[travel soon]

I wish we could send a letter for every patient and/or family affected by this too. Thanks for the link. I intend to pass it along to my class on Monday.

[BrokenRNheart]

Thanks for standing up

[Angie O'Plasty, RN]

Originally Posted by marie-francoise

Thanks. Although I'm a bit surprised that others on this board haven't responded. This affects all nurses, and all patients - all of us.

This is such a simple way to try to make a difference in nursing working conditions, is sponsored by the ANA itself, and potentially can have an impact on Congressinal opinion, and....

...THE SILENCE HERE HAS BEEN DEAFENING.

If we can't even hit "submit" on this pre-made letter to the ANA/Congress, how the heck are nurses going to improve their own working conditions?

If this is a barometer of how galvanized nurses are to change their own working conditions, it doesn't bode well.

This may not propose the best solution (I myself don't think that individual units/hospitals can be trusted to really staff safely, but that set ratios should be broadly applied across general categories of work settings). BUT, it's a START, at the very, very least.

There is also the possibility that this is not news to us, and we have been signing petitions for change in nursing for quite some time. So we're glad to have you on board with this initiative. Keep spreading the word, keep planting those seeds.

[ER_baby12]

I just sent my letter. Thanks.

[IMustBeCrazy]

This sounds like a great idea in theory, how many of you have read the letter in its entirety? (bolds are my emphasis):

--------snip----------

I am writing to urge you to cosponsor the Registered Nurse Safe Staffing Act (S. 73/H.R. 4138), legislation that would hold hospitals accountable for the development and implementation of unit-by-unit nurse staffing plans, in coordination with direct care nurses and based on each unit's unique needs.

The RN safe staffing requires the establishment of a staffing system that ensures a number of RNs on each shift and in each unit of the hospital to ensure appropriate staffing levels for patient care. The also bill provides public reporting of staffing information. Hospitals must post daily for each shift the number of licensed and unlicensed staff providing direct patient care, specifically noting the number of RNs.

Safe staffing is among nurses' top concerns and is key both to patient safety and retention of nurses at bedside as we face a growing nursing shortage. The link between patient safety and nursing care is well-established. According to a 2002 study by Linda H. Aiken, PhD, RN, each additional patient added to the average workload of staff registered nurses (RNs) increased the risk of death following common medical procedures by 7%, and the risk of death was more than 30% higher in hospitals where nurses' mean workloads were 8 patients or more each shift than in hospitals where nurses cared for 4 or fewer patients. Furthermore, research has shown that when there are more registered nurses (RNs), there are lower mortality rates, shorter lengths of stay, reduced costs and fewer complications.

When it comes to addressing the nursing shortage it's important that we address both recruitment and retention. The latest RN National Sample Survey of Registered Nurses by the Health Resources and Services Administration showed that on average in the US 16.8% of Registered Nurses are not practicing in nursing. Higher patient care assignments put nurses in the stressful situation where it becomes difficult to provide the level of care needed to assure the best possible outcomes for their patients. Under these circumstances, it is not surprising that staffing conditions are among the chief reasons nurses leave the bedside. In order to truly address the shortage we must create environments that retain nurses.

S. 73/H.R 4138 recognizes that the complexity and variability of today's hospitals requires the determination of staffing patterns at the hospital and unit level, with the vital input of the RNs caring for patients at those institutions.

I urge you to cosponsor this important bill. I look forward to your reply.

----------end of letter----------

IMO, this proposal is weakly worded with reference to a study that has little bite (the risk of death was more than 30% higher in hospitals where nurses' mean workloads were 8 patients or more each shift than in hospitals where nurses cared for 4 or fewer patients - lots of gray area there to exploit by hospitals.) So, we are empowering hospitals who, by the way, have already exploited us, to implement adequate staffing patterns?? We are expecting the public to understand the difference in care on a unit that may have 3 nurses, and 3 aides for 24 patients compared to, say, 5 nurses and 1 aide? Are we stupid? Who is the ANA really backing, nurses or hospital franchises?

I leave you with a thought. My manager dreamed up the idea in the last six months that our nurse-driven acuity system was broken. My manager's "fix" to that was we are to systematically lower each patient's acuity, thereby allowing even more patients onto our unit.

Why would I trust a hospital to implement an adequate staffing pattern?

[marie-francoise]

Originally Posted by IMustBeCrazy

This sounds like a great idea in theory, how many of you have read the letter in its entirety? (bolds are my emphasis):

--------snip----------

I am writing to urge you to cosponsor the Registered Nurse Safe Staffing Act (S. 73/H.R. 4138), legislation that would hold hospitals accountable for the development and implementation of unit-by-unit nurse staffing plans, in coordination with direct care nurses and based on each unit's unique needs.

The RN safe staffing requires the establishment of a staffing system that ensures a number of RNs on each shift and in each unit of the hospital to ensure appropriate staffing levels for patient care. The also bill provides public reporting of staffing information. Hospitals must post daily for each shift the number of licensed and unlicensed staff providing direct patient care, specifically noting the number of RNs.

Safe staffing is among nurses' top concerns and is key both to patient safety and retention of nurses at bedside as we face a growing nursing shortage. The link between patient safety and nursing care is well-established. According to a 2002 study by Linda H. Aiken, PhD, RN, each additional patient added to the average workload of staff registered nurses (RNs) increased the risk of death following common medical procedures by 7%, and the risk of death was more than 30% higher in hospitals where nurses' mean workloads were 8 patients or more each shift than in hospitals where nurses cared for 4 or fewer patients. Furthermore, research has shown that when there are more registered nurses (RNs), there are lower mortality rates, shorter lengths of stay, reduced costs and fewer complications.

