We know that having the right number of nurses means better care for our patients. We don’t want our patients to have to wait for medicines or treatment, and we don’t want to have so many patients that mistakes are more likely to happen.

We’re celebrating nurse and healthcare worker week May 6-12 by raising awareness of the important work we do to keep patients safe. Our union contract means we have a voice at the table to improve staffing. 12,000 SEIU members are bargaining this spring to make patient care improvements, including proposals to enforce our staffing plans in our contracts with levels of nursing care that will keep patients safe. By standing together we’ve already made patient safety improvements with safe patient lifting equipment and safe needle protections.

Listen for the radio spots on Seattle radio stations that tell the public we’re the nurses and caregivers you count on, and we want to make sure there are enough nurses and caregivers for you. 

Play the radio spot.

What can we do to guarantee our ability to practice nursing the way we were taught in school? How can we take control of our practice and give patients the care they deserve?

SEIU nurses and nursing staff members came together for a conference on February 26 to learn how to use data and evidence to make improvements in staffing.

Medical errors are the seventh leading cause of death in the United States – above car accidents and breast cancer. As nurses, we know that nursing care is directly related to patient safety and preventing medical errors. But frequently we feel like our requests for the nursing staff we need to keep our patients safe go unanswered.

When Mary McNaughton and the nurses at Swedish-Edmonds said they needed more nurses and CNAs on their shifts, they had the data to back it up, and could prove the current staffing plan was not working.
Mary and the nurses sat down and created a form to track how many nurses, CNAs, and unit secretaries were on a shift, and how many patients had needs including MRSA, chemotherapy, and suicide watch. They also tracked discharges, transfers, post-ups, and transfers to ICU, along with missed breaks, overtime, and use of agency nurses and working extra shifts.

The nurses at Swedish-Edmonds presented their data to management, and were able to show that on certain units and shifts, they needed to have additional nurses and CNAs. The form they created is still being used by all the nursing units to collect evidence on how well the staffing plans are working.

“Staffing and patient safety go together. We can’t just complain we don’t have enough staff, we also need to find our own solutions. One of our nurses, Gayle Hansen, worked on this tool to assess staffing needs that we shared with our staff, along with the staff variance report form. Now we’re going to go visit each unit based staffing committee to share it with the nurses, who can review it and see if the staffing plan isn’t working. If they don’t have enough staff they need to fill out staffing variance form, which is presented at the unit based staffing committee. We had one unit that had too many nurses on the weekends, but they were really needed Monday, Tuesday, and Wednesday. So by collecting data, the unit is working on a pilot to change the schedule and see if it improves.”
Cheryl Wallace, RN, Swedish First Hill

“Our safe staffing law says we have to evaluate our staffing plan every six months to make sure it’s working. It’s not enough just to do a staffing plan and say we have it done, we have to know it’s good. We can look at our own data and see if our plan was a success, and we can see if the numbers fall outside what is reasonable, and then we have justification to back up our request to flex our staffing plan up or down. The staffing plan that we recommended had 20% more RNs and cut our use of incentive shift and agency nurses, and hired a lot more CNAs.”
Mary McNaughton, RN, Swedish Edmonds

“I feel empowered, and I can’t wait to get to work and use the same tools and start collecting data on our units. Keeping our patients safe is our top priority, and now we’ve got the tools to show the need for more nurses.”
Susan Tekola, RN, Harborview

Many of us learned Abraham Maslow’s Hierarchy of Inborn Needs as students. The pyramid in the diagram shows various human needs, and Maslow’s theory was that people must first get their needs met at the lower levels before attending to the higher levels. We can apply this model to our nursing practice. When staffing levels are inadequate, we are unable to get breaks; we may work long hours and have little control over our schedules. We cannot guarantee our patients safe care. We are stuck at the lowest level of functioning. We not only have no control over our practice, but are also unlikely to be motivated or empowered to make improvements. Research shows that this is why many nurses leave their jobs and leave the profession.

Grace Yang, RN, Harborview, was recently elected to a two-year term on the board for the Washington Center for Nursing (WCN), a coalition of nursing organizations including our union, nursing executives, and  nursing educators. SEIU Healthcare 1199NW President Diane Sosne, RN, MN also serves on the WCN Board.

Board members including Grace are working to address the nursing shortage. With an aging population, aging caregiver workforce, and about 300,000 additional individuals who will become eligible for care under healthcare reform, Washington’s nursing shortage is expected to worsen. See how the WCN is addressing the nursing shortage here. The board also works to promote the image of nursing, address diversity issues, and bring new nurses into the profession.

“The future of nursing is one of our greatest challenges – we’re in a position to make changes in our environment and the care that we give. We’re not just providing patient care, we’re in a leadership position, helping to make policy decisions,” Grace said. “Nursing is ongoing work, and that’s how it should be. We have to change with healthcare and stay connected with our community on the issues we’re facing.”

Grace has been using her voice as a member of our union and Executive Board to make a difference in healthcare for ten years. “If you believe in providing safe, quality healthcare then you have to be active and use your voice to get the right things done, and the right changes made.”

The Washington Center for Nursing was created during the Nursing Summit in 2001. The WCN has worked on variety of nursing projects, including the Master Plan for Nursing Education and the organization of regional stakeholder meetings on the Nurse of the Future.

Visit the WCN website for more information on addressing the nursing shortage, and the projects of the organization.

Washington’s safe patient handling law has substantially reduced workers compensation claims for back injuries in the state’s hospitals, according to a report on the law’s implementation released Jan. 21.

The state enacted a law in 2006 requiring hospitals to establish safe patient handling committees and programs, and to acquire lift equipment with the help of a tax credit.

Lost time workers compensation rates decreased 31.6 percent in hospitals between 2006 and 2009, compared with a reduction of 12.9 percent in nursing homes, to which the law does not apply, a Washington State Department of Labor & Industries report said.

Previous studies indicate that 12 percent of nurses are leaving the profession nationwide each year as a result of back injuries, a statistic workers’ advocates have cited in support of legislation similar to Washington’s law (39 OSHR 918, 10/29/09).

The report on Washington’s law, part of a five-year study to assess its impact, found that although lifting injuries were on the rise in 2006 before the statute’s implementation, the incidence rate has since fallen.

In addition, hospital workers are more likely to be familiar with written safe patient handling plans; hospitals are more likely to maintain a committee to discuss injuries; and lifting devices have become more widely available, the report found.

Union Seeks OSHA Rule Standard

The Service Employees International Union, including SEIU Healthcare 1199NW, supports a national Occupational Safety and Health Administration safe patient handling standard, and pointed to the study as further evidence of the effectiveness of safe patient handling laws. The union said there is a carryover effect on nursing homes, despite their lack of coverage under the law.

“We are glad to see that positive changes also occurred in some nursing homes resulting in a reduction of back injury claims, especially in nursing homes affiliated with hospitals,” Bill Borwegen, director of health and safety for the union, told BNA in a Feb. 7 e-mail. “However as the study shows, the reduction of back injuries in nursing homes was only about one third as great as the more significant reduction of such injuries among healthcare workers employed in hospitals. This is yet another concrete example of the positive job saving versus ‘job killing’ impact of health and safety regulations.”

Matthew Fenwick, a spokesman for the American Hospital Association, called the safety of nurses a priority in a Feb. 8 e-mail to BNA, but said there are times when a patient must be lifted manually.

“In these circumstances nurses and other caregivers must have flexibility in making decisions about patient care,” he said. “Hospitals are undertaking a variety of voluntary measures … to accomplish that goal.”

By Greg Hellman

The Washington State Department of Labor Industries’ report is available here.