COMMENTARY

Nurses Get Political to Address Unsafe Staffing

NursesTakeDC Rally

Laura A. Stokowski, RN, MS; Maddie Stokowski, BA

Disclosures

May 24, 2017

Hi. I'm Laura Stokowski with Medscape, and I'm a registered nurse. I'm one of 3.3 million registered nurses in the United States. That's almost four times the number of physicians. Imagine what 3.3 million nurses could do if they all got together around the same issue.

Today [May 5, 2017], nurses from around the United States are doing just that. In a show of unity, nurses have gathered in the nation's capital to draw attention to one of the biggest challenges facing the nursing profession today: unsafe nurse staffing. And although rain forced the rally to move indoors, the enthusiasm of these nurses wasn't dampened.

Rebecca Love, RN, ANP, Boston, Massachusetts: "Today is the NursesTakeDC rally, a grassroots movement that was a started by nurses across the United States to support nurse-to-patient ratios in hospitals, nursing homes, and the facilities that nurses are working in on a day-to-day basis."

Kellen Squire, RN, Barboursville, Virginia: "I'm an emergency department nurse, and nurse-to-patient ratios are important to me. I want to fight for them here in DC, and I want to fight for them in Virginia."

The rally was organized by two all-volunteer nurse groups: NursesTakeDC (NTDC) and Show Me Your Stethoscope (SMYS). The nurses attending the rally have spent their own money to travel to Washington because unsafe staffing is an issue that affects everyone. When there aren't enough nurses to take care of the patients, it's unsafe for both patients and nurses. Mistakes are made, patients have more complications, and more patients die. Nurses suffer more workplace injuries and workplace violence, and they become burned out and leave the profession prematurely.

Four nurses who drove all the way from Florida to attend today's rally relate what it's like to experience short staffing, day in and day out.

Beth, Sanford, Florida: "We come on stressed to see our assignment. We work nonstop—if you get a lunch break of 15 minutes in a 12-hour shift, you're lucky. There's a feeling that you're not giving the care that you should for your patients. You are just running in and out of rooms."

Susan, Sanford, Florida: "Patient safety is huge."

Crystal, Sanford, Florida: "You can't give the care that you want to give."

Janet, Sanford, Florida: "You go home beating yourself up. You go home knowing that you weren't able to give 100%."

Catherine Stokes, BSN, RN, NTDC rally organizer: "Being a nurse myself, I can say that it damages the nurse mentally when you know that you should be giving that care to your patient that you're not able to give."

And the problem of nurse staffing isn't limited to hospitals. In many states, it also affects the schools.

Dana Holladay-Hollifield, BSN, RN, NCSN: "I'm here to make sure every child in Virginia has access to a nurse in their school for safety and for the appropriate care because now one out of five children has a chronic condition, and less than 50% of the schools in Virginia have a nurse."

Dee, a school nurse coordinator from Pennsylvania, reports that her state has only half the number of school nurses they need. She's here to support legislation to close this gap.

Dee Darragh, NCSN, MSED: "A federal law would help to move that case forward. And I hope that it can be revisited soon and help us stand and advocate for all those families who rely on us to be their eyes and ears during the course of the school day."

All of this attention might suggest that unsafe levels of nurse staffing (or inadequate nurse-to-patient ratios) is a new problem, but it's not. It has, however, become worse in recent years. One reason is that patients in the hospital today are sicker than ever before, yet the number of nurses assigned to care for them hasn't increased accordingly.

Catherine Stokes: "The patient acuity out on the floors is higher than it used to be. Patients are getting pushed out of intensive care units onto regular med-surg floors or step-down units who used to commonly still be in the intensive care unit. These nurses are being expected to provide a higher level of care with too many patients."

And as healthcare costs skyrocket, hospitals look for ways to save money. One of their prime targets is nursing staff.

Doris Carroll, BSN, RN, CRCC, Co-organizer, NTDC/SMYS 2017: "We are not a separate line item on the budget like physical therapists, occupational therapists, or respiratory therapists. We are actually in the room charge. That means that nobody knows what nurses' value is worth. My value, according to the hospital administration, is just as much as that chair that's over there."

But for the hospital's bottom line, it's short-sighted to allow unsafe work environments to continue.

Catherine Stokes: "In the long term, it can actually result in higher cost for the patient and the hospital. It also contributes to nursing turnover because when nurses are in an environment that they are not happy to work in, it can lower morale and increase the turnover rate, and that also costs the hospital money."

People have different ideas about how to achieve safe nurse staffing levels. One way is to require them by law. Only one state, California, requires minimum nurse-to-patient ratios. For the rest of the country, it's a voluntary system.

Doris Carroll: "In Illinois, we've had acuity-based staffing mandated since 2008, but there's no meat to it. There's no stick. There's nothing that forces hospitals to comply, and we suffer."

At today's rally, nurses are talking about more than just staffing. They're talking about using the power of their numbers to advocate for real change. And they're talking about how to get their nursing colleagues to join them in these efforts. Rally organizer and speaker, Jalil Johnson, has high hopes that nurses will do just that.

Jalil Johnson, BSN, MS, RN, ANP-BC, PhD (C), National Director, SMYS Foundation: "We really believe that nurses should be a driving force in the direction of institutions as well as the healthcare industry at large. The idea is to empower nurses to become more involved at whatever level is comfortable. We believe that nurses, being the largest workforce within healthcare, should have more power and more say-so in what happens in healthcare, in hospitals, in clinics."

The nurses who spent their own money and paid time off to travel to Washington this week have already taken that first step. At the same time, however, rally organizers know that for many nurses, it's easier to advocate for our patients than for ourselves.

Doris Carroll: "Nurses are trained, at least when I went to school, nurses were trained to be compassionate and caring. Those characteristics hardly translate into being vocal and active and sticking up for yourself. We are patient advocates, but I believe we should also be nurse advocates."

"Nurses aren't used to being political. They understand the process, but they're not used to saying, hey, I elected you, and you need to pass this legislation and support nurses. Support patients because it could be your mother one day in that hospital, and she might not have enough nurses to take care of her."

And that's why safe staffing has become such a rallying cry for nurses everywhere. It's not a partisan issue; it's a patient safety issue.

Jalil Johnson: "Having safe staffing levels doesn't have anything to do with whether you are conservative or progressive in your political ideology. Every nurse that I've ever met has said that staffing is an important issue."

Dana Holladay-Hollifield: "We're all nurses. We all fall under that umbrella and want to make sure there's safe care in different settings. So I think we all come under the same thing."

Jalil Johnson: "Nurses don't have to agree on everything, but nurses do agree on one thing."

And that one thing is the need for safe nurse staffing now. The nurses here today will soon be returning to their homes and their jobs. But rally organizers are confident that the end of the rally will not signal the end of the goals that brought them here.

Doris Carroll: "We're not staying silent. We're not going to stop tomorrow. We're going to continue on. We need to mobilize nurses. The conversation can't stop here. We need to let people know that we've started a fire, and you have a nation of nurses behind you."

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