Nurses say hospital staffing often driven by bottom line

Thursday, Oct. 28, 1999 | 10:07 a.m.

In recent years, registered nurse Theresa Morrow says the number of nurses who work any given shift has more often been determined by budget needs rather than "acuity" needs.

Acuity level is how hospitals measure how much care patients need, taking into account the type of illnesses and how closely their medicine and monitoring equipment must be watched.

Morrow, chairwoman of the Healthcare Oversight Committee of the Nevada Service Employees International Union, said the unsuccessful legislative fight for hospital staffing guidelines publicized the issue and laid the groundwork for the future.

Cynthia Bunch, state and federal legislative coordinator for the Nevada Nurses Association, adds that revised state Board of Health regulations that took effect Sept. 10 may have the same impact as the proposed legislation.

Bunch said the new regulation requires a registered nurse to make the staffing assessment and recommendation, but it's up to the individual hospital to agree to it.

The acuity level of patents will be determined by registered nurses in each hospital, according to the new regulation, and the number of nurses who will be on duty on any given shift will be based on patient needs.

Bunch said the nurse-patient ratio staffing has been identified by the American Nurses Association as "the primary crisis facing the profession."

The ANA has about 2.5 million members throughout the nation. The Nevada Nursing Association has about 14,000 members.

Ann Lynch, spokeswoman for Sunrise Hospital and Medical Center in Las Vegas, said she has not heard of the new Board of Health regulation but that her facility has always taken the level of care a patient needs into consideration when making staffing decisions.

"We've done that since we opened our doors," Lynch said.

She said setting nurse-patient ratio standards is very difficult because needs differ from unit to unit.

"What you do is you figure out with your nursing staff what is your optimum care," Lynch said. "That's the only real way to care for patients adequately.

She warned against laws or regulations that might set specific numbers of nurses who must be on hand at any given time, something that could have dire consequences.

"Who will suffer with set numbers is the patients," said Lynch, whose hospital is one of the biggest in the state. "If you say this (number) is what it has to be, you're going to end up with closed beds or breaking the law. You just can't set staffing numbers in concrete."

She said if nurses aren't available and the law requires a certain number of nurses, "What are you going to do? Throw grandma out in the street?"