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Understaffed hospitals add more nurses to meet
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By Jabulani Leffall
Staff Writer
California is short on nurses but not patients,
an epidemic that has everyone from hospitals to unions to universities
scratching their heads about how to deal with the deficit.
And while defining and eradicating the nursing
shortage -- that is, uncovering the reasons behind it and coming
up with solutions for it -- remains a contentious issue, there
are two facts that can't be ignored.
In California, there are currently 585 nurses per
100,000 people, the second lowest per capita in the country, just
ahead of Nevada.
The incentive for becoming a nurse isn't as appealing
for young people as it use to be. Nursing is one of few professions
that requires working during evenings, weekends and holidays.
The rigorous schedule can sometimes be seen as a deterrent.
"The average age for a nurse is 47 years old,"
said Jan Emerson of the California Healthcare Association, a group
representing hospitals and other health care industry institutions.
"More nurses are retiring than graduating."
And it doesn't help the situation that two of the
state's most prominent universities discontinued their undergraduate
programs.
UCLA currently doesn't offer an undergraduate nursing
program, having made the undergraduate department defunct in the
mid-1990s. In fact, no University of California campus offers
nursing even though five of those nine campuses have hospitals
and medical schools.
USC closed the doors of its nursing program in
September 2001.
The programs were cut in part because nursing requires
a lot of hands-on clinical instruction, which in turn requires
laboratories and smaller classrooms. Simply put, the programs
are expensive to administer.
"There aren't enough slots in the educational
systems for nurse training at the undergraduate level," said
Marie Cowan, dean of the School of Nursing at UCLA. "There
aren't enough trained nurses in today's high-tech medical environment.
We need more resources from the state to go toward nursing education."
Though the nursing shortage is a national problem,
it's amplified several times over in the country's most populous
state.
The situation became so perilous that California
enacted the nation's first law requiring specific nurse-to-patient
ratios for every unit of a given hospital.
The regulation calls for hospitals to provide additional
and clinically competent nursing staffing to cover for nurses
on breaks. Additionally, every hospital must develop a written
staffing plan based on patient care needs.
However, there aren't any provisions for funding,
according to the California Healthcare Association.
In the San Fernando Valley, where according to
a recently published report the health care industry is on the
verge of collapse, the nursing shortage threatens the ability
of hospitals to meet patient needs while area hospitals contend
that they can't meet the nurse-to-patient ratios that the law
requires.
Valley hospitals say it costs too much to add new
nursing personnel, a sentiment echoed statewide among hospitals.
Currently there is a 15 percent to 20 percent vacancy
rate at the state's 450 hospitals and hiring more nurses will
cost hospitals an estimated $422 million this year, $652 million
next year and $956 million in 2008, according the health care
association.
"Even if the money came straight from heaven,
the nurses just don't exist," Emerson said. "It's gotten
so bad that if a nurse takes a break, there's no one to cover.
Replacing the nurse on the break is an impossible standard to
meet because of the lack of staffing."
But there's another side to the shortage issue
and that is organized labor, which blames managed care and rising
health care costs for the glut of employable nurses.
"We have a profit-driven health care industry
that puts patients at risk by not hiring more nurses at hospitals,"
said Chuck Idelson of the California Nurses Association, which
represents some 56,000 registered nurses statewide. "The
priority should be the patient, and patients need nurses."
Diane Hirsch-Garcia, a registered nurse and union
rep, says the school closures coincided with a mass layoff of
nurses at area hospitals in the 1990s, and that now the health
care industry is complaining about the problem it created.
The union contends that the inception of HMOs convinced
hospitals that there would be little need for nurses because of
the preventive nature of managed care. Subsequently, the union
says, some hospitals told the state there would be no need for
nursing education and that that contributed to the closure of
several programs.
"In addition to layoffs, patients got sicker
because of staffing shortages," Hirsch Garcia said. "The
so-called shortage lies with the hospitals that don't want to
hire nurses that are out there."
Glenn Melnick, professor of health care finance
at USC, said the best solution in the long run is assistance from
the federal and state governments.
"The shortage has been exacerbated by the
ratio law," Melnick said. "And hospitals are pitted
against unions. The government just has to get involved."
And the government has gotten involved to the tune
of more than $60 million to the state's hospitals to meet staffing
ratio requirements. But in a multibillion-dollar industry, the
amount seems paltry -- especially in addressing the shortage.
Meanwhile, all sides appear to be making strides
a little at a time.
After years of cuts in nursing education, the state
has increased capacity in its nursing programs over the past year
and can now admit 6,600 students per year out of 10,000 annual
applicants.
Union president and nurse of 30 years Deborah Burger
says a sizable majority of area hospitals that the California
Nurses Association put pressure on are making a "good-faith"
effort to abide by the ratio law.
To that end, Kaiser Permanente has hired nearly
3,000 new registered nurses. Glendale Memorial and St. Bernadine's
in San Bernardino each brought on 100 nurses. UCLA added 200 to
its staff and Long Beach's St. Mary's and Long Beach Memorial
came up with 100 and 150, respectively.
"For the longest time, we allowed hospitals
and doctors to dictate what nursing was," Burger said. "Now
we've taken it back and we want people to realize once more that
this is a respectable and important profession."
Jabulani Leffall, (818) 713-3699! jabulani.leffall@dailynews.com
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