Thanks to Maureen Shawn Kennedy for her strong Editorial, "It All Comes Back to Staffing" (February), on the harm nurse understaffing continues to cause. Not enough nursing leaders embrace staffing issues, even though they underpin the vast majority of "missed nursing care," as researched by Beatrice Kalisch and others, and discussed in the December editorial, "Straight Talk About Nursing." In their recent study of 488 hospitals in 12 European countries, Ausserhofer and colleagues found missed nursing care to be prevalent, particularly in regard to educating and communicating with patients.1

When time is tight, nurse-prescribed work often gives way to physician-prescribed work. Thus, understaffing can eviscerate nursing care and cause nurses to become shells of our professional selves, unable to provide the care our patients need or to model good care for the next generation of nurses.

It's time for nurses to demand mandatory minimum staffing levels that allow us to provide the full range of nursing care we are legally and ethically bound to give-and that our patients need and deserve.

Sandy Summers, MPH, MSN, RN

Baltimore, MD

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