2,100 Nurses Heard in Sacramento & Call on State to Launch Major RN Reentry Training Program
Assured by officials and legislators that California's new hospital Safe Staffing law will go into effect as scheduled at the beginning of next year, the California Nurses Association is calling on the state government to launch a major educational reorientation program to attract sufficient Registered Nurses back into the hospitals to meet the new nurse-to-patient staffing ratios.
"It has been clearly demonstrated now that the current nursing shortage is traceable to the large number of RNs who have left the hospital setting to work elsewhere," said CNA President Kay McVay, RN. "What is needed now is a coordinated effort to bring them to bedside patient care."
CNA leaders announced the call for a reentry program yesterday following a massive march and rally on the State Capitol steps by 2,100 nurses. Thirty-two buses brought RNs from around Northern California. A large contingent of RNs also attended from Southern and Central California. There were also RNs on hand from Massachusetts, Maine and Arizona.
"It's time for California hospitals and their associations to step up to the plate," said McVay "They have sought to delay implementation of the new law on the grounds of the nursing shortage. Now, through a coordinated effort involving the hospitals, the government and the nurses' association, we can successfully prepare to fill any vacancies that exist."
Following the rally and march, the RNs gathered at the Sacramento Convention Center where a hearing was conducted at which RNs, physicians and patients gave testimony describing the conditions resulting from low staffing ratios in California hospitals. The session was opened by State Senator Sheila Kuehl (D-Los Angeles) and was addressed by Department of Health Services Director Diana Bonta, RN, whose agency will soon set the precise nurse-patient ratios.
Among those addressing the rally and the hearing was Belinda Morieson, RN leader of the Victoria Branch of the Australian Nursing Federation. Specific nurse-to-patient staffing ratios were legislated there last year, the first such regulations implemented in the world. Since enactment of the ratio regulation in the state 2,600 nurses have returned to the hospitals, overall a 13 percent increase in the nursing workforce, Morieson told the assembled RNs. This was due in large part to reentry and refresher courses conducted by the major hospitals and overseen by the board of nursing. Over 1,600 of the returning nurses came through the courses and there are currently 300 nurses waiting for training slots.
Bonta praised the RNs for making the new staffing law a reality and placing California in the position of "setting the standard for the nation." "You have created history," she said, adding that the DHS considers CNA "a valued partner" in the effort, of which "has presented us with the greatest opportunity to take a fresh look at how patient care in delivered in California."
"Your voices are heard throughout this process," said Bonta. "We value your input, we read your letters, listen to your testimony and pay attention to the wonderful research CNA has done."
"We need better working conditions," McVay told the cheering rally participants. RNs, she said, should be able to determine that their patient load is too great and say that too many patients to care for will undermine the quality of care. "Patients have come to know it is the RNs who make the difference," she said.
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Hospitals, nurses at odds over staffing
by V. Dion Haynes, Chicago Tribune
September 7, 2001
SACRAMENTO -- Two years ago California became one of the first states to embrace the concept of staffing ratios for hospital nurses, adopting a law aimed at lightening nurses' caseloads amid reports nationwide of patients dying from inadequate care.
Now a debate rages as state health officials work to determine where to set those nurse-patient ratios.
Nurses are seeking high staff numbers, asserting that patient care is compromised when nurses are overworked. Hospitals want lower numbers, arguing that the high cost of beefing up nursing staffs may harm patient care by forcing institutions to cut other services.
On Thursday, about 2,000 California nurses rallied at the state Capitol to press the state Department of Health Services to approve their recommended ratios, urging officials to reject the hospital industry's proposals that in some cases call for nurses to care for three times as many patients.
"We need better working conditions," said Kay McVay, president of the California Nurses Association, which represents 38,000 nurses and led the drive for the law that passed two years ago.
"We need to be able to say, `We can't take this other patient,'" she said. "`My patient will suffer if I take another.'"
Similar arguments are being made in more than a dozen states, including Illinois, where bills on nurse staffing are pending. States are trying to address a nationwide shortage of nurses and cost-cutting imposed by HMOs that have forced some hospitals to assign more nurses to mandatory overtime or to shift some duties to unlicensed care assistants.
Copyright © 2001, Chicago Tribune
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NO DELAYS IN SAFE STAFFING LAW
SEIU/UNAC BACK KAISER PLAN TO DERAIL RATIOS
Kaiser Permanente has endorsed a nurse-to-patient ratio proposal by the Service Employees Union and the United Nurses Assn. of California/AFSCME that is weaker than the comprehensive ratio proposal developed by CNA. As a condition of its support, Kaiser wants to wait years before implementation of the CNA-sponsored Safe Staffing Law, AB 394, and has launched a program to deskill its RN workforce. SEIU and UNAC back this program. Kaiser has asked the Department of Health Services to establish a ³transition period² and ³allowance for workforce planning needs² before the law goes into effect. Kaiser¹s vice president of patient care services, Marilyn Chow, told the Sacramento Bee July 20, that ³it is our hope that we could meet the ratios within five years.²
AB 394¹s ratios go into effect January 1, 2002. As the DHS confirmed to the Bee, the law doesn't leave room to extend the deadline. Additionally, Kaiser has begun to train unlicensed personnel to become LVNs, with the goal of displacing RNs at the bedside and filling the AB 394 ratios with LVNs.
