Better staffing is needed to solve salient problems in health care ("It All Comes Back to Staffing," Editorial, February). We can't hope to retain the best and the brightest nurses without putting in place measures that support them.

Yet nurses have taken a backseat in appreciating ourselves. In so many areas and in so many issues, we are second-class citizens. We are the most trusted profession yet the most vulnerable. We are the unsung heroes of health care. We are 3 million weak! We care for the patient. We care for the families. But who cares for or about us?

I don't think the hours nurses work are nearly as contentious as the acuity of patient care. Nurses have always been expected to pick up the slack, usually to their own detriment. We have been doing more with less since the days of Florence Nightingale and the Crimean War.

We've developed evidence-based strategies to improve our work environment, yet government agencies, administrators, and even nurses refrain from implementing these changes. Policies, politics, and economics take a front seat in determining health care delivery practices instead of those who provide the care.

Without appropriate staffing, we'll continue to see more than 98,000 unnecessary deaths annually, as detailed in the Institute of Medicine's 1999 report, To Err Is Human: Building a Safer Health System. Institutions of health care and advanced education, government agencies, and other health service providers must be accountable for the consequences of the policies they endorse. No longer can the sole responsibility fall at the feet of nursing.

Sharon Sussman, EdD, MBA, MS, RN

Old Westbury, NY