In Robert Howards swords and sorcery tales of Conan, the barbarian adventurer, muscles (Howard always says thews) are the answer to just about everything: evil wizards, giant reptiles, you name it. So, when the citizens of California found themselves faced with serious problems, they turned to Conan incarnate, in the form of Arnold Schwarzenegger, since it always worked in the movies. Gov. Schwazenegger rose to the challenge by taking on the California Nurses Association, and a law that mandated that California hospitals have one nurse for every 5 patients, instead of the earlier one nurse for every 6 patients. In November 2004, he issued an emergency order blocking the new ratio, setting off a year-long court battle that was decided in favor of the nurses.
Five years later, the nurses won again, this time in the pages of the journal Health Sciences Research in a report entitled Implications of the California Nurse Staffing Mandate for Other States. The authors compared data from California, Pennsylvania and New Jersey, and gave as their principle findings: California hospital nurses cared for one less patient on average than nurses in the other states and two fewer patients on medical and surgical units. Lower ratios are associated with significantly lower mortality. When nurses workloads were in line with California-mandated ratios in all three states, nurses burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care.
Some of those results are subjective, and a lot of people might not put a very high value on preventing nurse burn-out, but the mortality rate is very objective. The study surveyed 22,336 nurses, and looked at the records of 1.1 million patients, and concluded that in New Jersey, 225 deaths, equal to almost 14% of all deaths in general surgery, and 200 deaths in Pennsylvania, 10.6% of the deaths, could have been prevented with the nurse staffing ratios that are mandated in California. In those hospitals in New Jersey and Pennsylvania that had a 1:5 staffing ratio, the survival rates and other measures were the same as those observed in California. When Gov. Schwarzenegger was fighting for the 1:6 staffing ratio, he described the nurses union as a special interest, but the data indicates that a relatively modest improvement in staffing ratios offers significant advantages measurable in lives saved.
Beyond that, in 2004, when Gov. Schwarzenegger was fighting with the union, a spokesperson for Californias Health and Human Services Agency said that the State had been told there werent enough nurses available to provide 1:5 staffing. The study indicated that with a lighter work-load, nurses have more job satisfaction, and are less likely to drop out of the profession. At proper staffing ratios, nurses are more inclined to continue their professional practice, and so there are more nurses available to fill the positions.
And this is what politics does, because during the recent debates on health-care finance reform, advocates of an efficient single-payer system were never allowed to make the case, and even the public option, which would have been both real competition for the commercial insurers and a demonstration of what single-payer can do, was steamrollered. What we got was a capitulation to the insurance companies, and while the law protects us against some of their past abuses, it doesnt eliminate the level of waste that contributes to the rising costs of care without providing any sort of benefit. According to the website Salary Wizard (swz.salary.com), the median salary for a hospital staff nurse is $62,527. That means Aetnas CEO, Ron Williams, is worth 388 nurses. CIGNAs H. Edward Hanaway equals 196 nurses. Even Stephen Helmsley, CEO of United Healthgroup is taking the salaries that could have gone to 52 RNs.
It doesnt get any simpler. Its the equivalent of the classic economic trade-off of guns versus butter, and we got hustled. Its time to start over.
Sam Uretsky is a writer and pharmacist living on Long Island, N.Y. Email firstname.lastname@example.org.
From The Progressive Populist, June 15, 2010
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