Nursing Is What Needs the Cure
<http://www.latimes.com/news/opinion/commentary/la-000065625aug13.story>
Suzanne Gordon
August 13, 2001
How many sick patients can one nurse handle? Five? Ten? Does it make a difference if you -- or your child -- is one of the 10? Does it matter if the nurse is on her second eight-hour shift?
Over the past year, news reports around the country have confirmed the existence of a serious nursing shortage. In the U.S., the average age of working nurses, now 47, is rising, while enrollments in four-year nursing schools have declined for the sixth consecutive year. Polls and studies show why nurses are leaving their chosen profession: They are fed up with mounting workloads, mandatory overtime and pay levels. Elected officials are finally beginning to act. Unfortunately, what their proposals will do little to remedy the underlying causes of the nursing shortage.
Two Senate bills, the Nurse Reinvestment Act by John F. Kerry (D-Mass.) and James M. Jeffords (I-Vt.) and the Nursing Employment and Education Development Act by Tim Hutchinson (R-Ark.) and Barbara A. Mikulski (D-Md.), differ in their details, but both define the nursing shortage as a problem that can be solved through education and public relations. The Nurse Reinvestment Act, for example, would provide scholarships to students who agree to work for two years in understaffed public or nonprofit health care facilities and would allocate federal dollars to recruitment and ad campaigns to enhance the public image of nursing. While this is important, improving working conditions is crucial. Veteran nurses and even recent nursing school graduates are discouraging others from entering the field and even advising nursing students to get out of bedside care as soon as they can. Without substantive changes in working conditions, luring more people into the profession will aggravate, not alleviate, the situation and encourage the "management by churn" that has reduced customer service quality in fast food, retail sales and telemarketing, where the consequences are far less serious for consumers than in health care.
We need legislative initiatives to make nursing a stable, rewarding, long-term career. The place to start is with bans on mandatory overtime and steps in favor of safe staffing ratios. Sen. Edward M. Kennedy (D-Mass.) and Sen. Kerry have introduced legislation that would ban mandatory overtime for RNs. On the state level, California has led the way with a safe staffing law. Now the battle is over what nurse-to-patient ratio is "safe."
The California Hospital Assn. thinks it's safe for each nurse on a busy medical surgical floor to care for 10 patients, while California Nurses Assn. says the safe number is three and the Service Employees International Union says four. If you'd just had an operation, would you rather be cared for by a nurse who has to deal with nine other patients or a nurse who has to deal with just two or three others?
The positive impact of changes in salaries and working conditions has been proved. After intense lobbying by the Australian Nurses (sic) Federation, the state of Victoria recently adopted union-backed nurse-to-patient ratios of one nurse to four patients on busy medical surgical units and one to seven for nursing homes. In addition, Victoria mandated a 12.5% pay increase over three years, paid study leave and financial rewards based on education. Since these improvements in the past year, 2,300 nurses who had dropped out of the work force have returned. The federation also reports higher morale and reduced turnover and sick-day utilization at major hospitals.
In the U.S., a recent poll reported that a majority of the nurses surveyed would remain at or return to the bedside if working conditions and salaries were improved. In my own interviews with nurses, many also say they would gladly encourage new candidates if they felt nurses were allowed to provide high-quality care.
Policymakers should listen to these nurses. The rule should be that neither hospitals nor their industry association get any money for training, education or recruitment unless that money is tied to changes in the behavior that created the nursing shortage and that continues to threaten vulnerable patients every day.
Suzanne Gordon is author of "Life Support: Three Nurses on the Front Lines" (Little, Brown & Co., 1997).
Copyright 2001 Los Angeles Times
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Nurse-to-patient ratios are need now
<http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2001/08/16/ED211776.DTL>
Rose Ann DeMoro
August 16, 2001
A MAJOR battle is unfolding over California's historic law mandating minimum nurse-to-patient ratios, an event that will herald a dramatic change in our state's patient care crisis and nursing shortage.
In 1999, Gov. Gray Davis signed AB394, sponsored by the California Nurses Association, making California the first state in the nation to require specific hospital-wide ratios, just as there are minimum ratios for airlines, day care centers and other areas of public safety.
At the governor's request, the effective date of the ratios was pushed back a year, to Jan. 1, 2002. Now, California's powerful hospital industry wants the state to set weak ratios that would further exacerbate the current crisis, and Kaiser Permanente seeks a delay in implementation of up to five years.
Either course would be disastrous.
The law was a direct response to an alarming erosion of care standards and a hemorrhaging of nurses away from the hospital bedside. The state Legislature declared in enacting AB394: "Quality of care is jeopardized because of staffing changes implemented in response to managed care."
