Don’t let them fool you. There is no nursing shortage in America. Two million plus nurses is NOT a shortage. There is however, is a shortage of nurses willing to work under the conditions currently being offered by the hospital/healthcare industry/corporations. Nurses joke about it, “Yeah, yeah, lots of nursing jobs are out there. Trouble is they’re all basically the same crappy one!”

A veteran of 20 years of hospital nursing, I was recently talking with a nurse I worked with for years in an ER-Level I Trauma Center in NYC(veterans we are-we worked in ‘the trenches’). She is now doing legal nurse consulting and has cut her time down at the hospital to one per diem day a week, just to keep a hand in it. She says the old ER is like being in hell and I believe it. I’ve been out of hospital/ER work myself for over 2 years now and it was hell when I left. We discussed two other nurses who also left, one to do outpatient radiology at private practice and the other who joined a traveling nurse agency. They, like us, got fed up and got out. And we are not alone. Nurses are leaving hospital work in droves and of those who aren’t, most want to leave.

I consider nurses to be the “canaries in the coal mine” for the healthcare delivery system. And since we’re leaving or seeking to leave hospital work more than ever before this should be alarming to anyone who is…shall we say…HUMAN.

You might be perfectly healthy now but can still be in an accident and end up in a hospital at any time. Many of the patients I cared for did not plan to be in an ER that day.

Sure, anyone who has tried to help out a sick or injured relative who has been shuttled out of the hospital days too early to save the HMO money knows the value of good nursing care. So does anyone who has ever been critically ill in a hospital and survived. I could go on with other examples but the fact is that too few people really understand what nurses actually do(can’t imagine why with such accurate portrayals in the media!) let alone what they want, so here’s a simple rule of thumb: What’s good for nurses at a hospital is good for patients. This is a very, very important concept to bear in mind.

And what is it that nurses want/do not want?

1. We want safe nurse to patient ratios. This means not being so overwhelmed with such a large number of patients that you might make a mistake or are not able to give the most thorough of care. It’s common sense. One nurse can do more for 4 patients that he/she can for 8. And in our business, mistakes are not good.

2. We do not want mandatory overtime. In fact we loathe it with a passion. If you know a nurse, ask them what they think of mandatory overtime and you’ll see. No one wants to go to work and not know if they will be able to go home at the end of their shift. No one wants to be forced to work against their will leaving family/other obligations in the lurch. It’s unsafe for patients as well. To John/Jane Q. Public I ask: Would you want the nurse who is exhausted, or preoccupied about his own ill spouse who is at home alone, or the one who is upset about missing her kid’s long awaited dance recital?

3. We want real input into the running of our units and issues affecting patient care and the quality of our work lives-not lip service.

4. We want to be treated with respect for what we know, for what we do and for the mountains that we move every day. Again lip service doesn’t cut it.

But hospitals are run like businesses now. And nurses just don’t seem to fit the “corporate model”.

The hospital I used to work for insisted that we refer to patients as “clients” or “customers”. They changed the name of the Nursing Office to “Patient Care Services”, which was far better than “Customer Care Services”. But still, I couldn’t help but wonder if they would stop calling us nurses and start calling us “patient care servants” instead!

This same hospital had daylong “Customer Service” classes for all employees telling us how to treat our “customers”. I wanted to scream, “We learned how to care for patients in nursing school. We don’t need you to tell us this! We need for you to listen to us so that we can direct you in the best ways to care for people and make them well. We need you to not only listen to our problems, critiques, complaints and ideas for solutions but most importantly, we need you to act on them, instead of blaming us as if we’re the problem!”

But they don’t listen. Why? Because they don’t really care about making people well, they care about money. But to this end even, they are very short sighted. They don’t seem to realize if they gave nurses better working conditions(safe nurse patient ratios, respect, and decision making power for their units) they would save a bundle in so very many ways. Here are but a few: better cared for patients get well quicker and leave the hospital sooner, thus the cost is less for their care. A bit of a nurse’s time and reassurance given to a patient (which is free)can make more of an impact on a patient’s well being than an expensive IV medication. (I once witnessed a nurse lower a patient’s heart rate 25 points by just giving him calming attention rather than running to the doctor to get an order for a medication to do the same thing). Nurses are also the key monitors of the expensive equipment on our units. We make sure these items do not “walk” off the unit. I once stopped a new intern from accidentally opening up (thus contaminating) the wrong sterile kit, saving $600 that quickly, just because I had the time to notice. If I was loaded down with patients that day I might not have noticed. It’s also not very cost efficient to be so rushed you drop and break the $10,000 monitor. Happier nurses don’t leave their jobs, which saves a bundle on nurse recruitment. I read a brilliant analogy in a great article about the current hospital dilemma of inadequate retention/recruitment of nurses-I’ll paraphrase: “Trying to fill nursing positions while providing horrendous working conditions for the nurses already on staff who will simply leave is akin to pouring water into a bucket with a huge whole at the bottom and wondering why it’s never filling up”.

This statement sums up the essence of the nursing “shortage”. The hospital industry has it all wrong. Hospital administrators just don’t get it. They think they can ignore us, the nurses on the front lines of healthcare delivery, and still run their business efficiently. To them, as long as the patient won’t sue its no biggie if they die. And if they do bring suit, they have their trusty team of lawyers who will take care of the settlement and keep it low. Got no insurance? You’ll get no care. True the law forces them to take you in but though may need that ICU bed based on your medical need due to the injuries sustained in your accident, you, Mr Uninsured will lie on a stretcher in a busy overcrowded ER with over whelmed doctors and nurses barely keeping you alive until we boot you out as early as we can. But until then you’ll be crowded in with other uninsured patients and even those with insurance but whose doctors get such poor reimbursement from the insurance companies they send all patients to the ER rather than see them at odd hours or go through the trouble of getting a direct hospital admission to a room(which in fairness is usually not available anyway). An as for follow up care without insurance-good luck.

