Op-ed — Against the tide of normalization: the fight for safe nurse staffing

As we continue to navigate the post-pandemic world, let us not lose sight of what nursing stands for: care, safety, and empathy.

This story was published in the Spring-Summer 2024 issue of The Washington Nurse.

12 illustration Against the tide of normalization

Imagine we’re navigating a sailboat through a brutal storm, emerging battered but intact, only to realize we’re taking on water in calm seas. That’s the story of our healthcare system from my perspective as a staff and charge nurse over the last five years, particularly through the tempest of COVID-19. Now, with the storm passed, a quiet crisis starts to loom: the acceptance and normalization of unsafe staffing models as “the new normal.” It’s a trend that threatens to capsize us.

This is my call to action to nurses across Washington, especially those new to the field: It’s time to patch the leaks and steer our ship back to tranquility by becoming involved in staffing committees, donating to WSNA’s Political Action Committee, and being part of the solution.

As we emerge from the pandemic, it’s disheartening to observe that “crisis standards of care” have subtly and sometimes insidiously transitioned into everyday post-pandemic practice.

Nurses are entering a profession markedly different from what it was pre-pandemic. The shift to high patient loads not only compromises patient care but also nurses’ well-being. During the pandemic, we experienced an exodus of veteran senior nurses taking early retirements. The essence of nursing care, grounded in safety and empathy, is at risk if we continue down this path.

The implications are clear and ominous. If we accept these relaxed staffing standards as our new normal, we will have sacrificed and succumbed to the normalization of the abuse of inadequate staffing. We will be heading toward a future where burnout, decreased quality of care, and a demoralized workforce become endemic. This is not merely a prediction; it’s a reality that’s unfolding before our eyes. It’s management’s shrugging shoulders when we say we need more staff. It’s the silence and omission of commentary from administrations when we say this is unsafe. It’s the dread before your shift, knowing that your unit is short staffed, again.

If we accept these relaxed staffing standards as our new normal, we will have sacrificed and succumbed to the normalization of the abuse of inadequate staffing.”

In Oregon and California, legislation dictates nurse-to-patient ratios, ensuring that nurses are not overwhelmed and that each patient receives adequate attention and care. These laws are a major testament to proactive healthcare policy advocacy, recognizing the critical link between staffing levels and patient outcomes.

California was the first state to enforce such ratios, and there has been a notable improvement in patient care and nurse job satisfaction. Repeated studies have shown that hospitals with mandated ratios have lower patient mortality rates and fewer complications. Additionally, nurses in these environments report less burnout and job-related stress, leading to lower turnover rates and a more stable workforce.

These states serve as bellwethers, exemplifying how legislated staffing ratios can transform the quality of care. They demonstrate that better, safer staffing models are not just theoretical ideals, but tangibly practical, achievable, actionable standards that significantly benefit both patients and nurses. By implementing similar nurse-to-patient ratios, we can bridge the gaps in our system, ensuring a higher level of care for Washingtonians and setting a further precedent for nurses nationwide. This shift is not merely a luxury; it is a necessity for the future of healthcare, where safety and the quality of care should be a predominant factor.

However, simply an awareness of inadequate staffing, alone, while a substantive first step, is not sufficient to create substantive change. Action is imperative, and nurses are uniquely positioned to drive this change. Our participation in our hospital staffing committees and active engagement with our nursing unions are more than just organizational duties; they are opportunities for powerful advocacy. This advocacy can transform into action—action that produces results.

Legislative advocacy propels our nursing influence beyond the hospital walls, empowering us to mold policies at both the state and national levels. WSNA plays a pivotal role in this realm. Shepherded by the Legislative & Health Policy Council, WSNA vigorously champions the cause, the voice, and the spirit of nurses striving to enhance working conditions and patient safety. Individual engagement in this advocacy pathway enables us, as a collective voice, to champion laws that mandate safe staffing ratios, safeguard patient safety, and bolster nurses’ well-being, working conditions, and retention. Additionally, the Political Action Committee (WSNA PAC) is a steadfast beacon of political positioning with its nonpartisan endorsements and focused contributions to legislative candidates who embrace issues important to nurses.

Having a powerful PAC was crucial for Oregon and California to pass legislation for safe ratios. We will need the same PAC power to effect these changes here in Washington.

As nurses dedicated to the pinnacle of care standards, it’s imperative we leverage these advocacy channels, participate in the process, and use our voices to advocate for ourselves, our patients, and each other. Our expert nursing narratives serve as potent catalysts for policy reform, driving the essential transformations our healthcare system desperately needs.

I urge you to reach out to your local unit officers, initiate engagement, and become a part of the solution. The world is run by those who show up. Our unions are not just support systems; they are powerful tools for advocacy and change. They only work when you show up. By standing together, we can push for policies that ensure safe staffing levels are not just a pre-pandemic memory, but a restored and improved reality.

As we continue to navigate the post-pandemic world, let us not lose sight of what nursing stands for: care, safety, and empathy. The current trend of understaffing and overworking is not a sustainable path. We owe it to ourselves, our profession, and, most importantly, to the patients we care for to strive and advocate for a return to safe staffing standards. Let this be a rallying cry for all nurses in Washington—to recognize, challenge, and change the status quo. To patch the hull and to keep her sailing safely, the future of nursing depends on our actions today.

Below, you can find the links to donate to the WSNA PAC and find a directory to connect with your local unit officers.

Tristan Twohig works at Holy Family Hospital in Spokane and is a member at large on the Labor Executive Council.