"Yo! Here's Another No-Brainer Thing We Can Do to End the Nursing Shortage."
October 5, 2006 -- Over the last few weeks, Philadelphia Daily News columnist Ronnie Polaneczky has run at least three strong pieces about safe staffing and overtime disputes at Temple University Hospital. In describing labor negotiations between the hospital and its nurses, Polaneczky argues that nurses should get the staffing levels they need, as well as limits on forced overtime. She says such measures would improve patient safety and address key factors in the nursing shortage, potentially bringing many nurses back to the bedside. In making these points, she explains, using specific examples, how nurses keep patients alive--if they have the time and energy. We commend Polaneczky for keeping the focus on issues that are critical to the wellbeing of bedside nurses and their patients.
In "Temple nurses are sounding an alarm that we all should listen to," published on September 12, Polaneczky explains what lies behind the saying "Doctors may save patients, but nurses keep them alive": nurses are with patients 24/7. They monitor whether prescribed medication is working, and if a dressing is stopping the bleeding. They aren't just giving a spongebath--they are assessing the patient's skin color and feel. This all takes time, Polaneczky notes, and when nurses don't have it, patients are at serious risk. She cites the 2002 research by the University of Pennsylvania's Linda Aiken and others showing that doubling post-operative nurses' patient loads increased mortality by 31 percent.
Polaneczky reports that Temple's nurses, whose contract will soon expire, want to make mandatory 1-to-4 nurse-to-patient ratios a contract issue, but that the hospital refuses even to discuss it. (We assume some units, like the ICU, would have better ratios.) She quotes Temple nurse Patricia Eakin, who says the hospital does not always achieve the 1-to-4 ratio. And Bill Cruice, executive director of the nurses' union, the Pennsylvania Association of Staff Nurses and Allied Professionals, says that staffing is "the most important issue facing the hospital industry and the nursing profession today." Temple spokeswoman Rebecca Harmon argues that the hospital's staffing levels are "appropriate to the delivery of high-quality patient care."
Polaneczky says she expresses no view on Temple's specific situation. But she underlines the broad significance of the issue, noting that staffing problems plague hospitals across Philadelphia--a city whose "world class health industry" is vital to its wellbeing. And she notes that this kind of dispute is a key cause of the nation's nursing shortage, quoting Center director Sandy Summers:
Inadequate staffing creates poor working conditions, which drives nurses from the profession. And then hospitals say, 'We're understaffed because there aren't enough nurses.' ... Hospitals won't even admit that they're helping to create the problem.
In "Docs should help Temple nurses," published on September 26, Polaneczky takes the innovative approach of urging physicians to add their voices to those of the Temple nurses seeking safe staffing. She describes a recent rally at which the nurses, gearing up for an impending strike, repeated their staffing demands. Physicians--who "ought to be as vocal as nurses" about staffing--seemed to be absent. Polaneczky again describes the current staffing dispute at the hospital, and how better nurse staffing can save lives. Then she says physicians ought to be alarmed, and suggests that their influence could help resolve the dispute.
The reason for that, she suggests with some regret, is that "[m]ost people, including most hospital administrators, think more highly of doctors than they do of nurses." She lays some of the blame on nurses themselves:
For years, nurses have portrayed themselves as little more than compassionate hand-holders, dispensing love, hugs and back rubs to recovering patients. Rarely are they portrayed for what they really are: well-educated scientists who keep patients alive because they're trained to notice all the things that could kill them.
To explain why that is, she quotes journalist and Center board member Suzanne Gordon:
Nurses don't toot their own horns. ... They've been discouraged for centuries from explaining credibly and in ordinary language their technical skills and encouraged to focus instead on their caring and compassion and how nice they are. When they dare to step up and say, 'The patient got better, and we had something to do with that,' they get their knuckles rapped.
This is all fair enough and important to stress, though as we've noted in the past, the media has an independent responsibility to describe the world fairly and accurately. Many nurses have tried to get the media to do that with regard to
their profession, with limited success. In addition, as Polaneczky's column does not note, too many physicians themselves do not appear to be fully aware of the value of their nursing colleagues.
Polaneczky closes by urging support for staffing legislation she says has the support of Member of Congress Allyson Schwartz (D-PA), who attended the rally. Presumably this is a reference to proposed federal legislation setting mandatory staffing ratios, though it's not entirely clear. And Polaneczky again urges physicians to stand with their "partners in patient care" and say, "Give these nurses what they need to keep my patients alive."
On October 5, Polaneczky's column again returned to these issues, this time with a focus on forced overtime and its role in the shortage. The piece's title is its quick summary: "No forced OT = no nursing shortage = no-brainer." Polaneczky first expresses support for a pending state bill that would generally prohibit forced overtime at the end of any given shift, describing the bill as the "Yo! Here's Another No-Brainer Thing We Can Do to End the Nursing Shortage." The bill would apparently not prevent nurses from working those hours if they chose to, and it's not clear whether it would limit the number of regular shifts a nurse could work in a given period--elements that some might argue would also be needed to truly protect patients.
Polaneczky rightly notes that "[n]urses who are forced to work when they're stumbling with fatigue are at higher risk for, say, miscalculating the drip rate in an IV line, or dispensing the wrong drugs to patients. Which can, well, kill us." Polaneczky says that's why "groups like the Center for Nursing Advocacy and the American Nurses Association have been pushing for laws that would forbid the use of mandated overtime as a solution to nurse-staffing shortages." Polaneczky explains that administrators say they can't fill the additional positions this kind of legislation would require.
But she argues that forced overtime and short-staffing are themselves key factors driving nurses out of the profession. This is her link to the staffing issue, which she pursues for the rest of the piece. She notes that the Temple nurses decided not to strike, even though they did not get the ratios, because they "received other considerations that will help alleviate stress felt by nurses caring for more than four patients at once." It's not clear what these are.
Polaneczky says the "good news" in the related OT and staffing conflicts is: "Fix the problem, and nurses return to the profession in droves." She argues that's what happened in California where the mandatory ratios the California Nurses Association (CNA) managed to push through have resulted, according to CNA, in an increase of more than 60,000 RNs since they went into effect in 2004. Polaneczky closes with a plea for the Pennsylvania overtime legislation, and staffing measures to "do for us what [they're] doing for Californians: Help guarantee that, when we're sick enough to be hospitalized, an experienced nurse will be available to help us heal."
Taken together, these pieces are a powerful (indeed, relentless) effort to push the interests of nurses and their patients in getting adequate resources for bedside nursing. Polaneczky rightly links the problems to perceptions of the profession's value, and does her part to correct those perceptions with specific examples. She relies on bedside nurses and nursing advocates for commentary. And she hammers away at the reality that improving working conditions will help to attract and keep more bedside nurses, easing the shortage in which poor conditions have been a key factor. Of course, despite Polaneczky's inclusion of a little reaction from hospitals and managers, they are unlikely to find her analysis a measured and balanced one. She might have focused a little more on their arguments, including their views of what has happened in California.
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