It was International Patient Safety Day, and I joined with elected officials and my fellow Connecticut nurses to celebrate our legislative success, which requires hospitals to create a dedicated staffing committee to develop annual nursing staffing plans.
Reflecting back, I realized that it often takes a crisis or near-crisis to force needed change or, at the very least, to jumpstart a process of reforms, adjustments and steps to address significant challenges. We’ve all experienced these catalysts in our personal lives. It was clear with efforts to respond to the COVID-19 pandemic, and now, positive action finally is taking shape to help mitigate nursing shortages and strengthen safe-staffing practices. But our solution to these issues is tenuous; addressing them requires continuous effort, attention, support and action.
Nursing shortages here in Connecticut and nationally have been well documented. Nurses, like other health-care professionals, are in high demand and short supply. Many experienced practitioners have retired, and both seasoned and newer nurses are leaving the profession because of excessive work demands, difficult hours, pandemic challenges and professional burnout. There are not enough nurses entering the workforce, but even if there were, recruitment, education and training resources alone will not solve today’s staffing crises.
Hospital staffing gaps negatively affect nurse recruitment and retention. The need for safe staffing standards was a problem for nurses before the pandemic and has gotten worse. We have had hospital-driven ratios for some time, but they typically were not enforced. Also, nurses often weren’t sufficiently included at the negotiating table—without a proper voice, their needs and concerns often went unheard.
In addition to the strain on caregivers, insufficient nurse staffing jeopardizes patient safety and quality outcomes. The problems are multifaceted, but this cannot be painted as a “they-versus-us” scenario. There are not good guys or bad guys, winners or losers; instead, there are many diverse industry stakeholders who need to work together for the common good of patients, nursing staff and facilities.
This past June, Connecticut passed this new safe-staffing legislation aimed at addressing and closing some of these staffing gaps. It wasn’t easy. At the last minute, the proposed bill failed in committee; it was resuscitated at the 11th hour thanks to the combined efforts of the Connecticut Nurses Association (CNA) leadership team and government relations committee, nursing specialty organizations, unions and industry advocates. They were reinforced by thousands of nurses who took the time to send supportive emails, and a handful of dedicated lobbyists and legislators.
The Connecticut Nurses Association, in collaboration with the American Nurses Association (ANA), developed testimony that led to final language in the bill, based, in part, on reviews of similar efforts in other states across the country. It requires hospitals to create a dedicated, collaborative staffing committee, led by a majority of bedside nurses, to identify hospital and unit-specific ratios and challenges. It also mandates increased reporting and oversight by the Connecticut Department of Public Health and the collection of information to inform the Connecticut General Assembly about the hospital nursing workforce.
The law improves and addresses increased direct-care nurse involvement; compensation for their time when working on staffing committees; annual notices/posting of work; processes for sharing concerns, issues and suggestions; and “whistleblowing” protection to reduce fear of retaliation. It also gives the Connecticut Department of Public Health oversight of nurse staffing and creates pathways to enforce staffing plans, including corrective action plans and penalties.
This was a significant victory for patients and nurses, but it’s only one step. Far more communication within facilities and within the industry is required. Additional training and education resources must be made available; funding is needed to increase and support enrollment in nursing programs, especially involving minority and disadvantaged candidates; efforts to recruit experienced educators and faculty must be enhanced; and nurse-recruitment efforts in public education systems should begin much earlier.
I recently attended the ANA annual Membership Assembly in Washington, D.C., and was approached by peers interested in how Connecticut had successfully generated this legislation. Most states are suffering various degrees of support with their legislative efforts and employers and are struggling to form strong, focused coalitions. Connecticut, I told them, was able to preserve local control over unit ratios, which gives hospitals across the state the ability to set their own ratios, get direct bedside nurse majority and solicit enforcement.
Much work remains to be done, but we’re moving in the right direction. Kudos to the state, our talented nurses and the many nursing advocates who worked together to advance these important protections.
Susan A. Goncalves, RN, is an associate professor in the Dr. Susan L. Davis, R.N., & Richard J. Henley College of Nursing at Sacred Heart University in Fairfield, and president of the Connecticut Nurses Association.