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Making the Case for Better Staffing

Healthwire
Fall 2014
Feature Story

Providing safe, efficient, high-quality patient care starts with proper staffing.

LAST MARCH, between shifts as a registered nurse in the psychiatric crisis unit at Jersey Shore University Medical Center in Neptune, N.J., Marty Marino met with state lawmakers in an effort to persuade them to support a bill that would provide safe staffing in New Jersey hospitals. Marino wasn’t alone. He was joined by members of his union, Health Professionals and Allied Employees, who shared his passion for getting the legislation passed.

 “Safe staffing is about helping patients,” says Marino. “It’s not about creating less work for nurses and health professionals. We can’t be in two places at once; if we want to improve the quality of patient care, it requires more nurses and ancillary staff. That’s the message we tried to get across.”

Healthcare workers across the country are voicing the same message: Safe staffing saves lives. A growing body of research shows that there is a direct link between safe nurse staffing levels and patient outcomes, patient satisfaction, mortality rates and readmission rates. HPAE is among a number of AFT
Nurses and Health Professionals affiliates—including AFT Connecticut, the Oregon Nurses Association and the Washington State Nurses Association—that have launched efforts to improve nurse staffing through legislation in their respective states.

At the national level, delegates to the 2014 AFT Convention in Los Angeles this summer passed a resolution that solidified the union’s commitment to safe and effective nurse staffing, by calling for the support of state and federal laws that set minimum standards for the number of patients assigned to a nurse, as well as laws that establish nurse staffing committees. In addition, the resolution notes that the AFT will help locals negotiate contract language that establishes safe staffing levels and requires hospitals to share data on staffing, patient satisfaction and patient outcomes. As the resolution notes, “to reclaim the promise of  healthcare, we must ensure frontline caregivers and staff are well-prepared and supported to provide safe, sufficient and high-quality patient care.” And that starts with staffing.

‘Staffing guidelines are woefully inadequate’

In New Jersey, HPAE has called on the state department of health to update its staffing standards; the union also is supporting a state Senate bill that improves nurse-to-patient staffing ratios. “Nurse staffing guidelines haven’t been updated since 1987 and are woefully inadequate,” says Ann Twomey, HPAE president and an AFT vice president.
The meetings with state legislators provided an opportunity for the working nurses to talk about their daily work and educate the lawmakers on the importance of the bill.  “They heard our concerns, and we heard theirs,” says Marino. “The legislation may not pass this year, but it will eventually.”

Some states do have laws that address nurse staffing, and our affiliate members are working in coalition with healthcare unions, community groups, professional organizations and other allies to improve staffing regulations and to ensure that the laws are implemented effectively. “Our effort to reclaim the promise can’t be done alone,” says AFT President Randi Weingarten. “We have to get the community on our side, and our members engaged. When they are, they feel empowered—and no one can divide us,” Weingarten told AFTNHP members at a Professional Issues Conference in Baltimore this spring.

‘We want legislation that will work’

In June, the Washington State Nurses Association held a summit on staffing and patient safety, teaming up with SEIU Healthcare 1199NW to provide education and training to members so they can advocate at the state Capitol for a staffing ratio law and make a stronger case for safe staffing in their hospitals. Washington has a law that requires the facilities to establish staffing committees, but it isn’t effective, says Anne Tan Piazza, assistant executive director of governmental affairs and operations for WSNA. The union wants a bill to establish staffing ratios  as minimum standard while also requiring hospital CEOs to implement the staffing plan proposed by the staffing committee based on the needs of the patients.  “It’s not enough to simply adopt ratios,” says Piazza. “We want legislation that we believe will work in Washington state.”

WSNA members are trying to deal with the current law by improving its implementation. This is what led them to sponsor the summit with SEIU. More than 300 nurses from across the state participated in training on how to effectively advocate for safe staffing. “Hospitals haven’t always responded to the need for safer staffing,” Piazza says. “That’s why we need to continue the push so our voices are heard.”

The WSNA also is holding events called “RN Days of Action” in which members volunteer to help on the campaigns of “nurse champions”—people who are running for legislative offices in the state and who support issues that are important to WSNA members.

Raising awareness

Connecticut also has legislation on the books that requires hospitals to establish staffing committees. It, too, is ineffective. Earlier this year, AFT Connecticut implemented an initiative called Safe Staffing Connecticut to raise awareness. It is an AFT-led coalition of allies statewide that believe safe staffing is a key element of high-quality healthcare. The coalition has used legislative visits and social media to influence policymakers and community members, urging them to make safe staffing and quality care a priority as the new landscape of healthcare unfolds.

Ole Hermanson, an AFT Connecticut staffer, says nurses are showing their support for the coalition through the union’s social media campaign—by posting photos with signs detailing why they support safe staffing. “They share it on their Facebook pages and Twitter feeds and it has really helped to get our message out,” he says. “Staffing is a problem we are having in all of our hospitals, and we want to address it on all fronts—in our community, in our contracts and in state legislation.”

Resistance to optimal staffing

It has been 10 years since staffing legislation was passed in Oregon. The state also uses staffing committees in its hospitals. “In hospitals where the law is embraced, it works OK. But it’s been challenging in hospitals that don’t buy into staffing committees,” says Sarah Baessler, the Oregon Nurses Association’s director of health policy and government relations. “Staffing decisions in these hospitals are based on budget—not on the needs of patients.”

Frustration with the lack of enforcement led the ONA to push for a stronger law. The union has made passage of improved staffing legislation a priority in the 2015 legislative session. The ONA wants to strengthen the law to empower nurses on staffing committees and give the state more tools to effectively enforce the law. The ONA is not pursuing a nurse-to-patient ratio like many of the other affiliates. “We want to strengthen the structure that is already in place,” says Baessler.

Cheryl Brewer, an ONA member and a nurse at Sacred Heart Medical Center at
 River Bend in Springfield, is on her hospital’s staffing committee and is part of the Oregon Nurse Staffing Collaborative, where nurses share best practices and evaluate staffing challenges and opportunities. She says there has been resistance to optimal staffing at her hospital. “My organization either doesn’t understand the staffing law or doesn’t want to follow the law.”

In July, the ONA, which represents the 1,000 nurses at Sacred Heart, negotiated a two-year contract that contains provisions to address some of the staffing issues. In fact, a number of AFT NHP locals also have used contract language to make staffing improvements in lieu of stronger staffing regulations in their states. Brewer hopes the contract will help with staffing, but she also supports efforts to change the law. “No matter what we have in the contract,” the hospital will do what it must “to ensure CEOs are taken care of, but there are no guarantees for our patients that adequate staff will be at the bedside. The  law needs to be enhanced to empower nurses and make hospitals accountable for implementing safer staffing.”

—Adrienne Coles