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January 8, 2001

Valuable resources
I enjoy each issue of NurseWeek and decided to pull up the Web site, reread and print out "Quiet Epidemic" (Dec. 4, Calif.; Nov. 27, Texas) to share with the family of a Type 2 diabetic I am helping to manage.

As the author points out, nurses are valuable resources for patients. Often, the physicians spend little time educating diabetics once they are diagnosed. What the patient is told is many times forgotten, because the first news of diabetes is met with a sort of shock.

We need to include the author’s information regarding the increase in children developing Type 2 diabetes and stress the importance of nutritional behavior and exercise modifications.

Staffing ratios controversial
I would like to respond to the Editor’s Note, "Staffing Ratios: Be careful what you wish for" in the Dec. 4 issue. I would like to ask the author, Carol Bradley, whose side she is on? I would also like to know how she thinks nursing in the ’70s is anything close to what it is today. HMOs calling the shots on patient care and a much sicker and more educated, savvy consumer of health care are two of the numerous variables that make nursing much more "challenging" than ever.

I cannot fathom how it can be construed that staffing ratios are a "just punishment for the rare hospital that is ignoring or abusing its moral or legal responsibilities to quality patient care by grossly understaffing for financial benefit." I have yet to see a hospital that does not push the envelope when it comes to safe staffing.

Nurses are constantly faced with the dilemma of accepting unsafe assignments or losing their jobs. I would venture to say that "safe staffing" is in the eye of the beholder and almost always structured by someone with an office job who does not perform patient care.

With minimum staffing ratios (providing these standards are reasonable), a nurse has a legal and valid argument when rejecting an unsafe assignment. As it stands now, there is only a nurse’s subjective opinion, which as we all know carries little weight in a hospital setting.

Finally, the comment that implementing staffing ratios could "give the impression that nurses are not able to handle their own power and ability to influence" makes me wonder where this author’s concerns lie. Shouldn’t the concern be safe staffing and not impressions? Besides, nurses have traditionally been poor at organizing and taking care of business, and taking care of themselves. When you consider there is strength in numbers, and nurses account for the majority of employees in any given hospital, we should have taken care of this staffing ratio problem a long, long time ago.

Making a difference
I enjoyed reading the article "Breathing Easier" (Dec. 18) and seeing what is available in other cities. Here in Tulsa, Okla., I work for Good Samaritan Health Services. We have a 35-foot mobile medical van. We take the van to six different sites, usually low-income housing areas, and provide free medical care to the indigent in our city. So I know firsthand the impact that can be made in one’s community.

Adriana Cunningham, RN
Tulsa, Okla.

Million Nurse March update
I am one of the dedicated nurses organizing the Million Nurse March. I would like to begin by thanking you for your article "The Long and Winding Road" (Nov. 27, Texas; Dec. 4, Calif.).

However, the information posted was not entirely correct. The Million Nurse March idea sprang from a post on a www.allnurses.com bulletin board. We now are established as a nonprofit organization, The Million Nurse March Inc.

Our mission statement is as follows:

In May 2002, 1 million nurses, allied health care workers, legislators, public figures and private citizens will converge upon the Capitol Mall in Washington, D.C. as one collective, formidable voice to openly and honestly present the facts about the state of health care delivery in this country. The march to Washington will be the culmination of one and a half years of grassroots efforts by committed nurses, health care workers and citizens to educate the public about safe and appropriate health care delivery. The MNM will be the sentinel event in the promotion of positive, proactive, productive and sustainable changes in health care delivery in the United States.

The mission of the Million Nurse March is:

• To encourage and support meaningful dialogue among all health care workers about: working conditions in hospitals, long-term care facilities, clinics and anywhere nursing is practiced; safe nursing care, including the risks to patient/client safety; staffing levels and mandatory overtime; and the increased demand for nurses.
• To improve existing attitudes and traditions established between and among nurses and health care workers.
• To motivate all health care workers to act locally and nationally.
• To facilitate public awareness concerning safe and unsafe health care delivery.
• To encourage the media to represent accurately and vividly the issues nurses and allied health care workers face every day when care is delivered.
• To involve our elected officials in meaningful and sustainable change in health care delivery.
• To serve as a resource for accurate data and information exchange about nursing care delivery.
• To encourage and support recruitment and retention of new nurses into the profession.

We are planning to march on the Mall in Washington in May 2002. We are planning to remain as an alternative voice for nurses and health care workers.

We have evolved and multiplied. There have been differences in opinion and revelations among us, yet we press on.

We want the public to know that we are an all-inclusive, grassroots campaign and organization. The Million Nurse March is an independent, grassroots, chapter-based organization. We are not affiliated or aligned with any nursing or non-nursing organization, association or union. We are the voice of active caregivers speaking out about health in the 21st century.

We are open to all volunteers who want to be involved under the mission, purpose and goals of this organization.

Fight back
I pulled this article up ("The Long and Winding Road") after speaking with a friend who is a nurse in the Miami area. I was shocked and horrified at what he told me about the conditions at the hospital where he works. He didn’t even know he had options. I think articles about how nurses can fight back against unsafe working conditions are essential.

I live and work in Colorado, and when my hospital tried to float me to a unit that I felt I was unqualified for, I fought back and found out what my rights and responsibilities were. I still have my job and am no longer asked to float to units that I am not qualified to work in.

Nurses must use the nursing shortage to make conditions safer. Sometimes, it means taking a stand and making sacrifices, and I was prepared to be written up or even fired, but I stuck to my guns because I knew I was right.

Nurses need to read their nurse practice acts and know what they are liable for. You can’t be forced to do something that you could lose your license for. Nurses also need to remember that adverse publicity is something that hospitals will go to great lengths to prevent. There are regulatory agencies that hospitals must answer to. The bottom line is money, and if the hospital is going to lose money by an action, they will rethink that action.

A second look
The article "Roads Less Traveled" (July 24, Texas; July 31, Calif.) was very encouraging. I know I have thought about many of those various nursing careers throughout my years in nursing, but sometimes I forget what skills I really do have with more than 25 years of nursing experience.

Dee Rose Rathke, MA,RN
San Antonio, Texas

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