(Editor’s Note: Excitement mounts as we approach March 24th, the day that
will be remembered in nursing history for the self-empowerment of the nurses
of Massachusetts. It’s important to restate here the reason for this
departure and rebirth: nursing’s collective role as patient advocate. As the
corporatization of health care in Massachusetts intensified in 1994, the
Massachusetts Nurses Association launched the Statewide Campaign for Safe
Care. One of the first steps in unfolding this campaign was to convene a
summit of nursing organizations. The Massachusetts Organization of Nurse
Executives sent a large delegation which argued strongly against any
consideration of minimum enforceable staffing ratios as a necessary component
of nursing’s agenda at that time. We should note that the California Nurses
Association, in the early ‘90s during the administration of Mary Foley,
current president of the American Nurses Association, advocated before
regulatory bodies in that state for staffing ratios as a necessary component
to maintain standards of care. A few years later, the independent CNA mounted
a strong, and eventually winning, campaign to pass safe staffing legislation
with enforceable nurse-patient ratios and an acuity escalator provision. All
the while, ANA took the exact line as MONE in opposition to staffing ratios.
The term ‘management domination’ not only means statutory supervisors in
positions of potential influence over collective bargaining. It’s also an apt
description of ANA’s political culture, and underscores the urgency of
disaffiliation. -- Sandy Eaton, RN, Quincy, Massachusetts)

---------------------

Yet another newspaper has focused on the current nurse staffing crisis in our
health care system. Below is a front-page story from Tuesday's MetroWest
News, which once again highlights the need for passage of safe staffing
legislation. For those nurses and health care activists wishing to build on
this momentum, plan on attending a Nursing Summit on Safe Staffing
Legislation, to be held April 5 - 7, at the Seacrest Resort and Conference
Center in Falmouth. Call the MNA at 781-830-5723 or visit the MNA web site at
<http://www.massnurses.org> for more information.

Nurses say 'safe staffing' is health care key
<http://www.townonline.com/metrowest/dailynews/news/07062347.htm>

by Michelle Hillman, MetroWest News

March 12, 2001

Nearly every problem in health care today is a direct result of the unsafe
working conditions nurses face every day, according to the Massachusetts
Nurses Association.

The problems - fewer nurses per patient, overcrowded emergency rooms, medical
errors, decline in quality of care and dissatisfied professionals - are
getting worse, the association claims.

"Patients should be concerned," said MNA president Denise Garlick. "Patients
are concerned."

Last week nurses from across the state rallied at the State House to push for
a "safe staffing" bill that would mandate nurse-to-patient ratios.

The rally comes on the heels of MetroWest Medical Center nurses filing an un
safe staffing report with their union representative at the MNA. The
medical/surgical nurses at the medical center's Leonard Morse Hospital
reported four nurses caring for 31 patients on a shift one day last week.

Edith Harrigan, a nurse at St. Vincent Hospital in Worcester, said nurses
have been trying unsuccessfully to have "safe staffing" defined in their
contract. Like MetroWest Medical, St. Vincent is owned by for-profit company
Tenet Healthcare Corp.

The Legislature must act to solve the problems, she said.

"I believe the only way it will be fixed is when it's mandated by law," she
said.

Proponents believe that safe staffing is the answer to many of the industry’s
ills. If hospitals provide enough staffing, nurses would be less stressed,
would care for fewer patients and might make fewer errors.

Most recently, the state Department of Public Health decided to investigate a
patient death at Caritas Norwood Hospital. A woman died on Dec. 28 after she
was transferred from the hospital to Boston Medical Center.

The woman was reportedly transferred because Caritas did not have enough
critical care nurses to treat the woman in the hospital's intensive care unit.

If the measure were approved, the Massachusetts Nurses Association believes
more nurses might agree to stay in the profession.

"The system needs to identify nursing as a priority," said MNA spokesman
David Schildmeier.

Hospital jobs are so stress-packed, nurses are looking for other health care
careers.

After 20 years of intensive care nursing, Elena Murphy of Medway left her job
at MetroWest Medical Center because the job just got too hard.

Working conditions are tougher than ever - more patients come into the
hospital with serious illnesses, stay for shorter periods of time and require
critical care.

The American Nurses Association recently surveyed 7,000 nurses and found that
75 percent of nurses believe the quality of nursing care at the facility they
were employed declined in the last two years.

Forty percent said they would not feel comfortable having a family member
cared for in the facility where they work. Fifty-four percent of nurse
respondents said they would not recommend their profession to their children
or their friends.

