The nurses of this state bear witness daily to the impacts of the nurse shortage. Medication errors can be directly linked to unsafe nurse staffing. Emergency room diversions, which result in increased suffering and a recently reported death, are the result not of a lack of beds but of a lack of nurse-staffed beds. Mandatory overtime, which resulted in a strike at St. Vincent Hospital in Worcester as well as considerable labor strife throughout the commonwealth, exacts a cruel toll on both patient and nurse.

First-hand accounts of the hostile work environment in which nurses labor and the grim consequences of unsafe staffing were presented at Lobby Day (see article on Page 1) in honest and factual testimony by true leaders of nursing. Statewide media coverage including print, radio and television conveyed our clarion call for safe staffing. Local media utilized nurses from their geographic area, enabling the public to see, hear and read the words of their "nurse-neighbor" decrying a health system in chaos and a nurse shortage that is a public health crisis.

Preponderance of evidence

The preponderance of evidence that our health system has failed is present everywhere. Last month, the Institute of Medicine released a report that declared the health care system as "fragmented, broken and unworkable." Commissioner Howard Koh of the Massachusetts Department of Public Health testified at the ER diversion hearings last month that the nurse shortage was a public health crisis. Legislators visited the gathered throng at Lobby Day and spoke of their shared awareness and concern of the present and potential woes in the health care system for patients, their families and nurses. Individual meetings with MNA leadership and legislators confirm the facts of nurses' daily experiences.

Any nurse in this state can identify the root cause of the nurse shortage. It is a work environment that has been systemically engineered on the basis of profit in which the provision of quality, safe care is growing impossible; retention strategies are non-existent and the proven method of recruitment to the profession — recommendation from one generation to the next — is no longer sound advice.

Failure is not an option

In the movie Apollo 13 (a docudrama of an actual NASA experience) the spacecraft had experienced a major accident. At ground control in Houston all major system operators realized the extent of the damages and the dire consequences almost simultaneously. As these reports were verbally communicated to the ground crew commander in Houston, disaster was in the air. He replied, "Do not tell me what we don't have…tell me what we do…. failure is not an option!"

We are facing a disaster. And frankly, for our patients, their families, and nurses: Failure is not an option.

Here's what we do have:

1. Safe staffing legislation filed that will be debated and deliberated in this legislative session.

2. Nurses with a keen awareness that they are bound legally, morally and ethically to advocate for patients .

3. A membership with a rising consciousness that to be a true patient advocate necessitates being a true political/nurse activist.

4. An MNA poised to commit major resources, a committed membership to formulate a grassroots campaign, talented staff, time and money to win passage of this bill.

5. Natural allies invested in the positive outcomes of the safe staffing legislation.

6. A state facing a major political campaign season that will entail not only major statewide offices, but also federal positions and a block of committed, caring voters that favor safe staffing legislation.

Bringing it home

The process to ensure successful passage of the safe staffing bill begins now. Each nurse must commit to a plan for success given the appreciation that we all have strengths and unique relationships and roles in which we function.

For some nurses this means:

a. beginning to have conversations on the importance of passage of the safe staffing bill in our homes, neighborhoods and informal community gathering places like the supermarket and the line at the local pharmacy.

b. gathering more formal information and leafleting their colleagues in work and community settings, disseminating information at the PTA meeting or the senior center for aging, the local chamber of commerce meetings and town meetings.

c. willingness to "take the show on the road" and write letters and op-ed columns; to be ready and willing to engage the media.

d. testifying, attending meetings and lobbying.

Which role do you choose now? How many of the above roles do you want to fulfill? Pick one of these and do something. Success will take every one of us.

Not on our watch

The ability of the NASA crew to bring home the spaceship rested not only in their genius and dogged determination but also in the undeniable fact that no one else was available to do the job. This was their watch. Well, this is our watch. The abdication of our responsibility to advocate for our patients for safe, quality care and the demise of our profession is not going to happen on our watch. The future integrity of our profession and the safety of our patients depends on our ability to act. And yes, failure is not an option.