For the Health Professionals and Allied Employees (HPAE), Code Red started with a survey. In the summer of 2022, we asked New Jersey’s frontline caregivers about the state of hospital bedside nursing. We received many more responses than we anticipated—all from nurses—with much more alarming results than we expected (see go.aft.org/oo3). Thirty percent of nurses had left the bedside. Of the 70 percent who had stayed, another 72 percent wanted to leave within the next year. Most alarming was the statistic about new nurses: 95 percent of nurses with five years’ experience or less wanted to leave the bedside. The top two reasons nurses left or wanted to leave? Stress and stress due to staffing.
The stories nurses related through the survey highlight how much staffing and stress are intertwined. These nurses shared being given untenable patient loads and multiple patient support roles outside their job duties because of staff shortages. They shared stories of understaffed emergency departments with patients waiting in line for days to be seen or patients lying on ED floors because of a lack of beds. They also spoke of training dozens of new nurses only to watch them leave months later—or see them be pulled from orientation and given workloads they were never trained to handle. Nurses described the strain of watching patients becoming angrier and more prone to violence the longer they went untreated, colleagues in tears during their shifts from being overwhelmed, and many more stressful, unsafe working conditions causing them to fear their nursing licenses were in jeopardy.
Only half of the 140,000 licensed nurses in New Jersey are currently practicing. Our survey results tell us loud and clear that we don’t have a shortage of nurses; we have a shortage of nurses willing to stay at the bedside. The issue is retention, and it cannot be solved with simple recruitment efforts. What we need is effective, enforceable staffing ratio legislation to keep patients safe, keep us safe, and stop the bleed of nurses leaving the profession at alarming rates.
HPAE has been pushing for safe staffing legislation for 22 years. Staffing regulations in New Jersey, which only cover ICU and critical care units, have not been updated since 1987. Meanwhile, the terrible working conditions we wrote about in a 2001 white paper to advocate for updated legislation have only worsened.
Now, we’re fighting to pass bill S304, which establishes minimum nurse staffing standards for hospitals and ambulatory surgery facilities, and building a broad coalition to increase public support for safe staffing. In March 2023, we released another white paper (see go.aft.org/4su). We also held a lobby day, traveling to the state house in Trenton to call on legislators to pass the bill, and worked hard to secure the bill’s endorsement by the New Jersey State Nurses Association (NJSNA). In May, we organized a rally at the state house and bused in members of every healthcare union in New Jersey. Hundreds of people attended, and the crowd was a sea of union colors, all standing together to highlight the need for safe staffing.
We are also focused on getting our state legislators on board with the bill. This year, every seat in our Assembly and Senate is up for reelection, and we are only endorsing candidates who support safe staffing legislation. In a short questionnaire, we asked all legislators, “Would you pass safe staffing legislation?” Those who responded “No” or “Maybe” or who didn’t return the questionnaire weren’t endorsed. This tactic helped force important conversations about our priorities with candidates who want our support. We’re using that endorsement list to plan for further lobbying on safe staffing throughout the year.
We’re working with our bill sponsors and other unions and organizations like NJSNA to develop enforcement guidelines and language. We’ll continue building both internal and public support, but we also want to help our members find staffing solutions now at the bargaining table. Our October Professional Issues Conference will focus on internal organizing and mobilizing members to become advocates for safe staffing legislation. And we have several contracts up in 2024, so we’re preparing our locals to use staffing as a pressure point for bargaining.
We’ve never seen nurses’ stress levels this intense. Short staffing has inflicted unprecedented moral injury on the healthcare workforce, and we’re tired of trying to convince administrators to change. That strategy is like tossing pebbles to stem a flood, and it hasn’t worked. Nurses across the country are now throwing boulders. We’ll do whatever it takes to make our workplaces safer for our patients and ourselves. We won’t stop until we win.
Debbie White, RN, is the president of the Health Professionals and Allied Employees (HPAE), an AFT vice president, and a long-serving medical-surgical nurse. Barbara Rosen, RN, is the vice president of HPAE, a nurse educator, and a former critical care nurse.
[photo: courtesy of HPAE]