Editorial

The Good News and the Bad News

I am not sure how widely disseminated the news from other states is in your neck of the woods, but some recent legislation from the California governor’s ofice has been the topic of a number of articles and editorials in recent weeks. Govmor Gray Davis has mandated a nurse-to-patient ratio of 1:5. This ratio will be implemented in all the patient care areus not already covered by ratios. This ratio is a victo ry for a number of nursing organizations in the state and, of course, for the patients.

Opponents to the legislation complain it poses an unfair economic burden on hospitals, there are not enough nurses to fill the positions that would be mandated, across-the-board required ratios do not address hospital differences, and, inevitably, that healthcare is ”broke” and this is just a Band- Aid approach and hardly a cure. While each of these concerns is, on its face, a true statement, I do not believe they are legitimate counter- arguments to the benefits of setting an acceptable and reasonable standard of care.

The problems facing health care in California and elsewhere are not mandated nurse-to-patient ratios but rather the fundamental issues that have led nurses to force the implementation of these standards. Ratios will not address the fundamental issues but they will force hospitals, nursing professionals, and legislators to address those basic problems more directly. Along the way the message to the public and to those entrusted with the publicS health is that good health care is not

possible if registered nurses, the backbone of our healthcare system, are spread so thin and are so overwhelmed and distracted by regulatory demands and concerns about hospital bottom lines that they are incapable of doing their jobs without risking the patients’ safety and their own emotional and physical health.

We have been hearing for years that our healthcare system is badly flawed, but as a country we have never been able to do what needs to be done to f ix the problems of lack of access, the huge numbers of uninsured, and out-of-control costs of care. We are learning now that managed care is to all intents and purposes a failed strategy. The numbers of uninsured have grown and will continue to grow as our economy weakens. A s if in response to this woeful situation, a nursing shortage is looming that will be neither easily nor cheaply counteracted. Almost paradoxically, however, this is not a time to try and do more with less (including fewer nurses) but to set the bar higher, to realize that our nation’s health must be a priority in need of greater amounts of resources (human and otherwise). Also, we must acknowledge, finally and unequivocally, that nursing is a cornerstone of our healthcare system, one that cannot be neglected or dismissed with an easily conceived laundry list of reasons and excuses.

Just about every nursing organization of which I am aware is addressing the p r o b l ~ of the

Nursing Diagnosis Volume 13, No. 1, January-March, 2002 3

Editorial

nursing shortage in its own unique an(

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collaborative ways. Nursing cannot do it alone however. Legislators must make the difficult choices between f ind ing their pet projects and funding nurse education, recruitment, and work- site improvement.

Physicians must acknowledge that without a strong and healthy nursing force their ability to deliver quality medicine will be seriously compromised. They need to give up fighting for their own turf and come to appreciate that they likely cannot do their job without nurses. They need to remember that many of them zuould not be the physician they are today were it not for the nurses who helped and taught them along the way. And all the adults-mothers, fathers, teachers, counselors, ministers, others who have an opportunity to guide young people-must, for the sake of their own future care needs, steer bright, ambitious young people into nursing.

Nursing needs a critical mass of strong committed minds to create and force the change. This presents a hu<ye challenge and promises of subsidized education, ready employment, opportunity for job growth and development, and a workplace with high standards and the structure to achieve those standards can be very strong drawing points. Mandated nurse-to- patient ratios are but one starting place. When the nurses’ workplace is such that nurses can do the job they want, need, and are educated to do, we will begin to make a real dent in the nursing shortage and become a real voice in the efforts to establish a viable and competent healthcare sys tern .

Rose Mary Carroll-Johnson, MN, RN rose-mary@earthlink.net

4 Nursing Diagnosis Volume 13, No. 1, January-March, 2002