Do you know who first pushed for hand washing to prevent infection?

Florence Nightingale, one of the most important nursing pioneers. Outspoken and forward thinking, she changed the face of nursing by teaching that hand washing prevents infection. Her knowledge and attitude created a cascading effect, empowering nurses to advocate for more sanitary conditions.

As we navigate the covid 19 pandemic it becomes increasingly obvious that another challenge to nurse empowerment affects patient care: nurse staffing.

I’ll give you an example that is true even without taking the pandemic into account. I work in a surgical trauma intensive care unit. I care for patients who have experienced terrifying, painful and life-changing events. Due to the severity of illnesses, often these vulnerable patients cannot make health care decisions or advocate for themselves.

I come in to work ready to care for patients and their families. On a typical day, ICU patients are assigned two patients to each nurse. I can tell you that there is rarely a typical day. Last week I walked into work ready to take on my 2:1 assignment when I realized… all those texts coming in since 5am asking for another nurse had changed nothing. We were short staffed. We had to “Make it Work” Tim Gunn Style.

Amanda Buechel BSN, RN, CCRN
Amanda Buechel BSN, RN, CCRN

Because of being understaffed we were in a quandary during morning report. We had some severely critical patients who required a huge intensity of care and should be 1:1 with a nurse, but should we double them up? Should someone take three patients? Should the charge nurse take a patient? No decision would be ideal, but, knowing our patients, some choices were less ideal and would be more likely to lead to errors. Errors in the ICU are very serious. From the back of the room I offered up a solution: I could take three patients. I had worked with two of our two less acute patients from the day before. Instead of learning everything about them, I would only need to review their charts from the previous eleven hours. I could also take on a patient prepping to discharge. With this solution, our severely critical patients could stay 1:1. No one was sure it would work out, but, with some deliberation, we decided to try. I, as a nurse with knowledge of how our unit works and what was happening there, was part of the decision around how to best staff the unit. I impacted staffing and, thus, outcomes for my patients.

This is what we do as nurses. We continually think about our patients and what is best for them. After we made the staffing choice, I received report on my three patients, ensured the ones that could not feed themselves ate, talked to one about necessary seizure-prevention meds, took another to surgery, updated families and discharged the third home. All in a day’s work. As a nursing unit we stayed fluid in our staffing decisions, empowering nurses to be decision makers, and our patients benefited. 

Every single person is affected by nurses. Nurses look at patients in a holistic manner that covers every constantly-changing aspect of patient acuity, their specific needs.  To have the best possible quality of patient care, nurses need to have input into how they provide care on a daily basis.  SB 3636 empowers nurses to be flexible in a field that is not static. 

My offering ideas around staffing last week is one small example of positive outcomes the enhancement of our profession brings forth for patients and for healthcare. Most patients are not aware that staffing choices are an issue. However, they still feel the effects. Support of nurse staffing enhancements needs to be well rounded. SB 3636 provides well-rounded guidelines for enhancement of our profession. These are guidelines that allow healthcare facilities to  best navigate day-to-day challenges, as well as respond to emergencies–like the COVID-19 pandemic.

What a 200th birthday present this bill would be for Florence Nightingale. 



Amanda Buechel BSN, RN, CCRN
Surgical Trauma Intensive Care Registered Nurse
Oak Forest, Illinois