A Case for Safe Staffing Limits

Katie J. & Brad B.

The fight for health justice in the United States is gaining momentum, including rapid take-up of single-payer healthcare as a basic premise of left political platforms and as a rallying point for resistance to the gratuitous inequality of our economic system. Alongside wealth redistribution, health redistribution has become increasingly central to leftist visions for a just world.

However, the fight will not be easy, nor will it be won be overnight. While a majority of Americans support such demands and a Medicare For All Caucus is emerging in Congress, our corporate- and Republican-controlled government has stymied the most egalitarian proposals.

For these reasons, the Healthcare Working Group of the Boston Democratic Socialists of America agreed unanimously in June to endorse the Patient Safety Act, which establishes nurse-to-patient limits across different fields of care. In emergency rooms, for instance, one nurse could be assigned no more than five patients. It will be Question 1 on the Massachusetts ballot in 2018. We understood our endorsement as one component of a broader strategy for achieving health justice, bookended on one side by our mutual aid project to relieve the ravages of medical debt in local communities, and on the other by our continued support for a national single-payer healthcare program.

The Patient Safety Act could be brushed aside as a reformist reform. Its success would not directly call into question the entire system of for-profit medicine in the United States. But to disregard the fight for staffing limitations on these grounds would do a disservice to the workers, particularly organized nurses, struggling to make better care a reality. It would also understate the implications of a possible triumph.

Nurses in the United States face some of the most difficult, often brutal, working conditions in the country. A spate of recent articles have laid out the basic dilemma: salaries have risen marginally, but nurses in the United States are more and more overworked, which has resulted in immense burnout and lower quality of care. Cost-cutting at hospitals and an emphasis on maximizing the extraction of surplus value wherever possible have led to reductions in staffing, which has in turn shifted the psychic burden of care onto fewer and fewer individuals. This occurs alongside the violence and disrespect that nurses experience daily. Public health scholar Jason Silverstein put it bluntly: “We’re working nurses to death.”

This situation must change. America’s nurses have, for many decades, represented one of the most powerful voices of the working class. They have been at the forefront of left politics, particularly the fight for an egalitarian healthcare system. Recently, nurses in Vermont went on strike to demand a model of care that emphasizes patients rather than executive compensation. [https://jacobinmag.com/2018/07/vermont-nurses-strike-safe-staffing-ratios] One of their demands was reasonable patient limitations. The Patient Safety Act would represent an important victory for organized labor against the corporate care industry, particularly at a time when labor more broadly is threatened by right-wing politics and union-busting.

Tellingly, opposition to the Patient Safety Act has been led by wealthy hospitals, executives, and a powerful medical lobby. A campaign of disinformation — both in Massachusetts and in other states where staffing limits have come up for debate — has spread apocalyptic claims about the dangers to patient safety and about exorbitant costs. These groups emphasize fear over phrases like “government mandates” and “top-down control,” claims that have long served as bogeymen against left interventions. In some situations, they have resorted to rhetorical blackmail, threatening that hospitals will leave rather than hire additional staff.

It is not simply that these sorts of arguments have been repeatedly disputed, nor that nurses have made their perspective clear (77% of MA nurses believe they are assigned too many patients, with as many as 36% reporting deaths directly attributable to the problem). It is also the case, as Suzanne Gordon recently argued, that the “cost control” model, with its underlying assumption that profits should determine care, has entrenched our unwieldy and exorbitantly expensive healthcare system. The commodification of health has grown steadily alongside its devaluation. However, a consciously planned system with a more egalitarian distribution of health is possible.

Better care from nurses means better hospital experiences for patients, particularly poor and minority residents who cannot afford expensive hospitals and clinics. Throughout history, it has been a common tactic of the dominant to keep workers just healthy enough to work, but not enough to resist or live comfortably. Nurse staffing limitations would increase personalized care where and when it is needed most, shortening stays, lowering readmissions, and decreasing medical errors. Staffing limitations would ensure rested and supported nurses who respond within minutes, rather than hours, to the blinking of patient call lights. In the most difficult times for many families, this kind of care is critical for healing and well-being.

The campaign by Massachusetts nurses has received support and endorsements from groups across the country (only California currently has a staffing law). One important reason is that victories in the Commonwealth have historically spilled over to successes elsewhere. Success for organized nurses here could galvanize the national movement for safe patient limits.

At the same time, it is important to recognize that health provision in Massachusetts will remain unequal. We live in the shadows of Romneycare, the ultimately conservative reforms that led to the Affordable Care Act. The dream of just healthcare in Massachusetts remains unrealized, medical debt continues to afflict residents, and hospitals place the needs of managers over nurses and patients. That dream will require energy and determination beyond present the battles.

Victory against the forces of corporate care would bolster efforts by working class organizations to transform the structure of American healthcare. It would allow nursing unions, occasionally bogged down in staffing battles, to direct their energy fully toward other struggles. Success in support of the Patient Safety Act would send a strong signal that justice and dignity should determine our health, not the needs of for-profit hospitals and the health insurance industry. And it would strengthen the coalition of left political organizations and unions that is fighting for the most significant transformation of them all: free health care, for all, no matter what.


Bios: Katie is a registered nurse and member of Boston DSA. Brad is co-chair of Boston DSA’s Healthcare Working Group and a PhD candidate in History of Science at Harvard.

The Healthcare Working Group usually meets on the third Monday of the month at 7pm, and any changes will be indicated on our Facebook page

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