Here in Ohio the State Board of Nursing sent out a newsletter last fall. It is online at this link if you care to view it http://www.state.oh.us/nur/MomemFall2000.pdf
I quote the first paragraph, "The Board of Nursing is the regulatory agency for the state of Ohio charged with protecting the public in relationship to the safety of nursing care. Within the past 12-18 months the Board of Nursing has heard numerous reports from nurses and others about staffing problems in hospitals, long-term care facilities, and community settings. Inadequate staff and mandatory overtime are not typically within the Board's authority to regulate: however when these reports indicate that staffing inadequacies are affecting public safety, the Board must respond. In addition to the anecdotal reports from nurses, the Board has increasingly seen evidence in disciplinary cases indicating that far too often unsafe nursing practices have resulted from a shortage of nursing personnel."
I found the letter more than troubling because it seemed like they weren't even sure who was supposed to handle this mess.
In the second paragraph it reads, "Ohio lacks a statewide plan for nursing and is not prepared to address the impact of the nursing shortage on its citizens ...What to do from a regulatory perspective was the subject of intense discussions during several Board meetings."
Meanwhile you and I are out there trying to balance on the high wire to take care of people the best we can and not wind up in front of the "Board" for disciplinary action because we failed to do the impossible. It's like Catch 22.
The letter continues. They (the Board)had a meeting of all the "stakeholders", which include, "state agencies, acute care, long-term care, home health, nursing associations, and licensed nurses, including nursing educators..." They conclude, "If Not Nursing Then Who?" Apparently there is no one at the wheel of this runaway bus. (Somebody call Sandra Bullock!) Even the "Board" is uncertain if it's their "jurisdiction". But somebody better take control! So, "If Not Nursing Then WHO?"
They state, "Rather than relying on the workforce solutions devised by others, nursing should be responsible for addressing supply and demand issues; developing effective workforce recruitment and retention programs; collaborating with education and service to redesign educational programs to meet nursing work force needs." This is referred to as the "the initiative" in their next paragraph.
So while they are in their ivory towers "developing", collaborating", and redesign(ing)" you and I are still out there on that high wire, now hanging by our fingernails! I envision that soon it will be so bad in our hospitals they will have to have the "Good Sam" law apply to nurses that are willing to go inside one and work.
Wait it gets better! The answer to the problem, (the health care crisis, particularly the shortage of nurses, stemming from demoralizing working conditions created by a profit driven system), is the "initiative", (as described two paragraphs above). But the dilemma now becomes how to fund or pay for the "initiative". Any bets here folks? I'm sure all you veteran nurses out there know the answer! Yes that's right, let the nurses pay for it! At least in Ohio we will be, with a hike in our licensure renewal.
Here's the reasoning the Board used. " It is unlikely that the general revenue funds will be available for the "initiative" given the other priorities of the state budget, most notably schools."
HELLO! IS ANYONE ELSE OUT THERE TIRED OF TAKING A BACK SEAT FOR THE SCHOOLS?! Whew! I apologize! Just had to get that off my chest. Any teachers out there reading this, you have my greatest respect. But folks we are talking crisis now, CRISIS, I REPEAT. HEALTH CARE CRISIS! ANYBODY HOME!
Getting back to funding the "initiative". Can't use general revenue, it's not in the budget. " In addition, the Board has no authority to seek general revenue funds....by law it must rely solely on the fees it is authorized to charge." (i.e. your license renewal) "Letting another state agency fund the "initiative" means that some entity other than nursing would decide for nursing how to deal with nursing workforce concerns." Hmmm, let's think about that. I'm wondering could "another state agency" possibly do any worse? Let's face it folks we got where we are today because of an abysmal lack of nursing leadership. Is it suddenly going to appear now, because now we have a "nursing workforce initiative"?
What can I say? True we are not talking break-your-bank bucks here. Only part, of the ten dollars estimated hike in the licensure fee, will be used to fund the "workplace initiative". It isn't the money. It's the principle. We (nurses) didn't make this mess. Hospitals have abused their nursing workforce for years. For years they have given us two options, take it or leave it. Most of us chose the latter. They (hospitals) created the problem and now we (nurses) have to bail them out.
Sadly we, as the severely co-dependent, people pleasing profession that we are, will do, it. We will pay for a "nursing workforce initiative", to try to get adequate staff so we can do our jobs.
So folks don't expect anything dramatic from your Board of Nursing, at least not here in Ohio. If you have a different experience I'd like to hear it. The fact is, it's going to get a lot worse before it gets even a little bit better. If I weren't a single mom in my fifties, with two more kids to get through college I would have gotten out. My advice is, if you have options take them. I know that isn't going to make my life any easier, or our patients, but it will yours.
The best answer I can give you Kim is document, document, document! On the unit where I work we all know, now. If we feel the staffing level is unsafe we write it as an incident report. That way if there is an adverse outcome due to unsafe staffing levels you are covered somewhat, the onus is on them. Remember always, always, ALWAYS make a copy for yourself.
I have posted this information before but some nurses may not be aware of it. It is a useful tool. I have used it also where I work. It is called the Assignment Despite Objection form, at the Florence Project website, http://www.florenceproject.org/adodisclaim.shtml
It has just about everything needed to write up staffing concerns on a concise form that you can turn into your supervisor. Again, make sure you make a copy for yourself, before handing it in. I do both. Because my understanding is, at least at our facility, all incident reports have to go through the legal department. And that's just fine with me.
Lastly, if you do choose to stay in nursing, please get involved in raising our issues in front of the public. I believe that is the only way we are going to change anything. When patients start demanding that they have the staff available to meet their needs, and that insurance companies and hospital have to be accountable for the monies given to them, then things will change. There is federal and state legislation proposed to address the staffing concerns of nurses. Write your congressman. Get your friends, family, neighbors, co-workers to write to. Support H.R. 5179,
Write Rep Tom Lantos and thank him for proposing this important legislation at this link Tom Lantos http://www.house.gov/lantos/html_files/contact.html
In Ohio write to support HB 78.
Write to Ann Womer Benjamin Rep District 75.
Finally I need you and all your coworkers to meet me at the Million Nurse March in May 2002, in Washington, D.C., at the Lincoln Memorial so we can march shoulder to shoulder to the White House and demand that George "Dubya" listen to us!
Good luck to you Kim, and God bless and help us all as we try to get through this.
[This message has been edited by PeggyOhio (edited February 27, 2001).]