On Aug. 27 the Bangor Daily News reported that the Maine State Nurses Association will re-introduce a bill to mandate nurse-patient ratios in Maine in December. This was followed on Aug 28 with an editorial to underscore the seriousness of nursing staffing titled “Compromised compromise.”

Here is my perspective as president of ANA-Maine. I wish the new rules were in effect right now. I agree with the spokesperson from the Department of Human Services who said that it is too early to tell whether the rules change will improve the situation. We need to give those new rules a chance.

I advise your readers to also remember last weekend’s front page article describing how Eastern Maine Medical Center has an unanticipated shortfall in revenue and lower utilization which will lead to a five per cent decrease in EMMC’s budget. This translates into fifteen million dollars.

The hospital industry has been forced to operate within margins of less than 1 percent in recent years. This budget correction is bound to have a major impact. EMMC has many excellent nurses and doctors. EMMC employs about a thousand registered nurses.

What was it like to be at work at EMMC last weekend? I am sure the fears were escalating among the employees. Will this adjustment mean that workers are laid off? where will cuts be made? by whom? what services will be adjusted? This kind of speculation can cause anxiety and a feeling of powerlessness. Nobody wants to step forward to complain because they may feel the risk of being labeled as a disgruntled employee and would worry about retaliation. I would not be surprised if the lobbyist in Augusta spoke out, referring to the pending rules, just for the purpose of “taking the heat.” It might allow those in Bangor to avoid getting personal. Here is a case where the BDN is serving an important function as the court of public opinion. I congratulate the BDN for keeping focus on this issue, and it deserves future attention.

The actual content of the staffing rules and their adoption was not accurately portrayed, but let’s not get bogged down in minutiae – and the staffing rules are a sideshow to the budget cutbacks right now. The public needs to know that continued instability in the nursing work force is a public health threat. The BDN editorial writer is correct to inform us that the number of RNs working in a given hospital will have a direct effect on the outcomes of the patients. With fewer RNs there are more errors. More corners are cut.

Less well-staffed hospitals experience more infections and adverse consequences, and less well-staffed hospital are more likely to experience an effect known euphemistically as “failure to rescue.” Ten acute patients per registered nurse is too much – no matter which set of rules you are using.

Statewide, we are in a paradoxical situation right now. On the one hand, everyone agrees that there is a nursing shortage. On the other hand, hospitals throughout the state are under enormous pressure to control costs. From recent headlines in the BDN we see many hospitals in the red – Machias, Rockland, Blue Hill, MDI, Farmington. And so on.

The root cause is hospital funding and priorities. The state budget crisis. Using HMOs to control costs. Private insurance companies pulling out. Maine’s aging population. The federal government imposing unreasonable paperwork on all of us until we prove we are not committing fraud. Employees in the health care industry are no longer secure in having jobs or health insurance. Even the nurses who love their job have rents and college tuition bills to pay.

No nurse on the front lines should wait until December. Here is an action plan for every nurse in Maine:

1. All nurses need to call their local legislators. Tell them what it is like in hospitals right now. Help your legislator with the math. In eight hours there are 480 minutes. If there are 10 patients, divide 480 by 10 to equal 40 minutes per patient with half going to paperwork. That leaves 20 minutes per patient to get and give end of shift report, communicate with doctors, the lab, the pharmacy, transport, housekeeping, etc. and, oh yes, provide nursing care and monitor the condition of acutely ill patients. Ask your legislator if this gives each patient enough time with an RN. It’s not as if every patient needs one to one care – but how about an extra ten minutes per patient?

2. Learn the political jargon and what it means. “affordable health care” is not the same as “universal health care” for example.

3. We need to identify and

support candidates who will put the patients first.

4. Nurses have a political action committee, and ANA-PAC plans to announce some Maine endorsements in the near future. We urge you to contribute to ANA PAC so as to continue this work.

5. The nursing profession in Maine needs to re-organize and re-energize. Somehow we have gotten into a mode where every nursing issue gets pigeonholed into “labor vs management.” What we are really talking about is the care that your mom or dad or child will receive when they are sick. We need to get beyond this and to collaborate. We all have a stake in the health of hospitals. We need a grass-roots mechanism by which nurses can support the best patient care for all Maine citizens. That’s where ANA-Maine comes in. We will hold a statewide meeting in Portland on Oct 5 and we invite all nurses to be there that day. We will develop an agenda to address the root issues. To learn more and to register for this event go to www.anamaine.org/.

Joe Niemczura, RN, MS lives in Ellsworth. He is president of ANA-Maine, part of the American Nurses Association. He can be reached at josephn@acadia.net.