Nurses across the US are still fighting to join California in having mandated safe staffing ratios, says the visiting co-president of America’s largest nursing union.

Jean Ross was a keynote speaker at yesterday’s New Zealand Nurses Organisation annual conference in Wellington. She told New Zealand nurses that it didn’t seem to matter which country nurses were in as they were all battling the same issues, including understaffing and harassment and violence in the workplace.

Ross is co-president of the National Nurses United (NNU), which was formed in 2009 by bringing together the Californian Nurses Association (which successfully lobbied for safe staffing ratios to be introduced in California in 2004), the Massachusetts Nurses Association and United American Nurses to form the largest union and professional association of registered nurses in the US, with 150,000 members. NNU also helped to initiate Global Nurses United, an organisation of around 25 nursing unions from around the world, including NZNO, that work together to fight healthcare service cuts, bring in safe nurse staffing ratios and improve patient care.

“We [the nursing unions] want safe staffing, respect for nurses and safety for nurses,” Ross told Nursing Review. “We work outside the walls of our hospitals and outside of our union contracts for social justice and a system that lets us have the kind of health care that we know patients deserve. And it doesn’t matter what country you are in – the issues are all the same. Even in a country where you do have a good nationalised health system.”

Safe staffing ratios

Ross said safe staffing ratios was one of the tenets of Global Nurses United, but it was up to each member country to decide what that safe staffing ratio should be.

California is still the only state in the US to have a safe patient ratio law where it has had set RN-to-patient ratios since 2004, including 1:2 in intensive care units, 1:5 in medical/surgical wards, 1:4 in emergency departments and 1:6 in mental health. These are the maximum number of patients a nurse can be assigned and the Californian law also requires additional RNs to be assigned based on patient acuity.

There are currently two bills in front of the Senate and Congress calling for federal RN-to-patient ratios across the whole of the US and at a state-by-state level nurses are also campaigning for legislated safe staffing ratios.

“They [ratios] have been very successful in California,” said Ross. “Hospitals continue to fight them tooth and nail but they have worked very well.” She said arguments put up against introducing ratios included nurses being in short supply, but “surprise, surprise – nurses that had left the profession because the conditions were so bad came back into the fold and began working again”.

“Nurses are happy again,” said Ross. “They can do what they like at the bedside.” She said nurses used to worry about taking a break as it would foist all their patients onto a colleague’s patient load but now wards had circulating nurses so ratios stayed in place even when nurses were on a break.

She claimed at least one hospital system in California actually made more money after ratios were introduced, as they didn’t have to employ so many agency relief staff or pay overtime.

Universal healthcare, Bernie Sanders and Trump

Ross said one area in which nursing in New Zealand did differ from the US was in having a universal or ‘single payer’ healthcare system. She said nurses in the US had been fighting to have something similar to the New Zealand or UK health system “for years and years and years” because they believed health care was a basic human right.

“The US doesn’t really have a healthcare system – it’s a medical industrial complex – the only way to make money in the [US] healthcare system is to deny patient care.”

The NNU and Ross were active supporters of Senator Bernie Sanders for the Democrat’s presidential nomination and are also backing his ‘Medicare for All’ Act that was introduced to the Senate on September 13 with the backing of 16 Democrat senators. (At the same time this year, Republican politicians have been trying, unsuccessfully to date, to repeal and replace the Affordable Care Act i.e. Obamacare, the controversial bill expanding health insurance to millions more Americans that was passed during President Barack Obama’s presidency.)

Ross said that Obamacare saw more people than ever before gain access to health insurance, but what the NNU wanted was a system that assured all people had access to healthcare. “And the only way to do that is through a national healthcare programme,” said Ross. She said the aim of Sanders’ bill was to extend the current Medicare healthcare programme to cover more than just the current over-65-year-olds.

While the current political climate under President Donald Trump was not supportive of increasing government involvement in healthcare, NNU believed the ‘void’ created by the Republican’s failure to repeal Obamacare made it a good time to put forward an alternative model.

When asked for her view of the current president, Ross replied, “Oh my word, that man-child!” and chuckled. “You know, the nurse in me says, ‘Be kind, the man is ill’… no, none of us are fond of Donald Trump. Although, sad to say, we must admit some of our nurses must have voted for him.”

But nonetheless, Ross said, Trump’s campaign had given people something to fight and hope for – much like the mushrooming of support she experienced first-hand during the Bernie Sanders’ campaign, which the NNU had actively supported by travelling alongside Sanders on the “Bernie Bus”.

“Honestly, when we first started [on the Bernie Bus] we did not know Sanders’ campaign would take off the way it did – we [nursing unionists] were hungry for a person like this – with the kind of values we shared. And we believed the people across the country felt the same way, but it wasn’t until we actively travelled with our ‘Bernie Bus’ and talked to people along the way that we found out we were right, and look how well he did [almost winning the Democrat nomination off Hilary Clinton].”

Ross believes the absence of a positive candidate like Sanders led to Trump’s success.

“People need a hopeful campaign – and what nurses stand for is what people want … and we found that out.”

She pointed out that year after year nurses come up tops in the US, and in many other countries around the world, as the most trusted profession. “There is a reason that people trust us – and we need to use that and talk to people. And they will very often listen because they trust us.”

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