When it comes to addressing the nursing shortage it's important that we address both recruitment and retention. The latest RN National Sample Survey of Registered Nurses by the Health Resources and Services Administration showed that on average in the US 16.8% of Registered Nurses are not practicing in nursing. Higher patient care assignments put nurses in the stressful situation where it becomes difficult to provide the level of care needed to assure the best possible outcomes for their patients. Under these circumstances, it is not surprising that staffing conditions are among the chief reasons nurses leave the bedside. In order to truly address the shortage we must create environments that retain nurses.

S. 73/H.R 4138 recognizes that the complexity and variability of today's hospitals requires the determination of staffing patterns at the hospital and unit level, with the vital input of the RNs caring for patients at those institutions.

I urge you to cosponsor this important bill. I look forward to your reply.

----------end of letter----------

IMO, this proposal is weakly worded with reference to a study that has little bite (the risk of death was more than 30% higher in hospitals where nurses' mean workloads were 8 patients or more each shift than in hospitals where nurses cared for 4 or fewer patients - lots of gray area there to exploit by hospitals.) So, we are empowering hospitals who, by the way, have already exploited us, to implement adequate staffing patterns?? We are expecting the public to understand the difference in care on a unit that may have 3 nurses, and 3 aides for 24 patients compared to, say, 5 nurses and 1 aide? Are we stupid? Who is the ANA really backing, nurses or hospital franchises?

I leave you with a thought. My manager dreamed up the idea in the last six months that our nurse-driven acuity system was broken. My manager's "fix" to that was we are to systematically lower each patient's acuity, thereby allowing even more patients onto our unit.

Why would I trust a hospital to implement an adequate staffing pattern?

Although I personally would prefer more broadly applicable ratios, across SETTINGS as opposed to units, although I don't trust hospitals/units to staff adequately....

That said...

This represents an important first step because:

1) It's the ANA

2) It's going to Congress

3) It acknowledges one of the greatest problems facing nurses today

4) If unit-determined ratios don't work, then we can point to this as a precedent and move on to more federally-mandated ratios across settings.

Kind of a "lesser of the evils" approach, one could say.

Progress is full of compromises. Steps along the way...

[IMustBeCrazy]

Originally Posted by marie-francoise

Although I personally would prefer more broadly applicable ratios, across SETTINGS as opposed to units, although I don't trust hospitals/units to staff adequately....

That said...

This represents an important first step because:

1) It's the ANA

2) It's going to Congress

3) It acknowledges one of the greatest problems facing nurses today

4) If unit-determined ratios don't work, then we can point to this as a precedent and move on to more federally-mandated ratios across settings.

Kind of a "lesser of the evils" approach, one could say.

Progress is full of compromises. Steps along the way...

Understood. But this doesn't even qualify as a "compromise." It is merely a shell game where you lose sight of the real issue via and smoke and mirrors.

The ANA, with their purported massive resources, is proprosing schlock like this when CA has state ratio LAWS?? This is pathetic and unacceptable *and* and they have the unmitigated gall to pretend this is some sort of progress???? The reason we are in this situation is due to hospital mandated 'ratios' in the first place. I respectfully disagree.

[CPNEgrad07]

I DID IT! and yes, totally easy.

[marie-francoise]

Originally Posted by IMustBeCrazy

Understood. But this doesn't even qualify as a "compromise." It is merely a shell game where you lose sight of the real issue via and smoke and mirrors.

The ANA, with their purported massive resources, is proprosing schlock like this when CA has state ratio LAWS?? This is pathetic and unacceptable *and* and they have the unmitigated gall to pretend this is some sort of progress???? The reason we are in this situation is due to hospital mandated 'ratios' in the first place. I respectfully disagree.

I don't deny that this might be schlock gussied up as substance - BUT some aspects of it do ring true.

More importantly, at least it will increase awareness of the problem of nursing understaffing among Congress members.

I got into a debate with a family member of mine who's a doc, and I was totally on your side about this. He was arguing for unit-specific, I was arguing for, actually, federally mandated.

BUT... I have to acknowledge that the ANA is supposed to be the nation's leading nursing organization, so shouldn't we at least try to use such a pre-existing, well-known, well-resourced body to advocate for us?

If this measure doesn't work, we should try another approach.

P.S. And I do wish there were more studies on the effects of ratios published in prestigious journals, in addition to the 2002 Aiken study. It seems we only have that one study to cite all the time...

[BrokenRNheart]

ANA is national. Others are local.

We need national support. Each separate organization does not bring enough people locally to get it supported by legislation. That was the reason for choosing ANA.

It's not the best offer, but it's about the only offer short of struggling with local unions or your own union and they just keep plugging away but they do NOT have enough people to speak up with them. Nurses only complain in the background and when given the opportunity to do something about their complaints, they go quietly back to their corners. That is why the hospitals have gotten away with this for so long. People need to vote or do something or it will NEVER change. To say it will never change is a cop out and poor excuse to not act. Things do change when people push for it. The reason it won't change is because the majority of nurses that read this or see an opportunity will turn their heads and refuse to even try.

I have seen it for 15 years and others have seen it for much longer. That is the first problem that needs to change. If we can't get that message across, there is no hope.