As nurses, we live with the failure of the American health care system every day. We see the faces of those who are unable to get the care they need because they cannot afford it or are denied access to it. We see the waste and duplication, the endless paperwork, bureaucracy and unnecessary layers of administration. As front-line caregivers, we know that the U.S. health care system needs to be reformed now—before thousands more lives are lost, before millions more dollars are wasted.

We welcome the renewed focus on health reform precipitated by the upcoming presidential elections and we strongly support the principles for health reform laid out by the AFL-CIO Executive Council. We are committed to being visible advocates for those principles and to working closely with the AFL-CIO for the comprehensive reform of our health care system. We are also committed to working for the following principles that we believe must be essential components of any health reform proposal.

• Every hospital and health facility must be required to ensure there is sufficient and appropriate staff (both registered nurses and other support staff) present on every shift to provide safe patient care. Over thirty research studies have shown the effect of inadequate nurse staffing on patient outcomes and mortality, but many of our institutions are still routinely understaffed. Hospital and facility payment rates should take into account the need for specific numbers of direct-care staff and payments should be tied to the institution’s ability to prove they have maintained appropriate staff levels.
• High fatigue levels contribute to medical errors and unsafe patient care. RNs and other direct caregivers should not be forced to work long hours through the practice of mandatory overtime.
• Ensuring that enough registered nurses are trained to meet our nation’s future needs will require an adequate number of nursing programs to accommodate all qualified students. Advancing this goal requires developing and implementing strategies to increase the number of nursing faculty that are able and willing to teach.
• Patients must be provided maximum protection from preventable medical errors. It is well documented that medical errors are most often the result of system failures rather than individual mistakes. Hospitals and other facilities should be required to adopt practices that have been shown to substantially reduce the risk of medical errors.
• Finally, any health care reform must include a focus on ensuring disease prevention strategies and primary care services are available to all.