Filmed nearly 40 years ago, the “Politics of Caring” film provides history of the grassroots support groups and activities that we continue to build on. One of my favorite parts of the film is about 5 minutes in, when a group of nurses are discussing their frustration with hospital working conditions: “We don’t have enough staff, we don’t have enough time…” They talk about wanting to improve their working conditions, by moving to a different hospital, or unit, or leaving the hospital to work in the community described as “mecca”.
When I graduated nursing school it was not uncommon for nurses to regularly care for 8 or even 10 patients on a cardiac surgery step-down or transitional care unit. I knew this was not the way I wanted to practice nursing, and found my passion in community and home health nursing. The 2003 NurseManifest Study provided an opportunity to talk with my co-workers and colleagues locally and nationally, to better understand what changes were needed and desired by nurses to create their ideal working conditions. Some of the major findings were that nurses felt a lack of respect, a lack of voice, and a lack of unity. Now, over a decade later, my work is dedicated to research that tells the story of what it is like to practice nursing today, and that shows the value of nursing for patients and society as a whole.
Why everyone should care about nurses’ working conditions and staffing ratios was the subject of a recent New York Times Op-Ed “We Need More Nurses” by Alexandra Robbins. The op-ed piece mentions dozens of research studies providing the evidence that patients’ risk of death, infections, complications, falls, hospital and hospital readmission are greater when nurses are caring for more than 4 or 5 medical or surgical patients. Hundreds of readers’ comments brought personal stories and richness to the conversation from the views of nurses, patients, family members, physicians, administrators, and more.
Working conditions and labor force issues for nurses is an international priority, and one source of current information is the RN4CAST Consortium, consisting of nursing workforce research groups in 17 countries, including the United States. Currently the United States group, based at the University of Pennsylvania, is surveying over 250,00 registered nurses and advanced practice nurses about nursing care, patient outcomes, and general working conditions for nurses. You can learn more about their work, and the study director Dr. Linda Aiken here.
Another source of information and place for collaboration is National Forum of State Nursing Workforce Centers, comprised of nursing workforce centers in 33 states. The National Forum of Nursing Workforce Centers is a resource for finding information specific to your state, as well as about nursing workforce issues nationally. Their annual conference will be held next week in Denver, Colorado and you can download the conference brochure and registration information from their website.
NurseManifest 
As we consider the impact of staffing on patient safety and nurses themselves, we can not neglect the relationship between education of the nurse workforce and patient safety. Penn’s contribution to this literature is enormous yet only NY has a BSN-in-Ten Bill. Then there are relationship issues among nurses themselves, in some instances, that create toxic environments for both patients and nurses while care suffers. The Times op ed was moving and certainly we need champions among and beyond nurses themselves.
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In general, excellent points. The only area of disagreement being multiple “solutions” that rely on producing more nurses. The more nurses there are, the less regard nurses will get from employers. Producing more nurses has never led to better working conditions, just lower salaries and more demands for productivity that are evaluated on the wrong measures.
We don’t really need more nurses, we need more nurses that work more efficiently and are more caring. We need nursing management, informatics and documentation systems that cater to nurses rather than creating more problems for nurses.
We don’t really need the every increasing numbers of imported nurses, the movement of whom, negatively impacts our own, and the health care systems of their countries of origin. This is not, despite many who will assume otherwise, an issue of racism but a concern about the core values of nursing when employers hold green cards over the heads of foreign nationals.
Every respected profession of note, as well as many professions who deserve little respect, has that respect, in part, because of their ability to limit membership in the club. Doctors were very good about this 50 years ago, but they have lost a lot of ground in the intervening decades.
Actuaries, despite the fact that they contribute very little, have enormous respect and wildly inflated salaries because they make it extremely difficult to enter their ranks.
The sad truth is that even as the baby boomers age and make more demands on our health care system, the gross funding for health care is declining compared to the value of the dollar and this is going to get worse. The call for more nurses at a time of retrenchment is like the much heralded march of the lemmings…
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