Too few nurses could very well mean too many deaths

pickledpepperRN · Jan 15, 2004

http://www.timesstar.com/Stories/0,1413,125%257E1511%257E1889990,00.html

Article Last Updated: Wednesday, January 14, 2004 - 3:43:18 AM PST

NEARLY 100,000 Americans die every year as a result of avoidable medical errors -- at a time when insufficient monitoring of hospital patients, caused by poor working conditions and the assignment of too few registered nurses, increases the likelihood of patient deaths and injuries, reported the National Academies of Sciences last November.

Inadequate staffing precipitated one-fourth of all unexpected occurrences that led to patient deaths, injuries, or permanent loss of function reported the past five years to the private agency that accredits hospitals.

Dissatisfaction with staffing levels and heavy workloads are major factors contributing to a mass RN exodus from hospitals and the much discussed nursing shortage, the General Accounting Office informed Congress in 2001

Deteriorating patient care conditions and a seemingly intractable nursing shortage have grabbed headlines from coast to coast. Many are talking about it -- but only one state, California, has taken meaningful steps to solve the problem.

As of Jan. 1, all hospitals must be staffed in accordance with a law, sponsored by the California Nurses Association, that requires minimum numbers of RNs at a patient's bedside, plus additional RNs as determined by individual patient need.

Enacted in 1999, the Safe Staffing Law was a direct response to a decade of abuses associated with managed care and corporate business practices that put hospital profits ahead of the safe care and recovery of hospital patients. The law provides the first real hope of shoring up our tattered patient safety net, and reversing the steady stream of RNs away from hospital care.

Hospitals have had four years to get ready -- and since the law was signed, the state's RN workforce has grown by

30,000 more than state officials predicted. But those who profit off the pain and suffering of patients have never given up their opposition to the law.

In late December, the California Healthcare Association, the lobbying arm for the multi-billion-dollar California hospital industry, filed a lawsuit to challenge the law. In an editorial Jan. 12, ANG Newspapers endorsed the lawsuit, echoing the industry claims that the rules are "rigid" and need not be enforced at all times. That's a prescription for disaster for all of us.

Selective application of the law -- telling the hospitals they don't need to have safe staffing for periods of each day -- makes about as much sense as saying clean water or air standards should apply only in daylight hours. So what if poisons are dumped in the water or air at night.

If your loved one has suffered a heart attack or been seriously injured in an auto accident, should they have safe care at all times, or only during part of the day? Who plans to tell the family of a patient who experienced a life threatening emergency when one nurse was on a break and her or his colleagues left to cover were overwhelmed with other patients that "flexibility" was more important than safety?

The CHA knows full well that the law was always intended to assure safe staffing at all times, and that, at the request of the hospitals, the regulations were amended to permit managers and RNs without other patient assignments to provide break coverage.

But breaks are not the real issue here. The lawsuit is part of a wider political campaign to persuade legislators and Gov. Arnold Schwarzenegger to repeal or erode the patient protections established by the law. It coincides with an underground campaign by hospital opponents to derail the intent of the law at the bedside by providing tips and encouragement to hospitals on how to evade full compliance.

California nurses and patients will not stand by as the wealthy hospital industry steps up its efforts to roll back patient protections. Our families deserve no less.

Deborah Burger is president of the California Nurses Association.