Nursing Shortage Federal Regulations Petition

(Signatures hidden for confidentiality purposes to increase participation)

"We, the undersigned, endorse federal and local legislation to ensure safe nurse-patient ratios across the United States. Widespread understaffing of nursing units across the U.S. is placing the lives of our nations patients in jeopardy, and causing hundreds of thousands of nurses to decide to leave the field of nursing.

We respectfully ask our leaders to address nursing understaffing through passage of legislation capping the number of patients assigned to a nurse, based on work setting and acuity of patients.

Multiple studies have shown that a patients risk of dying increased with each extra patient added to the nurses patient load, above four patients, and that this risk of death increased considerably more when nurses were assigned eight or more patients each.

This is the situation threatening us and our loved ones across the United States as we face both an ever-worsening nursing shortage and an ever-growing population of older and sicker patients. At the very same time we are facing a gray tsunami of aging baby boomers, which will need hospital or nursing home care, nurses are leaving the profession.

In fact, there are an estimated 333,000 able-bodied Registered Nurses with active licenses, who are under the age of 65 and not rearing children, who are not using their licenses. In all, there are nearly 500,000 Registered Nurses with active licenses who are not using those licenses (http://bhpr.hrsa.gov/healthworkforce.../appendixa.htm).

Why are hundreds of thousands of nurses leaving nursing? Why this deepening nursing shortage, which is now a decade old? Although the roots are complex, the major reason is fairly simple: No one wants to work in understaffed nursing units anymore. Understaffing that endangers both patient lives and nurses licenses is the single biggest reason nurses are deciding to leave nursing. Who, then, will take care of our nations sick and elderly if this serious problem is not solved?

Current "stop-gap" measures to address the problem have focused on infusing the field with new graduates and foreign nurses. New graduates, however, have been burning out quickly once they enter nursing, as they experience the same intolerable working conditions their more seasoned forebears had. Thus, nursing particularly bedside nursing has become a revolving door of new graduates who are called in to fill the gap left by seasoned nurses, yet who find themselves equally unable to tolerate working conditions. Imported nurses so desirous of being in this country (understandably), in the meantime, are accepting jobs on under-staffed units that other U.S.-educated nurses would not tolerate; this has kept working environment standards low and is not an appropriate answer to this problem when we have over 330,000 inactive licensed nurses that could be potentially persuaded to return.

How did this nursing shortage happen? The evolution is complex, yet root causes are identifiable. As managed care arrived on the scene in full force in the 1990s, hospitals and nursing homes sought to cut costs by cutting nursing staff (the cost for whom, incidentally, is rolled into room and board charges). This nursing decrease led to short-staffing that burnt out the remaining nurses, who also left, leaving behind greater understaffing, and so started a vicious cycle.

Nurses also find themselves spending less time caring for a patient, and more time with interruptions and performing other tasks to save money on hiring or maintaining other employees to perform these tasks. They are inundated with documenting care, due to rising fears of medical-related litigation that have resulted in almost obsessive requirements for care documentation (i.e., charting). Twelve-hour shifts have turned into 14-hour workdays due to the charting requirements, with management frowning upon recording of this extra time. Documentation as well as other responsibilities of the nurse has increased in equal proportions to the acuity and number of patients cared for as a result of errors and other risk factors due to the understaffing models of institutions. Mandatory overtime is another administrative answer to the problem. Bathroom and meal breaks for nurses have been reduced to stolen seconds. Self health care of nurses is replaced with physical injuries, stress and exhaustion related ailments as well as medications or therapy in order to maintain employment.

