Assessing Nursing Staffing Ratios: Variability in Workload Intensity

Source: Valda V. Upenieks, Jenny Kotlerman, Jaleh Akhavan, Jennifer Esser, Myha J. Ngo, Policy, Politics, & Nursing Practice, Vol. 8 no. 1, February 2007
(subscription required)

In 2004, California became the first state to implement specific nurse-to-patient ratios for all hospitals. These mandated enactments have caused significant controversy among health care professionals as well as nursing unions and professional organizations. Supporters of minimum nurse-to-patient ratios cite patient care quality, safety, and outcomes, whereas critics point to the lack of solid data and the use of a universally standardized acuity tool. Much more remains to be learned about staffing policies before mature links may be made regarding set staffing ratios and patient outcomes—specifically, how nurses spend their time in terms of variability in their daily work. This study examines two comparable telemetry units with a 1:3 staffing ratio within a California hospital system to determine the relative rates of variability in nursing activities. The results demonstrate significant differences in categorical nursing activities (e.g., direct care, indirect care, etc.) between the two telemetry units (X² + 91.2028; p ≤ .0001). No correlation was noted between workload categories with daily staffing ratios and staffing mix between the two units. Although patients were grouped in a similar telemetry classification category and care was mandated at a set ratio, patient needs were variable, creating a significant difference in registered nurse (RN) categorical activities on the two units.

Shafted: How the Bush Administration Reversed Decades of Progress on Mine Safety

Source: Ken Ward Jr., Washington Monthly, Vol. 39 no. 3, March 2007

…More than five years later, the Bush Administration can claim that, indeed, no more terrorist attacks have occurred on American soil. But its record on mining safety is decidedly more troubling. As of mid-January of this year, 165 coal miners had been killed on the job since the Jim Walter disaster…. While administration supporters can point to a steady drop in the number of coal mining deaths through 2005, when a record low of twenty-two occurred, those numbers don’t tell the whole story…. [Elaine] Chao’s promise to the families of Brookwood was not, as many probably assumed, a call for tighter rules and stricter enforcement. Instead it was a signal for greater cooperation with mining companies. Under the Bush appointee Dave Lauriski… he filled the agency’s top jobs with former industry colleagues, dropped more than a dozen safety proposals initiated during the Clinton administration, and cut almost 200 of the 1,200 coal mine inspectors. Mine-safety experts have linked many of these actions to the causes of deadly mine accidents since 2001.

Remembering Norma Rae: Why is the Working Class Invisible in Movies Coming Out of Hollywood Today?

Source: Robert Nathan and Jo-Ann Mort, The Nation, Vol. 284 no. 10, March 12, 2007
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“Unionized” isn’t a word you hear in many American movies. “A decent wage,” now there’s a phrase that doesn’t crop up too often. As for the evocative “your lives and your substance,” poetic descriptions of the human condition aren’t generally found in contemporary entertainment.

The Care Crisis

Source: Ruth Rosen, The Nation, Vol. 284 no. 10, March 12, 2007

For four decades, American women have entered the paid workforce–on men’s terms, not their own–yet we have done precious little as a society to restructure the workplace or family life. The consequence of this “stalled revolution,” a term coined by sociologist Arlie Hochschild, is a profound “care deficit.” A broken healthcare system, which has left 47 million Americans without health coverage, means this care crisis is often a matter of life and death. Today the care crisis has replaced the feminine mystique as women’s “problem that has no name.” It is the elephant in the room–at home, at work and in national politics–gigantic but ignored.

Mother Load: why Can’t America Have a Family-Friendly Workplace?

Source: The American Prospect, Vol. 18 no. 3, March 2007

Values Begin at Home, but Who’s Home?
In the struggle to balance work and family, work is winning.
By Heather Boushey

The Architecture of Work and Family
To have a job and a life, we need to redesign the national household.
By Ellen Bravo

What Do Women and Men Want?
Many of the same things — but our system contributes to gender conflicts over work, parenting, and marriage.
By Kathleen Gerson

The Opt-Out Revolution Revisited
Women aren’t foresaking careers for domestic life. The ground rules just make it impossible to have both.
By Joan C. Williams

Responsive Workplaces
The business case for employment that values fairness and families
By Jodie Levin-Epstein

Setting a Low Bar
By Ann Friedman

Atlantic Passages
How Europe supports working parents and their children.
By Janet C. Gornick

What About Fathers?
Marriage, work, and family in men’s lives.
By Scott Coltrane

The Mother of All Issues
What it will take to put work and family on the national agenda.
By Tamara Draut

Related Web-Only Content

Fighting Apart for Time Together
Why is all the activism for work/life balance split along gender lines? By Courtney E. Martin

Grade Inflation
Too many magazines and organizations set a low bar for honoring “family-friendly” companies. By Ann Friedman
A shorter version of this piece appeared in the print edition of the Mother Load special report.

