At 8 am one morning a few years ago, after working a 16-hour shift in the hospital's 12-bed ICU in Iowa City, Iowa, I had a life-changing moment. At 11 pm the night before (when my shift was scheduled to end), I'd been told I would have to stay; we were short two nurses. If I'd gone home, my coworkers would have struggled overnight to care for 11 critically ill patients.
When I left the hospital that morning, I felt like a survivor. But the feeling didn't last. As I climbed into bed, I realized I couldn't remember the colors of the traffic signals on my drive home. I couldn't say for certain that I hadn't stopped at a green light-a jolt of fear ran through me-had I run a red light? How could I have cared for critically ill patients safely if I couldn't recall such quotidian details? I knew I had to do more for my patients.
As hospitals cut budgets, wages, and staffs, nearly 500,000 nurses have left the profession altogether, according to the National Sample Survey of Registered Nurses March 2004 preliminary findings. A 2001 report from the U.S. General Accounting Office (now the Government Accountability Office), Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors, cited "inadequate staffing, heavy workloads, the increased use of overtime, a lack of sufficient support staff," and inadequate wages as factors in the nursing shortage. I can't fulfill my duty to my patients if inadequate staffing and supplies, forced overtime, and other conditions prevent me from giving them the care they need.
As president of the Nurse Alliance of the Service Employees International Union, I work with a group that consists of "84,000 nurses in 23 states working together to raise standards for their profession and patient care," according to the Web site. The alliance gives nurses a voice on issues that affect patient care, forming committees by unit in hospitals and working with other organizations to reform the U.S. health care system. In Florida, for example, nurses are working on a trial project with their employer to decrease the time patients wait in the ED before they're transferred to a particular unit. The alliance is working to pass the first federal legislation to set safe staffing ratios and to ban mandatory overtime. Working as a group, rather than alone, we're making a difference in our hospitals, in our interactions with management, and in our state legislatures. Nurses, as leaders in the organization, not only witness our broken health care system but also craft solutions.
We recently launched an initiative, Value Care, Value Nurses (http://www.valuecarevaluenurses.com), to address the conditions that have led nurses to leave the bedside. Nurses have come together in cities across the country to say "enough is enough"; they participated in the national Nurse Alliance Networking Conference on Quality, sent letters to editors, contacted elected officials, and signed a petition calling for the Department of Justice to investigate wage suppression by hospitals. We sponsored a study conducted by the Institute for Women's Policy Research, released in March 2006 (Solving the Nursing Shortage Through Higher Wages, available for $10 from http://www.iwpr.org). The study found that between 1996 and 2000, wages for nurses remained unchanged, even as hospitals cited nursing shortages. When wages for nurses increased between 2001 and 2003, hospitals added 186,500 nurses. But when wages began to fall in 2004, the number of nurses working in hospitals dropped.
This research has been the basis for class action lawsuits filed against hospital corporations, which have illegally colluded to keep nurses' wages down. We've shared this research with members of Congress and our state legislatures and are working to pass legislation that holds hospitals accountable to the communities they serve.
I miss being at the bedside, but I know that when I do go back it will be because I'm able to do the job I went into nursing to do. We're going to change hospitals for the better and put the focus back on patients' care. That's what they-and we-deserve.