Two Important Questions for Nurses to Ask Potential Employers in 2003

It’s important not only to get nurses back into to the nursing profession, but also to keep them in nursing. To this end, we hope you will ask potential employers some tough questions to let them know what nurse retention will require.

1) What are your RN-to-patient ratios?

Many nurses who left bedside nursing over the past decade did so because of hospital cost-cutting policies that left RNs caring for too many patients. Nurses objected, knowing that patients can’t get good care from overworked nurses. Yet, until recently, nurses did not have the research data needed to adequately protest this short-staffing.

Then Linda Aiken, Ph.D., RN and her colleagues from the Center for Health Outcomes and Policy Research at the University of Pennsylvania proved what nurses already knew. In a study published in October 2002, they examined the effect of short-staffing on 230,000 patients and 10,000 nurses from 168 hospitals in Pennsylvania from 1998-1999. Their study¹ indicated that for each additional patient assigned to a nurse, 30-day patient mortality increases by 7%, failure-to-rescue rates increase by 7%, and nurses are 15% more likely to be dissatisfied with their jobs and 23% more likely to be burned out. In essence, Dr. Aiken’s group showed that high RN-to-patient ratios set to cut costs burn out the very nurses hospitals desperately need--and cause serious, even mortal, harm to patients.

Following the Aiken study, an Oct. 25, 2002 New York Times editorial entitled “Dying for a Lack of Nurses” called for mandatory public reporting of hospital RN-to-patient ratios “so that prospective patients can decide where to take their chances.” We can help move hospitals in that direction by pushing for good ratios before saying yes to a job. Your livelihood and your patients’ lives are at stake.

2) Do you have Magnet Hospital status? If not, are plans underway to obtain it?

The Magnet Hospital Program was started in 1994 by the American Nurses Credentialing Center to promote nursing professionalism and excellence and a supportive environment for nurses—common qualities of hospitals that are “magnets” for nurses. Magnet hospitals have: lower nurse turnover and vacancy rates; higher nurse job satisfaction; an easier time recruiting nurses; lower patient mortality; higher patient satisfaction; higher quality physicians and specialists indicating an overall positive healthcare team; and a “Magnet Culture” with core values including “empowerment, pride, mentoring, nurturing, respect, integrity and teamwork.”⁴

Since only about 74 US hospitals currently have Magnet status, it might be hard to find one. Regardless, we can still ask potential employers if they embrace the qualities of such hospitals. Does each unit have its own nurse manager, clinical nurse specialist, in-house Nurse Practitioner and nurse educator? Does the hospital provide and pay for CEUs and the hours needed to earn them? Does it support nurses’ efforts to become certified in their specialties? Does it provide tuition support and encourage nurses to seek BSNs and graduate degrees? Does the hospital have a mentoring program for nursing recruits? How many members of the hospital’s Board of Directors are nurses? Does the hospital have a needle-less device policy and a “no-lift” policy?⁵ Is nursing research funded on each unit?

We urge you to ask employers these questions and hold them accountable for how they treat nurses. If you give them a second chance by coming back to the profession, let them know that you will expect just as much of them as they expect of you. The well-being of our profession and our patients demands it.

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¹Aiken, L., et al (2002). “Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.” Journal of the American Medical Association, October 23/30; 288 (16), pp. 1987-1993. Available online http://jama.ama-assn.org/issues/v288n16/abs/joc20547.html

²Scott, J. G., Sochalski, J. & Aiken, L. (1999). “Review of magnet hospital research: findings and implications for professional nursing practice.” Journal of Nursing Administration, January; 29 (1), 9-19.

³American Nurses Association. (2002, May 6). “American Nurses Association endorses legislation addressing RN staffing shortage.” Available online http://www.nursingworld.org/pressrel/2002/pr0506.htm

⁴American Nurses Credentialing Center. (2002). “Magnet recognition program: The benefits of becoming a magnet designated facility.” Available online http://www.nursingworld.org/ancc/magnet/Benefits.htm

⁵Mason, D. (2003, Feb.). “Our Aching Backs.” American Journal of Nursing, 103 (2), 11. Available online http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=404183

© July 2003 The Center for Nursing Advocacy, Inc. Take action with us online at www.nursingadvocacy.org