By Kris Hundley
St. Petersburg Times
February 17, 2010

Before Gwen Collins headed to Tallahassee this week to ask lawmakers to limit the number of patients each hospital nurse cares for, she asked her fellow RNs at St. Joseph's Hospital in Tampa if they had a message to convey about their workloads.

Their response: "Tell them this is madness."

"Nurses want to see safety for patients and sanity for themselves," said Collins, a registered nurse who has heard similar sentiments from burned-out nurses at hospitals throughout the country. "They want to make sure mistakes are not made."

Patients who have wondered why their call button isn't answered aren't the only ones frustrated with the status quo. With medical errors in U.S. hospitals causing up to 98,000 deaths and 400,000 drug-related injuries each year, registered nurses across the nation are pushing for laws that would mandate higher staffing levels. Florida nurses, who have seen similar efforts go nowhere during the last two legislative sessions, are organizing to try again.

On Wednesday morning, about 175 nurses from throughout the state, including 33 from the Tampa Bay area, rallied across from the Capitol wearing red scrubs and coats. They were in town to lobby legislators to support a bill that would establish nurse-to-patient ratios based on patients' acuity. In the intensive care unit, that would mean no more than two patients per nurse; in the emergency room, the ratio would be one nurse for every four patients. The bill would also guarantee whistle blower protection for nurses who expose unsafe conditions.

Florida is one of about a dozen states seeking to follow the lead of California, where an aggressive nurses' union pushed through patient ratios in 2004 over protests from both Gov. Arnold Schwarzenegger and the state's hospital industry. In Florida the effort this year is being led by the new state chapter of the National Nurses Organizing Committee, an affiliate of the California Nurses Association.

Florida's Hospital Patient Protection Act is sponsored by Rep. Oscar Braynon (D-Miami Gardens) and Sen. Tony Hill (D-Jacksonville), both of whom acknowledge the bill faces an uphill battle. Braynon sponsored similar bills during the last two sessions. "At least we want to put it out there again to educate people about the full nature of what nurses are going through," he said.

Nurses can expect opposition from their employers, according to Bruce Rueben president of the Florida Hospital Association.

"Hospitals face widely varying peaks and valleys in terms of the number of patients and their acuity levels," he said. "It makes more sense for nurses and management to work together to determine the most effective staffing."

The California experience, which Rueben said is seen by hospital officials as an example of what not to do, has had mixed reviews. California hospitals have complained about the difficulty of meeting rigid staffing standards and blamed the law for longer wait times in the ER and higher costs.

Though nurses say it's cost-effective to put more RNs at bedside, where they can work to prevent infections and bedsores, independent studies have found no change in length of stay or adverse events in California's hospitals since the ratios went into effect.

But nurses from the Tampa Bay area who went to Tallahassee say the existing situation, where hospitals cut staffing to cut costs, jeopardizes patients as well as nurses, whose licenses are on the line.

Tina Bauer, a nurse at St. Anthony's in St. Petersburg, usually cares for six or seven patients recovering from orthopedic surgery.

"If you're giving pain meds to six patients, somebody's going to have to wait and that last person is not thrilled," said Bauer, a nurse for 33 years. "If you have to help feed a patient recovering from shoulder surgery, by the time you get to the last patient, they're going to be quite perturbed."

Cheryl Lecher of St. Petersburg has worked as a contract nurse in several hospitals in the Tampa Bay area and is currently on assignment at a South Florida hospital. After three decades in nursing, Lecher has seen increased reliance on technology and lower-skilled aides as her patient load rises.

"On any given day, nurses are catching five to 10 errors, with patients being given the wrong drugs or drugs being given to patients with certain allergies,'' Lecher said. "The buck stops with the nurse when she's handing that pill to that patient. It's overwhelming."

And nobody can tell Collins, the nurse from St. Joseph's, that California's hospital care has not improved. She recently spent five years as a contract worker at hospitals nationwide. In California, she had four patients in a post-operative/telemetry unit. At St. Joseph's, she's routinely assigned six post-surgical patients.

"In California, I had time to teach patients and do good charting," she said. "Here people are constantly rushing to get the orders done."