Go into almost any hospital in the country and ask a nurse what is the No. 1 challenge she/he faces, the answer probably will be "trying to deliver safe, quality care without enough staff."

That is why RNs Working Together, a national coalition of 10 AFL-CIO unions representing more than 200,000 working registered nurses, is supporting the Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007 (H.R. 2123), introduced by Rep. Jan Schakowsky (D-Ill.). This bill is integral to improving the health care system for all Americans.

Nurse staffing is vital to patient safety and quality care. Providing enough nurses at the bedside is the most reliable and cost-effective way to ensure quality care and decrease preventable hospital deaths. However, research by such institutions as the Joint Commission and the Institute of Medicine (IOM) demonstrates that too few nurses are caring for too many patients. And when nurses are responsible for caring for too many patients, there is an increase in the number of medical errors and preventable patient deaths.

The Joint Commission found nurse-staffing shortages are a factor in one out of every four unexpected hospital deaths or injuries caused by errors. Another study found that patients at hospitals with staffing ratios of four patients to one nurse or higher suffered from cardiac arrest or shock 9.4 percent more often than patients at hospitals with ratios of 2.5 patients to one nurse or lower. They also had 9 percent more urinary tract infections, 5 percent more gastrointestinal episodes and 6.5 percent more cases of pneumonia acquired in the hospital. Also, surgery patients in short-staffed hospitals were 6 percent more likely to die from complications like shock or sepsis. A study in JAMA, The Journal of the American Medical Association found that for each additional patient over four in a registered nurses’ workload, the risk of death increases by 7 percent, and in hospitals with eight patients per nurse, patients have a 31 percent greater risk of dying than those in hospitals with four patients per nurse.

The American public recognizes the dangers of low staffing levels. A 2003 poll commissioned by the AFL-CIO revealed that an overwhelming number of Americans think there are not enough registered nurses to care for the number of patients admitted into hospitals. Three-quarters of respondents said there were not enough registered nurses, while only 15 percent said there were enough. Additionally, more than three-quarters of those surveyed said the nurse staffing shortage has a huge or big impact on the quality of care provided to patients (42 percent agreed with “huge”; 43 percent went with “big”).

Inadequate nurse staffing makes the nursing shortage worse and decreases the quality of care. Recognizing that having enough nurses at the bedside is critical to the provision of quality care, a critical question is why do we keep losing nurses? Why are there currently 500,000 RNs who are not practicing their profession? The JAMA survey notes a key reason nurses leave the profession is that chronic understaffing and unmanageable workloads leave them exhausted and in the untenable position of trying to deliver high-quality, complex and compassionate care to an unsafe number of very ill patients. Each additional patient over four per nurse corresponds with a 23 percent increased risk of burnout and a 15 percent increase in the risk of job dissatisfaction. Other surveys have found that a majority of nurses cite work-related stress and patient care loads/staffing as having a major impact on turnover—above the impact of compensation. Another survey by Peter D. Hart Research Associates found 62 percent of hospital nurse respondents said nurses’ leaving due to burnout was a serious problem in their facility, with 42 percent calling it a very serious problem.

An overwhelming number of hospital nurses (82 percent) favor legislation that would establish a maximum number of patients that nurses can be required to care for at one time, according to the Hart survey. In another survey, nearly 90 percent of nurses responded that better staffing ratios would improve recruitment and retention of nurses; 85 percent also said they thought reduced nurse-to-patient ratios would help solve the nursing shortage.

Minimum nurse-to-patient staff ratios work. Where minimum nurse-to-patient ratios exist, interest in nursing has increased. Since the 1999 passage of California’s nurse-to-patient ratio law, California has experienced an increased interest in nursing. For example, the number of actively licensed RNs in California increased by more than 60,000—nearly 25 percent—from 246,068 on June 30, 1999, to 306,140 on Dec. 30, 2005. According to an article in the Sacramento Business Journal, “vacancies for registered nurses at local [Sacramento] hospitals have plummeted 69 percent since early 2004,” the first year ratios were implemented. In the Australian state of Victoria, within six months of the implementation of ratios in 2000, 3,300 nurses returned to work full-time and a pre-eminent technical institute in Victoria reported the number of graduating students planning to study nursing increased by 144 percent.

Our nation needs a national solution to confront the nursing shortage and improve the delivery of safe, quality care. The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007 (H.R. 2123) addresses the nurse staffing crisis by heeding the call of our nation’s nurses who are asking we ensure there are enough nurses to provide safe, quality care. The legislation would mandate minimum nurse-to-patient ratios in the following manner:

By mandating minimum safe nurse-to-patient ratios, our nation will be taking an important step toward improving the quality of patient care, saving lives and creating working conditions that will encourage more nurses to remain and return to the bedside. However, making this change will not be easy, noted Steve Francy, executive director of RNs Working Together. “Powerful corporate interests make money off the current system. We know that this is going to be a long, hard fight. But we’re in it for the long run.”

Want to get involved in improving your profession and ensuring your patients get the care they need and deserve? Contact your local union or become an RNs Working Together Patient Advocate by clicking here.

Learn more about H.R. 2123.

Learn more about NJ RNs Working Together.