I sit in my car after a nursing shift. Drained. Again.
Numb but frazzled. Again.
Feeling that sick anxious worry in the pit of my stomach. Again.
I had 6 very sick patients to care for on my shift- too many. Again.
I anxiously review the shift in my mind, questioning. “Did I do enough?”
I did the best I could. I gave everything I had. I didn’t eat, I didn’t even pee.
“But was it enough? Could I have done more? Could I have saved that one patient/not let that patient die alone/been a better nurse/done better”?
I wish the answer was “Yes. My patients received the best care they could.”
But after this shift, my gut and my heart tell me the answer is “No”. Again.
If only I had less patients, a safer level of patients, maybe I could have.
Maybe my first patient wouldn’t have fallen and broken her hip because I would have been there to help her get out of bed.
Maybe Patient #2 wouldn’t have suffered in pain for so long because medications were delayed while we were coding my 3rd patient.
Maybe I would have caught patient #4’s fever earlier, before they became septic and had to be transferred to the ICU.
Maybe I could have comforted the daughter of patient #5 who was just told there was nothing more we could do.
Maybe patient #6 wouldn’t have died, in the dark, afraid, in pain and alone because I was dealing with emergencies with patients 1-5.
These patients were someone’s mom, dad, child.
Maybe if I had a safer number of patients to care for, I could have saved just 1.
This is the norm, rather than the exception for nurses.
No matter how good of a nurse I am, taking care of too many patients is unsafe. Impossible, unfair to patients and nurses. People are dying unnecessarily, or developing complications that could have been avoided.
The evidence is clear. Studies show that there is a “safe” number of patients to care for, and an “unsafe “number of patients to care for.* For every patient over 4 that a nurse cares for on a Med/Surg floor, there is a 7% increased risk of death for her patients. If a nurse cares for 6 patients, that means there is a 14% increased risk of death. 7 patients =21% increase. Not just risk of a complication or a mistake- DEATH.
How would you feel if that was your mom. Your child. Your brother. How many patients do you want their nurse to be taking care of? And why would hospitals staff nurses at levels that put patients at an increased risk for dying?
In Massachusetts, voters will have the chance to save lives. Issue 1, written by nurses, would limit the number of patients that a nurse can care for, based on the the most recent studies that show how many patients are safe.
Opponents of Issue 1 instill fear about the implications of the bill- “there won’t be enough nurses”, “hospitals will close”, “NICU units will shut down” “You will be turned away at the ER” “ER wait times would increase dramatically”
I wish we could see what it would look like 10 years, 15 years later after we passed Issue 1- what would it look like? Would all of these fears come to pass?
Guess what- we can.
California, the only state to have nurse patient limits, passed a nearly identical law in 1999. I went to California and interviewed nurses in Los Angeles and San Francisco from a variety of hospitals and asked them about what it was like before and after their law passed.
They responded with nearly identical responses:
-Hospitals are making more money than ever.
-Not one hospital has closed, even smaller community hospitals
-Nurses are coming back to the bedside to work- they have less stress, less burnout
-Patients are getting better care- they have less infections, less readmission rates
-No units have closed
-Support staff have not been eliminated
-ER wait times? California has some of the lowest ER wait times in the country. Patients aren’t turned away.
-LESS PATIENTS ARE DYING
In fact, most nurses looked at me like I was crazy to even ask those questions. I said “that’s what they are telling Massachusetts nurses”. “Nope” they replied, “we love our patient limit legislation”. They couldn’t even imagine working without these limits. Even nurse managers and hospital administrators had positive stories about the nurse patient limits legislation.
So why are hospitals staffing nurses at an unsafe level? Why are there 2 standards of care? Is it costs? How much is your loved one’s life worth?
Which hospital would you send your mom, or your child to? A California hospital with research based safe patient limit laws. Or a hospital in a state like Massachusetts, without safe patient limits, where nurses may have 7 patients or more, giving your mother, your loved one a 21% higher risk of dying. A hospital where patients have a greater risk of complications, of being in untreated pain, of dying alone, in the dark, in pain and in fear.
I’m choosing California and safe patient limits. I choose Yes on Issue 1 in Massachusetts.
SMYS members, please reach out to family, friends, colleagues in Massachusetts and let them know how important Issue 1 is for patients. Patients deserve better. Bedside nurses, just like you, just like the nurses who wrote this bill, tell us every day, over and over that safe patient limits are needed. They never want to think to themselves after a shift- if only I could have saved just 1 by having a safer patient load. They worry for their patients, their loved ones, your loved ones.
Vote Yes on 1 to save lives. Voting No costs lives.
*Aiken, L.A, et al, Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction, Jama 288 (16), 1987-1993, 2002
-Kelley Muldoon Rieger, MSN PNPShare this post with friends!
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