"The conditions in the hospital with managed care have changed," Murphy said.
"It’s difficult to do what you were trained to do. It’s more difficult to
give good nursing care."

Murphy and others have said the conditions in hospitals are so bad there were
times they worried their nursing licenses could be taken away. The constant
turnover of acutely ill patients and overflowing emergency rooms leave nurses
fearful of making a serious mistake.

"There were times when we considered it unsafe," Murphy said. "Of course
there were times when you felt your license was in jeopardy."

Susan Burns-Tisdale, chief nursing officer at Leonard Morse Hospital, said
the hospital has hired staff to keep up with the demand.

She said that eight medical/surgical nurses were recently hired and compared
to other hospitals, Leonard Morse has a "generous" amount of staffing.

"There are hospitals that function leaner," she said. "If we get to a
situation where we see we need more staffing, we call in our per diem staff."

Murphy decided she wanted a job where she wouldn't have to fight for benefits
or vacation time, a less stressful environment and something that would still
allow her to do what she loved - nursing.

She now works at Sun Life Financial in Wellesley and runs a health clinic for
employees where she is in charge of administering flu shots, checking blood
pressure and dispensing over-the-counter medications.

Does she miss bedside nursing? Sure. Would she go back? Probably not.

"By working in a business setting with patients ... I’ve kind of removed
myself from the bedside which is something I always thought I would do until
I retired."

In January, Anne Ferrari-Greenberg of Ashland stopped working per diem at
Newton-Wellesley Hospital. Although she wasn’t on the front lines, she said
all hospitals are busier and seem to be in constant crisis mode.

"We worked really hard and I felt like we were always understaffed," she
said. "It’s just getting crazy. Floor nursing is so hard nowadays I can see
why nurses are getting out of it."

Maureen Kahn, Newton-Wellesley senior vice president for patient services,
said she believes the hospital has enough nurses, but they can feel
overworked if there's not enough support staff.

Kahn said there are only a few openings right now but the hospital is having
difficulty recruiting in specialty care areas like the emergency department.

"Any nurse today would tell you that they're working harder," she said. "The
environment has a high degree of stress in it."

Greenberg, owner of CPR Services of Ashland, teaches the public, businesses
and medical professionals the proper way to administer CPR. She said she
doesn't regret leaving the hospital after almost 18 years of full-time
nursing and about five of per diem, or temping.

"I’m an old-fashioned nurse," she said. "Those days are gone."

David Schildmeier
Director of Public Communications
Massachusetts Nurses Association
800-882-2056 x717 (Within Mass. only)
781-830-5717
781-821-4445 (fax)
781-249-0430 (cell phone)
508-426-1655 (pager)

------------------------

Nurses union proposes minimum 1-to-5 staffing ratio

by Audrey Cooper, Associated Press

March 12, 2001

SACRAMENTO (AP) -- Hospital nurses would have to care for at most five
patients under staffing ratios suggested Monday by the state's largest
registered nurses' union.

The California Nurses Association's ratios for different types of registered
nurses allows about half the number of patients requested by the California
Healthcare Association, a group representing hospitals.

The hospital association numbers -- which range from a 1-3 ratio for
postoperative care to a 1-16 ratio for patients in transitional care -- allow
for hospital flexibility while maintaining safe care standards, said CHA
spokeswoman Jan Emerson.

But many nurses say the higher ratios reflect current staffing levels that
have forced nurses out of hospitals for fear they will be unable to
adequately care for patients and lose their license.

"I go home every day thanking God that we haven't killed anybody," said
Karen Rothblatt, a nurse at Alameda Hospital.

The final ratios will be set by the state Department of Health Services and
go into effect Jan. 1, 2002. California is the first state to implement
minimum staffing requirements for hospital nurses.

Draft regulations are expected to be released early this summer.

Minimum ratios of one nurse for every two patients are already in place for
Intensive Care Units. Patients under anesthesia or in labor must be in the
care of one nurse.

Emergency, psychiatric, postpartum, surgical and pediatric nurses, among
others, would be assigned between two to four patients and five healthy
newborns could be assigned to nurses under CNA's ratios.

Industry officials say minimum ratios set at the lowest levels will do little
to relieve nurses' stress levels. California is expected to be short 25,000
registered nurses by 2006, said CHA's Emerson.

"A low ratio will not solve that," she said. "Our concern is that hospitals
can't find nurses now but what if we can't find enough for a lower ratio? Is
the state going to shut down the hospital? Nobody wins then."

Union officials say improved ratios will help improve work conditions and
eventually encourage more nurses to work in hospitals. Only about 60 percent
of registered nurses work in hospitals, said Jill Furillo, a nurse and CNA's
government liaison.

