#SafeStaffing? Are Ratios the Answer
Is the fight for #Ratios the wrong fight?
For more than two decades I have studied power and the culture of Nursing. ?Eventually, I understood that nurse-to-nurse infighting occurs when people lack the power to get what they need - and that nurses unknowingly oppress themselves.
Results from surveying over 6,000 nurses at every level consistently showed that nurses self-silence 95% of the time. ?Speaking our truth is just not worth the consequences. ?Nurses do a quick risk analysis and decide that speaking up is not worth the fear of retaliation, making the situation worse, being ignored or isolated from the group. Belonging is a much stronger motivator in humans.
Only when I ask nurses, “Who is doing this to you? Who is ignoring or outing you?” does the room get very quiet.?As Pogo said, “We have met the enemy, and he is us”.
But the oppression nurses experience doesn’t stop with Nursing.
If we expand perception, it becomes obvious that this power struggle is about values. In our current business model, the dominant value is profit - and caring is oppressed. Nurses are empathetic healers whose acts of heart-felt service are not reimbursed in the current business model.?There is no billing code for compassion.?Nor is there is no billing code for the vigilant nurse who intervenes in-time to prevent a bad outcome, or the only nurse who can get a patient to take their meds. These exceptional moments when a nurse saves a life or connects profoundly with his or her patient are free… like pennies on a convenience store counter.?
Because the work we cherish has no monetary “value” in the current business system, our self-esteem decreases, in-group arguing prevails, and we start measuring ourselves using the language of the dominant group: turn-around time, length of stay, hours of care per patient day. This is why staffing ratios are the wrong fight. It’s still about control – like Rosa Parks fighting for a seat on the 2 a.m. bus.
We think we are exerting power, but we are not.?It is pseudo power designed to placate, and a poor solution. By fighting for ratios, we are still playing into the values of the dominant group. I want to waive a red flag and yell “Stop! There’s another way! Look!” ?
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If you are going to fight, fight for the real thing: autonomy and power.?
The only person in an organization who is qualified to decide staffing levels is the charge nurse.?This person knows 1) the real time acuity level of every patient, and 2) the experience and skill level of oncoming staff.?The charge nurse (with the support and endorsement of their manager) should get as many nurses as they request. Period. Fight for that!
If you are smart enough to be a charge nurse, run a crash cart, save lives, manage complicated calculations and patients etc., then you are smart enough to know how many nurses are needed for safe staffing for the next four hours (and yes, staffing must be assessed q 4 hours). Any other option dummies us down.
Where is the advocacy for our own judgement, power, skill and knowledge?
Staffing ratios are a temporary, emergency solution. They will not create the respect and value our profession deserves.?By fighting for ratios, we are still holding ourselves in an oppressed position because we are discounting our own ability to make this critical decision.?You. YOU, the nurse, should tell the charge what you need and then YOU should get what you need to do your job safely. That's nursing unchained.
Only when we are given the resources that we request to do our job will our patients ever be safe.
Only then, and not until then.
RN
1 年Even as a charge nurse and fully knowing what the unit needs....the hospital scheduler never agrees and pulls from floors anyway. Including CNA'S sometimes leaving nurses to do aid care as well as passing meds, charting. Our hands are tied no matter what. Overall, we do not get what we NEED.
Assistant Nurse Manager, Lactation & Childbirth Education at Penn Medicine Lancaster General Health
2 年Spot on!!
"No Day But Today." ~J. D. Larson
2 年Ratios are a definite must/game changer, and the reason I haven’t left California. When enforced correctly, they allow RNs (of varying skill sets) the opportunity to safely provide patient care. They also hold leadership accountable for ensuring appropriate staffing. I don’t know a single RN that would discourage ratios.
Perioperative Nurse at Windsor Regional Hospital
2 年Sorry, totally disagree with this article. Safe staffing ratios is the main fight we should be advocating for because there is litterally only so many hours in a single shift. Patients are more complex, more mental health issues and less funding. Nurses are taking on so many roles and wearing so many hats in healthcare already that empowerment is not what we need or will fix our problems, only putting more responsibility back on to the Nurse when in fact we need less. We need and want to take care of people the best way possible, not draw labs, not remind Doctors to put their orders in, not act as a psychologist, not act as a social worker, not be a physiotherapist, not be a pharmacist and double check meds that are safe of efficient enough for our patients. We just want to be Nurses and we can only do that with #staffingratios!