at the bedside.

The study of 22,000 RNs, led by Linda Aiken, RN, PhD, from the University of Pennsylvania, compared California hospitals to facilities in Pennsylvania and New Jersey. It predicted that New Jersey and Pennsylvania hospitals would have 14 and 11 percent fewer deaths, respectively, if they were to match California's 1:5 ratios in surgical units.

They also found that California RNs have far more time to spend with patients, so they miss fewer changes in patient conditions. More of California's hospitals have enough RNs on staff to provide quality patient care than in New Jersey or Pennsylvania.

Staffing ratios also save money by stopping preventable infections, lowering the number of medical errors, and helping patients recover and go home more quickly.

Cost-savings, improved patient care, more nurses — why isn't this a done deal everywhere in the United States? It's simple: Our current profit-driven, insurance-based system, by its very nature, exists to maximize corporate bottom lines and minimize costs such as providing more nurses. But a hospital that tries to save money by skimping on staffing levels puts its patients at risk. These are not risks our patients and their families should have to endure.

That's why America's nurses are fighting on several fronts to improve care for our patients. We're making the case at the state and federal levels for safe RN staffing ratio laws that include patient advocacy protections.

National Nurses United also believes that this country would best be served by extending Medicare to all Americans. This universal approach would replace our current uneven system of care that leaves millions without access to treatment and routine checkups. We are working to make this alternative, which would put patients' needs first and is the norm in most of the developed world, a reality.

I look forward to the day when RNs will no longer go home after their shift and wonder if they forgot a vital medication or treatment, and patients will not lack appropriate nursing care. For too many years, nurses and patients haven't had a voice, and insurance corporations, hospital chains, and drug companies have called all the shots.

It will take a strong national movement of nurses to heal our ailing health care system, and that movement has arrived.

Deborah Burger, RN, is co-president of National Nurses United, the largest union and professional association of U.S. registered nurses, with 175,000 members. NationalNursesUnited.org
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