The movement for safe staffing rations for all nurses: an interview

Labor movements have always tried to find ways to wrestle control over working conditions away from the boss. Workplace injuries and deaths are still at epidemic levels which in some industries in particular can mean life and death. Health care still suffers from disproportionately high levels of injury in in-patient settings such as hospitals, rehab centers, and nursing homes. Led by nurses, the movement for safe staffing has sought to create hard limits on the amount of patients that can be assigned to health providers for both the safety of the patients and their care givers. Following decades of militant action California nurses and nurses in provinces in Australia achieved safe staffing legislation which research has vindicated in improving care, reducing mortality, and avoiding provider burnout. We interviewed Jenny, a Maryland nurse involved in the movement to spread these measures about her experiences as a nurse and the movement.

Was there a moment or event at work convinced you that safe staffing is needed? 

I didn’t focus on safe staffing fully until I had left the hospital. I wasn’t aware of the problem fully until I became a legal nurse consultant, and it made me look back on my experience, and I realized I had been incredibly lucky that no one died while they were under my care before I left the hospital.

But because hindsight is 20/20 this is my story.  I interviewed for two positions in the city of Chicago.  The first one (the one I should have taken) was a night shift at another hospital that was working towards Magnet status. However, I knew nothing about Chicago and saw the neighborhood around the hospital and saw that it was dilapidated and run down, and decided it wasn’t a safe neighborhood.  The second one was on the lake front and appeared to be in the safer neighborhood. My first clue that this was a bad job for a new nurse, and later for any nurse, was that they were honest with me, and it had been a decade since they had hired a new nurse.  I was honestly flattered that they thought I would make a good fit as a new nurse at their organization, and I needed a job. So I accepted.  I got a signing bonus, because at that time everyone got a signing bonus, and I was supposed to get training and mentorship that was the common standard for new nurses as the time (2006). After about 6 or 8 weeks I was considered ready to take on my own patient load without supervision, and was “assigned” a mentor. The mentor I was “assigned” was my boss. Having your boss be your mentor doesn’t work, at least for your first mentor, it may work down the road once you’ve had some experience and you can recognize what your boss has to offer.  It wasn’t long after I started off on my own that I realized that something (and what that was I didn’t know yet) was going to have to give if I wanted to do the job well.  It turns out the something was not only patient safety (which was a misnomer to begin with at this organization), but my personal health. Not long after I became a floor nurse I was regularly in charge of 6 patients over the course of a shift, a slow night saw me down to three with discharges, and within 3 months of me being on my own I was expected to manage vent patients- training consisted of this is how you suction, this is how you silence alarms- it was only later that I learned about breath support, changing settings and how to better understand the patient on the vent, now you can take care of a vent patient.  New nurse on a telemetry step down unit (my unit) and now responsible for six patients, with one on a vent regularly. It’s a wonder that I didn’t kill anyone. I’m still amazed. At about the one year point, I was diagnosed with shingles, which my primary care physician directly related to stress on the job. It was right after this (the timeline starts to get fuzzy at this point, so it may have been right before this) that I came in one day only to find the dedicated charge nurse had a family emergency and as the second most experienced nurse on the floor I was being trained to be charge nurse, on top of my patient loads. Needless to say this was not pretty. Not only was I a charge nurse but many nights we had ANOTHER new grad whom I was responsible for training as well. Talk about the blind leading the blind. About six to eight months after this I was in a hurry passing medication and had two patients located in the same room, as with most of the rooms being double, and a good night resulted in many of the patients being in the same rooms, because then there was less travel, I put the medications for both patients in my pocket, and forgot to do one more check at the bedside, administering the wrong medications to the wrong patient. I had been written up for any number of things since I had become a nurse, but a wrong medication error was too much and I was fired from the job.

Have you gotten involved in other social movements because of your activism on safe staffing? 

Before this year I wasn’t aware that there were safe staffing movements outside of Magnet Hospitals or California.  While I recognized the importance of it I wasn’t aware of anything being done outside of those areas. Legal Nurse Consultants are, in my experience, treated like we’re either second class nursing citizens, or somehow that we failed as nurses, rather than those who have a unique perspective to nursing, and a unique impact on the role of safe staffing.

How have you experiences organizing affected your perspective at work or within the health system? 

I think it’s made me hyper aware of the problems faced by staff nurses, and I now ask about it when I’m in a new facility. I recently had the chance to visit an acute care rehabilitation hospital where staffing wasn’t ideal but it was significantly better than the standard at 1:7 or 8, and I got to talk with the nurse manager about some of the difficulties in getting that and some of the benefits that have allowed them to maintain that level of staffing, including less patient falls, and better outcomes in the care surveys sent to the patients and better discharge outcomes. She also said they were able to better respond to patient acuity needs with lower staffing numbers.  It was heartening to hear that it has worked well.

Where do you see this movement in 10 years?

Assuming we do not win safe staffing we need to move forward to continue to push back against the people who say it costs too much, who say that nurses need a bachelors or put other barriers in place. Part of the biggest barrier against safe staffing include the number of employed nurses.  If we do not consider all possibilities in encouraging safe staffing the movement will fail within 10 years.

Assuming we win national safe staffing ratios, what next?

Enforcement of the laws. If there is no financial reason for enforcement, many places will not enforce them. Ensuring that enforcement includes more than just the hospital, ensuring that enforcement is in place in the nursing home, assisted living, and long term acute care facilities as well.

Why do you think we have unsafe staffing essentially across the country, and in reality in most places in the world? 

Money. Money is at the heart of the problem. Also a lack of understanding into each others roles. I posted an article to one of the safe staffing websites that I found interesting because the administrator admitted that their staffing ratios contributed to the problem, and there was an immediate attack on the consultant that was being called in to help resolve the problem.  Is there something else that the consultant could bring to the facility besides the facility paying them money to pay for what they already know? Sometimes a new set of eyes can identify another problem that is overlooked by the staff because it’s status quo. We don’t need to be afraid of consultants, we need to embrace the importance interdisciplinary relationships, even within the field of nursing.

What can everyday healthcare workers do to ensure safe staffing today in their jobs and neighborhoods? 

Talk. Talk about the role of safe staffing, share stories of staffing gone right and staffing gone wrong. The stories of things going wrong are important, but the stories of things going right are almost more important.  Its not just killing PAT, but it’s the times in which safe staffing saved a life that’s important too. People need to know that it makes a difference. They need to respond to it on a personal level, and when the neighborhood, when the community at large recognizes the need for safe staffing, and the importance of it, they’ll start demanding it, but as with most things, until it directly impacts them, they don’t recognize the importance of it.

At the same time its important to SHOUT IT from the rooftops because the squeaky wheel gets the grease.

Jenny has been a registered nurse for 10 years, currently residing in Maryland and is a certified legal nurse consultant. Her speciality is nursing home malpractice, but she’s worked in Workers Compensation, telemetry/stepdown, private duty and home health nursing. 

 

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