Consumers are all potential patients who have the right to demand an excellent product in return for their investment--in this case, the product is nursing care. Why should they settle for am mediocre product, simply because some manager or insurance company is trying to cut costs? Would that administrator or insurance company executive settle for less than a quality product if he or his family member were on the receiving end? He absolutely would not!

I encourage all nurses to write similar articles or letters and send them to your local newspapers and magazines such as AARP, Family Circle, Working Mother --any publication that will be read by non-nursing consumers and get them thinking about how they can advocate for nurses, as well as for themselves and their family members. We MUST get the word out about how our adverse working conditions affect the quality of patient care we deliver.

When potential patients add their voices to ours, safe staffing levels will become law everywhere, and we can deliver the level of nursing care we are currently being prevented from delivering--the quality of nursing care that we would want for ourselves and our own families--excellent care by which standards are set. Less than that is simply not good enough. We are dealing with human lives.

Stephanie Tate, RN, Operating Room Nurse, Legal Nurse Consultant

Paradigm Legal Nurse Consulting

3008 NE Alberta Portland, OR 97211-7630

To: oped@news.oregonian.com

From: legalnurseadvice@justice.com

Date: 07 May 2001 01:48:33 PDT

Nurses need to assert their right to "just say no" to mandatory overtime. What is so difficult about simply saying "No, I cannot stay overtime?" No apologies or excuses are needed. By accepting it, they are delaying what needs to be done: the passage of a staffing law, that will hold managers accountable; this will ensure a safe ratio of nurses to patients, rather than compromising patient care.

This is the real reason for the nursing shortage: nurses are tired of being forced by management to deliver substandard and, at times, downright dangerous patient care. They see too many incident and occurrence reports documenting mistakes, and witness plenty of "near misses" that weren't documented. Every nurse has witnessed an error made by a colleague who was either overtired or was denied the proper resources to carry out a job safely, due to understaffing, and has had the same thought: "There, but for the grace of God, go I."

"Mandatory overtime" is a contradiction in terms. It is an unfair labor practice, and is illegal. Management knows this; the nursing unions know this. Too many nurses in Oregon, however, are afraid to "make waves," or be thought of as troublemakers, so the practice continues. Indeed, why should the nurses themselves HAVE to make waves? This is what they pay union dues for, so that they can concentrate on patient care, and rest secure in the knowledge that their union is protecting them from unfair labor practices. Why are the unions falling short? Staffing is a management dilemma. Management may like to use a lot of guilt inducing catch phrases to try to force nurses to stay overtime; these phrases include "Health care is changing everywhere. We all have to pull together to work with less resources; it's the same all over the country," (Untrue!) or "How can you leave? How would you feel if that was YOUR mother in there?" or, my personal favorite, "If you don't stay over, you will be disciplined for patient abandonment!"

Mandatory overtime is a ploy used by management as a way to avoid hiring and benefiting the proper number of employees to do a job. There are other options available to ensure safe levels of staffing, such as using traveling or registry nurses to augment hospital staff, but some nursing managers simply refuse to use them.

Nurses need to learn to advocate for themselves. If they can't, how can a patient trust them to advocate for him or her? No hospitalized patient should have to advocate for himself or herself. That is a role traditionally played by nurses, who have those skills. Potential patients or family members can learn some self-advocacy skills before they even enter a hospital. Health care is a commodity for which they pay handsomely; they have every right to demand the best care, and to hold people involved in that care accountable.

I suggest every patient, or designated family member, ask the following questions of his nurse when he is hospitalized, and any others that might help ensure quality care and his peace of mind:

• Are you my primary nurse?
• What is your name?
• Who will be in charge of my care when you are on breaks or at meals?
• Will you actually be making rounds on me at intervals, or just talking to me via intercom when I ring my call bell?
• What is the reason you have to stay at the desk, rather than making rounds? Does it have to do with understaffing? --Is there a safe nurse to patient staffing ratio on this floor today?
• Will there be unlicensed personnel doing procedures on me that, in your opinion, should be done by a Registered Nurse?
• Are you forced to be here today on mandatory overtime?
• To your knowledge, are there policies and procedures on this floor that were implemented after an incident report was generated that documented a mistake that occurred because of unsafe staffing levels? (If your nurse seems uncomfortable answering that last question, ask to speak to the nurse manager, and direct the same question to her.)
• To whom can I address a letter of complaint regarding the unsafe patient care and adverse working conditions I noticed while I was a patient here?
• To whom can I address my immediate verbal concerns?

Let's hope it doesn't take a death or tragedy to force Oregon to implement a safe nursing staffing law. Assertive RNs and proactive potential patients can pull a lot of weight when it comes to enacting a safe staffing law. I know; I saw it happen in California, where I still choose to practice hospital nursing, even though I live here. Even before California had a safe staffing law in place, I can honestly say that every manager I ever worked for there did her utmost to ensure that we had all the resources we needed to ensure outstanding patient care.

If someone called in sick, she was replaced by registry; if staff were out on vacation, travelers were contracted to take their place in the interim. Overtime was something you were ASKED to do, and for it, you were compensated generously, and thanked.

If you could not do it, you did not need to fumble for excuses as to why you could not and you were not made to feel guilty. Management had too much respect for our intelligence to try to implement unfair labor practices; plus, we had, and still have, an incredible union. God bless CNA!

By the way, physicians are under some of the same pressures we are: to get more done, in less time, with fewer resources, particularly in HMO affiliated and teaching hospitals. There are many questions patients or designated advocates can and should be asking their physicians, as well, as a way of being pro-active in their own treatment plans. That, however, is the subject for another op-ed article or letter!

Sincerely,

Stephanie Tate, RN

Operating Room Nurse

Legal Nurse Consultant

Paradigm Legal Nurse Consulting

3008 NE Alberta

Portland, OR 97211-7630