by Socialist Nurse
For 4 months now, we’ve been waiting for management to fill an open nursing position in our department. The word from the nursing manager is that there are “very few applicants” none of whom appear to be a “good fit.” Insert your bromides about the nursing shortage here, if you’d like, but be prepared to put your foot in your mouth: It is no big secret that the biggest chunk of any hospital’s budget is labor and, therefore, payrolls which are the first to see cuts when CFOs go looking for ways to trim costs. (For some reason, building a new half billion dollar campus is not a cost, but an investment. Pity they don’t value their workers in the same way as buildings or profit margins.) Just over two years ago, our hospital management decided that the best way to cut costs would be to get rid of the most experienced and, therefore, most well compensated workers via a buyout offer. The offer was extended to 9% of the total workforce. Two nurses on our unit decided to take the package: both were nearing retirement and, in part, were made to fear for their benefits if they did not accept. I had been hired to replace one of them: a nurse with almost a decade of experience replacing a nurse with nearly four decades under her belt. It took several months for the department to fill the other position. That person has since left the position as has another recently hired nurse. Both referenced the heavy workload and stressful conditions caused by chronic short-staffing as reasons for leaving. That’s four nurses–all well-qualified–any of whom could have filled the current position.
There is no lack of studies pointing to how more adequate staffing leads to both better patient outcomes and worker satisfaction (for example, see this study looking at effects of the nursing ratios implemented in California; for more, see here). What does short-staffing look like? Well, for me, it is mostly stress-filled days punctuated by an unending chorus of ringing phones with anxious patients on the line and a full waiting room of patients waiting to be seen. However, the stress and burnout that result from short-staffing also negatively affects the quality of care my colleagues and I can provide our patients. If you speak to any nurse, they could recount numerous situations where either their safety or that of their patients have been put in jeopardy because of short-staffing. The mandate put in place by Question 1 would allow nurses to provide the safe, timely and compassionate care that we want and have been trained to provide our patients. As it is now, we are often forced to choose between our well-being and that of our patients–skipping lunch, working past our shifts or rushing through safety protocols to make sure that we can meet their needs. This, as you can imagine, negatively affects our ability to continue providing the kind of care we want resulting in a vicious circle of overwork and diminishing outcomes across the board.
In short, what hospital executives mean when they say there is a nursing shortage and that it is too costly for them to hire more nurses is that they value profits over both workers and patients. Full stop. They’ve even put a number on it: $19 million–that’s how much hospital executives have been willing to spend to defeat Question 1 through misleading and deceptive ads designed with the singular purpose of stoking doubts and uncertainties among voters about “rigid government mandates” or “closure of small community hospitals.” Neither of these are based in facts. For example, at present, nurses have no say in the type of care they provide nor do they get assignments based on their knowledge and experience. Rather than a rigid government mandate, Question 1 would require healthcare facilities to develop, in partnership with their nurses, tools for measuring acuity to help determine appropriate staffing per unit based on the needs and condition of patients. I think many people would be surprised to find out that such things didn’t already exist. At present, nurses have little to no say in what appropriate staffing levels should be or how much time and care our patients need. These decisions are decided by executives and administrators; in other words, by something even more rigid than any government regulation (hint: it’s profits).
Safe patient limits are both a public health and a labor issue. If Question 1 passes, it would result in dramatically improved patient outcomes and working conditions for nurses in Massachusetts. It won’t solve all the problems facing healthcare today but it will improve healthcare access and health equity in a largely problematic system driven by profit margins and corporate greed.