RNs Working Together, a coalition of 10 AFL-CIO unions representing more than 200,000 registered nurses, took another step in its campaign to build support on Capitol Hill for the first national nurse-to-patient ratio legislation (H.R. 2123) introduced by Rep. Jan Schakowsky (D-Ill.).

The coalition sponsored a briefing July 14, 2008, for health care staff experts from House and Senate offices to explain the dangerous and sometimes tragic impact of understaffing on patient care.

Suzanne Gordon, nursing professor and co-author of the new book, Safety in Numbers: Nurse-to-Patient Ratios and the Future of Health Care, noted the formula too many hospitals use today to establish nurse-to-patient ratios should be called the “whatever-we-can-get-away with” formula.

Gordon, along with RN representatives from four AFL-CIO nursing unions, said understaffing also is a major factor in driving nurses from the profession, thus contributing to the growing shortage of nurses.

H.R. 2123, the Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007, would establish minimum nurse-to-patient ratios to improve patient safety and quality of care and address the nurses shortage that has left our nation’s hospitals critically understaffed. The legislation also would give nurses manageable patient loads, allowing them to provide better care while also avoiding preventable medical errors. The bill would establish safe staffing standards in all hospitals, including hospitals that serve Medicare and Medicaid patients and federally operated hospitals.

Gordon, whose book traces how hospital cost-cutting in the 1990s created huge new workloads for nurses and led to deteriorating patient care, told the group more than 60 studies have documented that hospital understaffing results in more patient deaths, plus more preventable complications like pneumonia, urinary tract and catheter infections and medication errors.

Ann Converso RN, president of the United American Nurses (UAN), said the need for safer staffing levels and higher patient care standards were the reasons some 700 Kentucky and West Virginia UAN members waged a three-month strike in 2007 at the Appalachian Regional Hospital system.

Deborah Burger RN, president of the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC), said before the nurse-to-patient ratio law was enacted in California, it was not uncommon to find a single nurse in charge of eight, 10 or 12 or more patients on a single shift.

When hospitals force nurses to care for so many patients, the outcomes can be deadly. A study in JAMA, The Journal of the American Medical Association found that for each additional patient over four patients a nurse is assigned to oversee, the risk of death increases by 7 percent; in hospitals with eight patients per nurse, the risk of death increases by 31 percent.

Jane Nygaard RN, who works in a VA hospital in Minnesota and who is an AFGE national vice president, said nurses are dedicated to providing the best care possible and giving the correct medications and dosages. She described this practice as “What you do is try to do the best you can with what you’ve got."

But the unmanageable workload—mandatory overtime, double shifts, canceled days off—caused by nurse understaffing is the main reason behind the exodus of nurses from the profession and the resulting shortage. Some 500,000 RNs in the United States are not practicing their profession, according to a 2007 Business Week article.

Barbara Blake RN, state secretary of the United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP-AFSCME), noted the ratio law in California has resulted in more and more nurses returning to the profession and said “the law has made a huge difference for nurses and patients."

Steven Francy, executive director for RNs Working Together, said the briefing was an important step in building political support. However, Francy noted, “getting this bill passed is not going to happen overnight. The forces that oppose this bill, such as the American Hospital Association, are well financed and like the system the way it is. Working nurses must be prepared for a long, hard fight."