What a Load
In the discussion about achieving work/life balance, men are getting a free pass. By Linda Hirshman

Father Load
A TAP Exchange on the role of fathers in achieving work/family balance. By Kathleen Gerson, Courtney E. Martin, Brian Reid, and Linda Hirshman

Pleading Their Case
Can “Family Responsibilities Discrimination” lawsuits change the workplace? By Jeanine Plant

Just Jobs? Organizing for Economic Justice

Source: Race Poverty and the Environment: A Journal for Social and Environmental Justice, Vol. 14 no. 1, Spring 2007

One doesn’t have to possess an advanced degree in economics to see that there is something definitively out of alignment when it comes to job creation in the United States. Multinational corporations with no national, much less local, allegiances are given billions of dollars in tax subsidies in a shell game, which moves an ever-shrinking number of manufacturing jobs from city to suburbs, and state to state. Big box retail stores are destroying locally owned small businesses in shopping districts across the country, and the largest employment growth is taking place in low-paying service sector jobs. Real wages are stagnant and fundamentals, such as overtime pay, health insurance, retirement benefits, job security, even regular paid vacation, are swirling away at hurricane speeds.

Articles include:

Economy in Crisis
· The Fight for Quality Jobs: Our Battle Against Neoliberalism
· The Great Corporate Job Scam: Money for Nothing
· The Economic Crisis Ahead
· Fastest Growing Jobs of ’06: Are You Handy with Bedpans and Brooms?
· Are Bad Jobs Good for Poor People? The Wal-Mart Question
· Healthy Jobs for All: What Will It Take?

Economy in Transformation
· Rising from Below: Immigrant Workers Open New Organizing Fronts
· Blacks and Immigrants: More Allies Than Adversaries
· The Poor People’s Campaign: Non-Violent Insurrection for Economic Justice
· Black and Brown: The United Colors of Low-Wage Workers
· Flint
· Paving the Road Out of Poverty

Economic Impacts
· Rooted in Slavery: Prison Labor Exploitation
· Toxic Sentence: Captive Labor and Electronic Waste
· Racism in United States Welfare Policy
· From Welfare to Low-Wage Work
· Home Is Where the Work Is: The Color of Domestic Labor

Organizing
· Worker Centers
· The Workplace Project
· No Justice, No Growth: How L.A. Makes Developers Create Decent Jobs
· Sweatshops on Wheels: Union-Community Coalition Takes Aim at Port Trucking
· Sewing Alliances: Anti-Sweatshop Activism in the United States
· Growing Local Food into Quality Green Jobs in Agriculture

Case Studies
· Health Industry Jobs Help Build Healthy Economy
· Green Jobs Corps in Oakland
· Painting Boston Schools for a Fair Wage
· Quality Work Through Self-Employment
· One Million Good Jobs
· Work Work Work

The Color of Care

Source: Nina Williams-Mbengue and Steve Christian, State Legislatures, Vol. 33 no. 4, April 2007
(subscription required)

Legislators are seeking answers to difficult questions about race and child welfare.

Thirty-three percent of kids in foster care are African American, but they make up only 15 percent of the child population. Yet federal studies indicate that child abuse and neglect is actually lower for black families than it is for whites.

Our Fractured Fiscal System

Source: Carl Tubbesing and Vic Miller, State Legislatures, Vol. 33 no. 4, April 2007
(subscription required)

Fiscal relations between the states and federal government may be at an all-time low.

For two decades, unfunded federal mandates have symbolized the growing fracture in state-federal fiscal relations. Most legislators can readily name the current offenders—the Individuals with Disabilities Education Act, No Child Left Behind, the Help America Vote Act and homeland security. And they are girding for the possibility of the next huge one, the Real ID act. The National Conference of State Legislatures estimates that the federal government has shifted $100 billion in costs to states over the past four fiscal years—not including the $11 billion that Real ID could cost states over the next five years

Avoiding Jail Pays Off

Source: Sarah Steverman and Tara Lubin, State Legislatures, Vol. 33 no. 4, April 2007
(subscription required)

Diverting people with mental illnesses out of prison takes commitment from the community along with adequate funding.

Community mental health care can be costly, but it is far cheaper for states than incarceration. It costs around $26 a day to treat someone in a community mental health program, but it can cost more than $65 a day to keep them in jail. And states can tap federal resources to help pay for community mental health services. The vast majority of prison costs, however, falls on the state.