Moreover, the intensifying and extreme focus on money and cost savings in health care has led hospitals not only to cut nursing staff, but also to try to win patients now termed clients or customers - back to their particular hospital by focusing on gloss and facade. While critically understaffed, hospital units are yet made to look shiny and pretty, nurses are made to utter canned slogans coined by expensive consultant groups about the wonderful care that the customers and clients are receiving, and customer satisfaction surveys are sent out by the hospital that do not even give consideration to the real, hard medical decision-making behind a patients care. Another tactic to cover up the overall lack of care is what is now called scripting in which nurses are mandated to recite statements to the patients in an effort to improve the care at the bedside, which has been compromised by responsibilities beyond reasonable time management.

And these problems are heaped upon the one major, overriding problem in nursing today that of UNDERSTAFFING. Patient-nurse ratios have become unreasonable, and indeed dangerous.

Hospitals and nursing homes are, in effect, creating a nursing shortage within their own walls by refusing to staff their nursing units adequately, in order to save money. Therefore, you find medical-surgical units full of very sick patients with intense needs and only one R.N. assigned to 6-9 patients, even on day shifts. This has proven to be unsafe staffing. Nurses are leaving the field because they cannot provide safe care to their patients with such understaffing, and to try to do so amid impossible circumstances puts their licenses in jeopardy. Moreover, those that remain in the field daily face a mountain of paperwork to complete on each patient, and multiple interruptions further lessening time spent with actually tending to a patient.

Furthermore, due to changes in health care reimbursement, patients are sicker than they used to be. Thus, not only do nurses have more patients and more charting, but also their patients are sicker. Technologies and protocols have evolved such that care for any one patient has grown more complex: nursing is not the same as it was two decades ago. Although staffing to patient acuity level has been tried, this staffing approach still leaves much wiggle room for management to understaff a unit.

The critical understaffing of nursing units has reached such a point that caps on patient-nurse ratios for general categories of settings is needed. Beds must be filled based on how many nurses are available to care for patients, not on how many beds are available. The practice of using nursing units as dumping grounds for patients and profits must end. It is simply dangerous for the patients. This cannot be stressed enough. To ensure safe patient care, we must accept the fact that some beds must remain empty.


Lastly, nurses who speak up against dangerous staffing levels need protection against harassment by supervisors and against losing their jobs for their candor. This is another serious problem resulting in licensed inactive nurses. While a large number of nurses leave to find a better setting, many nurses are forced out of institutions with unfair and negative harmful remarks in their personnel records for speaking up. Nurses need strong legal protection for whistle blowing to turn the tables on administrative abuse.

It is a sad say when nurses are warning their loved ones to beware of inpatient care, and to try to avoid becoming an inpatient if at all possible.

It's a bleak picture for both nurses and patients, and becoming bleaker. As the baby boomers age and start filling hospital wards, the picture will likely become truly grim.

In summary, we the undersigned are asking our legislatures to:

1) Enforce federal guidelines for safe staffing numbers where the nurses and patient care staff outweigh any personnel from administration on the decision of patient assignment ratios which includes adequate staffing of nurses, aides or techs and other appropriate personnel to divide the responsibilities of the unit fairly and to allow nurses to perform bedside care without the interruptions that interfere with appropriate care and safety.

2) We are asking for more legal protection in regards to whistle blowing or enforcing acknowledgement of unsafe assignments or inability to perform duties with protection from being terminated or negative records in personnel files. If unionization is not an option for a facility, then an outside neutral mediator should be available at the hospitals expense for such conflicts before termination is determined.

3) We are asking that incentives be applied to hospitals that have proven retention records as well as efforts to offer terminated nurses re-employment with the new staffing regulations and incentives for returning licensed inactive nurses to bedside care. Other incentives based on exit interview scores from terminated employees to ensure appropriate compliance with regulations.

Incentives for nursing program enrollment are not enough to address this crisis and shortage. The return of experienced nurses to the work environment is crucial to the balance of seasoned nurses to train new graduates.

(Names of signatures are not shown for confidentiality purposes to increase participation. Nurses and other medical staff may fear participation due to identification from employers. These names will not be provided to the public or any other agency. You will remain anonymous except to the owner of the petition and legislatures.)