The ratio's effect on the market will be analyzed by the state, although it
will not play a role in the final ratios, said Gina Henning, who is
overseeing the ratio project for the state.

State policy makers are expected to make surprise visits to many state
hospitals in the next few months to judge staffing needs. The state has also
contracted with experts through the University of California to advise on the
ratios, Henning said.

Two other nurses' organizations have submitted ratio proposals that closely
mirrors CNA's.

On the Net:

Department of Health Services: www.dhs.cahwnet.gov

California Nurses Association: www.calnurse.org

California Healthcare Association: www.cha-cahhs.org/

©2001 Associated Press

----------------------

Battle Afoot to Decide Staffing Levels for Nurses
<http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2001/03/13/

MN208685.DTL>

by Sabin Russell, San Francisco Chronicle
<mailto:srussell@sfchronicle.com>

March 13, 2001

Hospital operators and their unionized nurses are squaring off with rival
plans to implement California's first-in-the-nation law that will set minimum
nursing staff levels at hospitals throughout the state.

At stake is just how many nurses will be required to care for patients at
various units in a hospital, and consequently just how expensive medical care
at California hospitals will be once the new law takes effect in January 2002.

With the unveiling of its plan yesterday in Sacramento, the California Nurses
Association is promoting a set of staffing ratios that -- not surprisingly --
are deeply at odds with numbers proposed last summer by the California
Healthcare Association, which represents 450 public and private hospitals
throughout the state.

"We need more licensed personnel on the floor," said Pam Herron, a union
nurse who works a night shift at Kaiser Hospital in Walnut Creek. "There is
not enough time to take care of the unpredictable things that happen in a
hospital."

The two sides are furthest apart over staffing levels for medical and
surgical wards, where the majority of hospital patients stay to recuperate
from surgery or recover from injuries or illness. The union, which sponsored
the law signed by Gov. Gray Davis in October 1999, contends there should be 1
nurse for every 3 patients in medical/surgical units. Hospitals say the
minimum should be 1 nurse for every 10 patients.

NURSES HOPE FOR 'NEW REALITY'

Union nurses are enthused with their new plan. "I am hoping this can become a
reality," said Herron, who said she typically cares for eight patients in the
medical/surgical unit. Policies to shorten hospital stays mean that the
average hospital patient is sicker than in the past. "The type of patients I
take care of today would be in the intensive care unit 20 years ago," Herron
said.

The California Healthcare Association issued its recommendations for staffing
levels in August. Jan Emerson, a former nurse and spokeswoman for the
organization, said her group needs to study the union proposal before
responding to it in detail.

"This is very serious work, and we do not want to be pulled into a public
debate," she said. The nurse's union, which has conducted 19 "town hall"
meetings in California to publicize the nurse staffing issue, has engaged in
"publicity stunts," she said.

Emerson stressed that her group provided what it considers the bare minimum
of safe staffing levels -- which is what she said Davis had asked for. Actual
staffing levels would frequently rise above the minimums, depending on how
sick patients are in a given unit.

The hospital association fought passage of the staffing bill in 1999, but now
has to cope with it. "We still believe that you cannot legislate a number
that's going to work on a daily basis," she said.

Neither side would estimate the cost of the staffing requirements they
propose -- but nursing costs represent one of the largest components of
hospital operating expenses, and the union plan would require more than twice
as many nurses as the hospital minimums.

SEVERE SHORTAGE

The new law will take effect in the midst of a severe nursing shortage, but
the two sides disagree on the cause of it. Hospitals cite the aging of the
nursing workforce and the fact that nurses have numerous opportunities to
work outside a hospital setting. Nurses claim that nurses are leaving
hospitals because of "unsafe staffing levels."

Both sides accept the current ratio of 1 nurse for every 2 patients in
intensive care units -- the only ratio mandated by state law for 20 years.
But they agree on little else:

-- In so-called sub-acute care, in which patients are placed in a nursing
home setting for long-term convalescence, hospitals seek a ratio of 1
licensed nurse per 16 patients. The nurses union wants 1 to 4.

-- In emergency rooms and recovery rooms, hospitals propose 1 to 6; unions 1
to 3.

-- In psychiatric wards, hospitals propose 1 to 12; unions 1 to 4.

Neither side is likely to get what it asks for. The decision lies with the
California Department of Health Services, which has commissioned its own
study at the University of California at Davis of nurse staffing practices,
and will air its own proposal at public hearings. The final ratios must be
set 90 days before they take effect in January.

The union recommendations are based on a study c