Many patients who have had recent hospital experiences can certainly testify to long waits for appropriate care and mistakes associated with inadequate staffing. Many registered nurses (RNs) have shown how they feel about short staffing and the erosion of patient-care conditions by voting with their feet. The RN turnover rate nationally was 18 percent last year -- the highest in decades.
California RN job-vacancy rates hover around 20 percent. While the total number of RNs continues to rise -- by 5.4 percent from 1996 to 2000 -- the percentage who work in hospitals is steadily falling, and is now down to 59 percent. One-third of California RNs only work part-time.
A General Accounting Office report released in July cited dissatisfaction with staffing levels, heavy workloads and increased use of overtime as major factors affecting the recruitment and retention of RNs. That echoes a 1997 survey by the California Board of Registered Nursing (BRN) that found 17 percent of RNs are not working in nursing.
Top reasons for discontent cited by the RNs were increased workload, inadequate staffing, poor patient ratios, harmful changes in health care delivery systems and decreased quality of care.
There is a solution: Establish strong ratios, and the nurses will come back.
Both the BRN survey and a report by the industry-friendly California Workforce Initiative suggest that a significant percentage of California RNs who have left the profession would be candidates for re-entry if conditions improve.
'This inflow of RNs would increase the state's nursing-employed workforce by 4 percent, which would help alleviate the current nursing shortage," said the Workforce report.
Similarly, it notes, if all part-time RNs increased their employment to full-time, "the overall RN labor supply in California would increase by approximately 11 percent."
They won't just come from California. In a fiery commentary June 24, Las Vegas Sun Executive Editor Mike O'Callaghan castigated Nevada lawmakers for inaction on that state's nursing crisis. Noting that many California nurses moved to Nevada to escape staff downsizing and work redesign, O'Callaghan predicted a reverse tidal wave when California's ratios go into effect.
"When developed, these laws are likely to result in a mass migration of Nevada nurses to California," he said.
Evidence from afar demonstrates that salutary effect ratios can have. Last year, the Australian state of Victoria enacted minimum nurse-to-patient ratios.
While other Australian states battled their nursing shortage, ratios led to 2,300 nurses returning to Victoria's public hospital system. Hundreds more were waiting in the wings to start a re-entry course. Overall, the number of nurses working in Victoria increased 10 percent.
A comparable turnaround to restore our patient safety net and bring RNs back to the hospital bedside can be achieved here -- if strong ratios are adopted by the state without crippling delays.
Rose Ann DeMoro is executive director of the California Nurses Association.
©2001 San Francisco Chronicle
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Hospital agrees on Brockton nurses' contract
<http://www.boston.com/dailynews/248/region/Hospital_agrees_on_Brockton_nu:.shtml>
by Associated Press
September 5, 2001
BROCKTON, Mass. (AP) Brockton Hospital's board of trustees approved a labor contract on Wednesday that officially ends a 103-day strike by nurses.
The nurses had voted to accept the agreement on Tuesday.
A sticking point in negotiations had been dissatisfaction by the nurses with staffing, mandatory overtime and salaries. A key disagreement was language sought by the nurses that would require the hospital to make ''best efforts'' to maintain staffing that would avoid mandatory overtime.
A statement from Brockton Hospital Vice president Robert L. Hughes said that the hospital ''endured this strike to uphold principles'' vital to the hospital's mission.
''This strike was unjustified and unnecessary,'' Hughes said in his statement. ''The contract accepted by the nurses yesterday is essentially the same as the one proposed by the hospital on the day before the strike. The union took our nurses out on strike for nothing.''
Since May 25 when the strike began, Brockton Hospital has made do with replacement nurses, and a handful of regulars who crossed the picket line.
Many striking nurses took other jobs to help support their families.
© Copyright 2001 Boston Globe Electronic Publishing, Inc.
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THE NURSES of THE PROFESSIONAL CHAPTER AT BROCKTON HOSPITAL
CORDIALLY INVITE YOU TO JOIN US IN CELEBRATING THIS VICTORY!
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Attention: Nurses, Unionists, Community Members and Politicians:
"The Worcester Nurses Solidarity Picnic"
Sunday, September 23, 2001, 1 - 6 PM
Sac Park, 438 Lake Street, Shrewsbury
Join the MNA-represented nurses of St. Vincent Hospital/Worcester Medical Center, U.Mass Campuses (University, Memorial, Hahnemann, Home Health & Hospice), Worcester Public Health, Unit 7, Worcester State Hospital and American Red Cross for a day of celebration, relaxation, good food and rides and games for kids of all ages.
The day will include a barbecue, DJ, magic show, volleyball, softball, horseshoes, basketball and more ...
This is a wonderful opportunity for those who have worked so hard to improve the health care of Worcester to come together in solidarity as we bring the summer to a close. Everyone is welcome, the more the merrier!
Tickets are $10 per family/$5 for an individual. Tickets must be purchased in advance.
To ensure we have enough food, please RSVP to Dolores Neves at MNA at 1-800-882-2056x722 or Sandy Ellis at 508-752-6979 prior to September 10th.
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