Our hospital administrators would talk about how they valued their nurses even as they cut nurses from our shift. “You only need one nurse to cover both triage and the trauma rooms in the early morning on weekends from now on.” we were told. Say what?. Yeah that’s fine…unless there’s a trauma!! We were a level one trauma center and the thing with trauma is you never know when you’ll get one. Then no one who walks in to be triaged will get triaged. They’ll sit and wait..cause the one nurse covering both areas cannot be in two places at once (that would be THE ultimate multitasking ability and the only one that nurses have yet to master!) and his/her obligation is to be with the guy who got hit by the car, cause he might die any minute. But the administrators aren’t worried. They’ll pin any problems(like, say, a patient who waited in triage until they died) right back on the nurse. The administrators don’t care. It’s Saturday and they’re off doing whatever they do on weekends. Theirs is a Monday to Friday, 9-5 world. I used to wonder what the CEO was thinking as he would walk thru the ER, appearing to survey the scene but walking quickly without stopping to speak with anyone-God forbid. I wondered, did he hear Ka Ching! when it was packed to the rafters with sick, suffering people? I heard their moans. What did he see, income, as in business is booming? All I saw were the sick suffering people, who had too few nurses available to them and who were consequently getting substandard care for which they were paying more than anyone else in the world!

The hospital administrators would disrespect the nurses by disregarding our hard fought for union contract in too many ways to count but here’s a few: They’d put out our schedule far too late, sometimes only days before its start rather than the 2 weeks the contract stated. This caused problems with the personal lives of the nurses who would have to wait to make vital appointments let alone any personal plans, as the days off were always different. Vacations requests were strictly regulated to be handed to management on time lest the nurse lose her seniority in the granting of the request yet they went unreturned weeks and weeks after the contract stated that the response to our request was due. It’s hard to plan a vacation if you don’t find out you’re able to take it until a week before! They would consistently not pay time and a half for overtime worked as was stipulated in the contract but decided instead to consider the overtime they were asking you to do that day to be per diem work(which is signed up for in advance) rather than overtime, just so that they could pay the nurse at the(much) lower hourly per diem rate(a “redefining” move that George Bush and company would applaud mightily). Here’s the kicker….They spent tens of thousands of dollars to fight our union with their trusty lawyers over the extra $14 a day charge pay that the staff nurse in charge of the 57 bed ER would get!!(I used to say that the $14 was just enough to buy the Pepcid and Mylanta needed to cure the heartburn from the stress of being in charge of the ER for the day!) (PS: we won that one in arbitration)

So, what can the public do to help nurses? (and consequently themselves-see rule of thumb, you haven’t forgotten it already?)

If you or anyone you love goes into a hospital for care:

1. ASK the person taking care of you/your loved one, “Are you a Registered Nurse?” If they aren’t then ask the name of your nurse. Different ancillary staff may do things for patients but still all patients should have an RN assigned to them.

2. ASK your/their RN on each shift, “How many other patients are you taking care of?” or if you’re feeling savy, “What is your nurse patient ratio?” The number is always something to one, the something being how many patients and the one being the nurse. There are researched based specific acceptable ratios depending on the time of day, type of unit and the acuity of illness. In an ER that number is usually 4:1. In an ICU 3:1, 2:1 or sometimes 1:1 if the person is critically unstable. On a night shift on a regular medical/ surgical unit the acceptable ratio might be 12:1 , 15:1 or even higher. Nursing research over ten years has proved that the higher the nurse patient ratio goes above the acceptable safe numbers, the higher the patient mortality. Need to know more? Google Linda Aiken, the wonderful woman who did the research to finally prove what we knew all along, much of which I believe was used by the California Nurses Association in its successful(?) fight to become the first state in the nation to have a state law mandating safe nurse to patient ratios in hospitals. Remember the Governator, Arnie, incurred the wrath of nurses (well deserved wrath I might add) when he tried to delay the implementation of this life saving legislation? To add insult to injury, he attempted to portray the NURSES as the special interest group!! I don’t think he, or anyone else for that matter, realized how nurses all over the country were looking toward California, waiting with great interest for this groundbreaking legislation to pass and be implemented. Arnie said it would cause hospitals to close. Again I ask John/Jane Q Public: Would you rather have safe hospitals but fewer hospitals or more hospitals but have to worry whether you’ll make it out alive?

The California law is a very good thing for nurses and that is good for patients. If only, if only legislation like this could be passed in every state. Then no patient would ever have to fear that there will not be a nurse to answer their call for help or to care for them when they are in a hospital.

3. All people, no matter what age or level of health need to educate themselves about advanced directives(or not and maybe end up like Terry Shiavo). They encompass a living will, a health care proxy and, for the terminally ill, a do not resuscitate order.

4. ASK to speak with a nursing supervisor if you are not satisfied with your care or if you feel you are being discharged and sent home prematurely. Go as high as the CEO, the CFO or the COO if you have to. Write letters to them. Letters to the CEO are huge, believe it or not. In their world they hate bad letters from “customers” and they respond to them by taking action (unlike the lip service they pay the nurses).

You, the American public, do have the right and the power to ask and do all these things. It’s only your life that’s at stake.