Don't be afraid to tackle short staffing

By LENORE BORIS
Adequate and safe nurse-staffing levels is a concern voiced at every worksite by PEF nurses. Quality of nursing care and high stress levels are driving efforts to find methods to ensure appropriate staffing.

In October, the Service Employees International Union (SEIU) Nurse Alliance held its first conference on staffing so that members of many locals could share their insights and experience in addressing this widespread and difficult problem at the local level.

Representing PEF at the conference were three members of the PEF Statewide Nurses Committee - Millie Lewis, Pat Wilson and Christina Brady - and PEF's nurse organizer (the writer of this column).

It's a vicious cycle

Inadequate staffing patterns decrease nurses' morale, increase sick-leave use, increase health and safety incidents and increase risks for patients.

The unwillingness of management to staff sufficiently to cover vacations, sick days and other earned time off creates the need to staff using voluntary or mandatory overtime. Mandatory overtime reached epidemic proportions at some New York State facilities during the summer.

While many state agencies use mandatory overtime to solve staffing shortages, other facilities simply deny vacation and other days off.

Excessive overtime can compound staffing shortages. Exhausted, overworked nurses ultimately get a much needed rest and day off by calling in sick. This, in turn, can trigger mandated overtime for another nurse or necessitate working short staffed. Either outcome puts additional stress on nurses, which continues the cycle.

Legal standards lacking

While many nurses want to believe the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or a regulatory agency such as the state Health Department establishes safe staffing levels, this is simply not true. JCAHO standards do not prescribe a specific staff-to-patient ratio.

Like JCAHO standards, New York State law does not specify staff-to-patient ratios. New York Administrative Code, Title 10, Section 405 addresses nursing services, requiring a hospital to have a nursing service that "meets the care needs of patients." Only in the provision of nursing care to burn patients does the law provide a specific ratio of one nurse for every two to three patients.

Other options available

Absent enforceable laws and standards, what options do registered nurses have for addressing inadequate nurse staffing levels? Nurses from other SEIU locals spoke about their use of contract language and labor-management meetings to address the issue.

Success of either approach was enhanced, nurses reported, when union representatives could back up their claims of inadequate staffing with facts.

Many SEIU locals found the most effective tool for gathering information was the use of forms by nurses to protest their assignments or short staffing. These forms put management on notice that a staffing problem exists and allow union representatives to collect needed data.

Unfortunately, negotiating contract language about staffing is not an option because staffing is not a subject the state is legally required to bargain. Employers are very reluctant to agree to any language limiting their ability to deploy the workforce.

Negotiating effective staffing language is unlikely, particularly given the large number of work settings of PEF nurses.

What you can do about staffing

PEF nurses can still be proactive in addressing staffing issues:
­ Raise issues with your division officers and PEF field representative;
­ Start collecting data with protest-of-assignment forms;
­ Try to resolve specific problems, such as unavailability of staff to respond to codes, that result from short staffing; and
­ Put the whole issue of staffing on your local labor-management agenda.

Working together, we can effectively resolve staffing issues.