Pennsylvania has a 16% vacancy rate for nurses, but that doesn't apply to Pennsylvania Hospital.
It has managed to keep its vacancy rate at 2%, partly by being ahead of the country in limiting nurses' patient loads with minimum staffing ratios and by banning mandatory overtime. Both issues are key for nurses throughout the nation.
The hospital also established nurse leadership committees for each of its units, to get nurses' thoughts on matters affecting all levels of operation-before decisions are made. When the 423-bed hospital was planning a new critical-care wing, nurses were consulted on the layout.
"What we're trying to do is create a milieu where they have a certain amount of self-autonomy," said Kate Kinslow, chief operating officer at the hospital and a certified registered nurse anesthetist. "We are making sure we are involving nurses where they need to be involved."
The scenario at Pennsylvania Hospital is far from commonplace. But if nurses have their way, it will become standard.
During National Nurses Week, which runs May 6 through May 12, nurses around the country will be hitting Washington as Congress is considering several pieces of legislation that could change the nursing landscape significantly.
At the root of what the nursing industry calls a crisis is a nursing shortage estimated by HHS at 150,000 nurses and expected to grow to 800,000 by 2020. Nurses say working conditions have deteriorated and in reaction, many have organized to join unions. According to the Service Employees International Union, the country's largest nurses' union, 513,000 nurses were under collective-bargaining agreements as of 2004. The SEIU represents 110,000 nurses. This week, the SEIU plans to take its concerns to Washington at meetings it has organized with members of Congress.
"From our perspective, what we're finding is that nurses are being asked to work longer hours. Pay is not keeping up with the demands of the jobs, and they're being asked to care for patients that are sicker," said Elizabeth Buchanan, director of communications for health systems at the SEIU.
In one of the SEIU's latest efforts, in April it launched a union drive at Catholic Healthcare Partners, a 29-hospital system based in Cincinnati that employs 28,000. Meanwhile in Washington last week, the House passed an $82 billion supplemental military and tsunami spending bill that includes an amendment that would free up 50,000 visas for foreign nurses. The Senate was planning to take the bill up this week.
Also awaiting congressional action is legislation that would require hospitals to consult with nurses in setting staffing levels and would ban mandatory overtime. The SEIU has placed the two bills at the top of its legislative agenda, along with turning back Medicaid cuts, Buchanan said, and SEIU representatives will lobby lawmakers this week on them.
The legislation's future is uncertain, however. "I think in the current congressional environment, it's a heavy lift," said Michelle Artz, associate director of government affairs at the American Nurses Association.
One bill would require hospitals participating in Medicare to set nurse-to-patient ratios based on the intensity of care required, among other factors; seek recommendations from registered nurses in developing hospital staffing systems; and publicly report staffing information. Sen. Daniel Inouye (D-Hawaii) is the Senate sponsor. Reps. Rob Simmons (R-Conn.) and Lois Capps (D-Calif.), a registered nurse, are sponsoring the House bill. Unlike a California law, which establishes specific nurse-to-patient ratios, the federal bill would leave exact staffing levels for individual facilities to determine.
A second bill, introduced by Reps. Pete Stark (D-Calif.) and Steven LaTourette (R-Ohio) in the House and by Sen. Edward Kennedy (D-Mass.) in the Senate, would prohibit mandatory overtime for nurses.
"They don't take into account the nursing shortage," said Carla Luggiero, the American Hospital Association's senior associate director of federal relations. There are only so many nurses available for hospitals to hire, she said.
The healthcare industry also is fighting for federal money for nurse workforce development. President Bush asked for $150 million for such programs in his fiscal 2006 budget. The AHA and some members of Congress are pushing for $175 million. The budget resolution recently passed by Congress did not specifically address funding for nursing programs.