Where I Stand — Cynthia Bunch: An unhealthy system

Thursday, Aug. 9, 2001 | 10:18 a.m.

Editor's note: In August Where I Stand is written by guest columnists. Today's writer, Cynthia Bunch, is a registered nurse and volunteer legislative coordinator for the Nevada Nurses Association. IN THE MIDST of a health care crisis, nurses and doctors are bailing out of "the system."

We have a severe shortage of nurses and the support personnel they rely on. Now it looks like a shortage of doctors may be on the horizon as well. If you don't know why this has occurred, you need to -- your health may depend on it.

Multiple forces have been driving our local health care system to the brink in recent years. We have the fastest-growing population, and burgeoning numbers of senior retirees. Nursing and medical school enrollments have been declining for several years now, and most of those practicing today are part of the baby boomer generation on the verge of retirement.

As working conditions and job satisfaction continue to decline and stress and fatigue take their toll on the aging bodies of nurses and doctors, many are opting for earlier retirement or other careers. The last decade saw others enjoying a booming economy while nursing and physician pay remained stagnant or dropped. Workloads were doubled, paperwork increased, and the only ones who benefited were the CEOs and executives of hospitals and health insurance companies whose salaries skyrocketed.

Nevada now has the worst nurse-to-population ratio in the United States and the fifth worst physician-to-population ratio. All the experts agree that this is only the beginning of a more severe long-term shortage worsened by the aging and retirement of the vast baby boomers.

The changes that are needed to recruit and retain health professionals remain elusive as industry executives continue their "race to the bottom" with increases in health insurance premiums and further decreases in reimbursements to health care providers. A recent survey of doctors in California showed that almost half planned to leave the medical field within three years. California has long been a bellwether for health care trends as well as a feeder state for Nevada.

Bedside nurses have been hit the hardest as cost-cutting runs downhill. In the early '90s hospitals nationwide began laying off large numbers of nurses, winding down in '95 and '96 when 40,000 nurses were laid off and replaced by 100,000 lower-paid nurses' aides whose average on-the job training was two weeks in length.

Two years later these large hospital chains started lobbying state and federal lawmakers for taxpayer dollars to educate and import more nurses to address an emerging nursing shortage. Many of these same hospitals now offer recruitment bonuses and other insufficient short-term incentives while they watch their few remaining nurses continue to walk out the door.

A recent study sponsored by the National Institute of Health revealed that one in three nurses under the age of 30, and 20 percent overall, plan to quit their jobs within the next year. Another study by the federal government revealed that almost a half million nurses who are licensed in the U.S. are no longer practicing in the field of nursing.

Hospitals know that retaining their nurses will require reducing their workloads, but that would increase their labor budget and lower profit margins. Instead they are choosing to invest their limited resources in capital acquisition, advertising/marketing, the latest in high-tech equipment and expanding and building new hospitals across the valley.

At least one local hospital CEO "gets it," according to many of my nurse colleagues who have migrated to Mountain View Hospital this year. He has chosen to re-allocate his advertising budget and increase nursing and patient care services. He also listens to and knows his staff, and has created a family-style work environment that is likely to increase retention and ultimately lower his personnel costs.

Symptoms of the shortage are now visibly impacting patients. Our hospitals in the north and south have been routinely shutting the doors of their emergency rooms and diverting patients to other facilities. When all facilities are over capacity, patients are lined up on gurneys in the hallways. Some patients remain in the ER for days and surgical patients may find themselves lying in the recovery room waiting for a bed (i.e., a nurse to staff the bed).

Time has run out for needed changes to address this growing public health care crisis. Nurses and doctors would prefer to spend their time caring for patients rather than on the picket lines and at the state Legislature. It is time for employers and executives to listen to those who provide their primary service and act accordingly.