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These states are not alone in their fight to institute safe staffing. Unions in Michigan, Minnesota, and Oregon and other states have won contracts with hospitals that either set exact ratios or give nurses input on staffing guidelines.

Additionally, unions in Philadelphia, northern Michigan, Honolulu, and Long Island, N.Y., among others, have held hospital strikes to try to win contracts limiting patient loads for nurses.

Due to the growing concerns for patient safety, New Jersey and West Virginia have enacted laws to eliminate mandatory overtime for nurses. A similar proposal in Iowa is gathering momentum.

New Jersey This bill, signed into law February 21, 2004, orders hospitals, nursing homes, and home care providers to ban forced overtime, except during "unforeseeable emergent circumstances." The law, which goes into effect next year, mandates a 40-hour workweek for nurses and other workers, "beyond which the employees cannot be required to perform the overtime in order to safeguard their health, efficiency, and the general well-being" of patients.

West Virginia This new law which was passed just days after New Jersey’s statute, bans forced overtime for nurses who work in private hospitals, except in emergencies or when required to complete a procedure. Under the measure, nurses must have at least eight hours off after working more than 12 hours at any of the state’s 60 private hospitals.

Iowa Inspired by these victories in West Virginia and New Jersey, RNs in Iowa lobbied lawmakers February 25 in favor of a law that would eliminate mandatory overtime and establish nurse-to-patient ratios.

The purpose of these laws is to address the growing crisis in patient care caused by managed care and market-based decisions on hospital care that resulted in a growing exodus of RNs out of hospitals, creating a serious nursing shortage.

The real key to meeting the ratios is for hospitals to hang on to the RNs they already have. Many union-represented hospitals have taken big strides by enacting significant improvements, through collective bargaining, in retirement security, compensation, and improved patient care conditions.