Regarding the online news brief "International survey links nurse, patient satisfaction" (Nurse.com/Article/International Survey), after 32 years, I have left direct care nursing. I have written the top scholars, policy people, ANA, Magnet and at best got a sympathetic response.

To make a long story short, there is no accountability for poor managers. While nurse-sensitive indicators is a buzz word being thrown around, the measures on manager quality are too indirect.

I have championed accountability, written managers up, reported hospitals and fought the good fight. Until hospitals stop protecting these managers and nurses start speaking up, it will never change.

— Name withheld
Houston