Where I Stand—Mike O’Callaghan: A dangerous situation

Friday, June 22, 2001 | 3:52 a.m.

Mike O'Callaghan is the Las Vegas Sun executive editor.

THE 2001 Nevada Legislature made an attempt to relieve the shortage of nurses in our state. Their efforts can be compared to spitting on a forest fire hoping to put it out. Their good intentions, by providing funds in AB378 and additional dollars for WICHE, should be applauded, but 20 or 30 scholarships won't get the job done. Lately not too many talented young people are eager to enter this honorable profession. Certainly there are fewer entering than the number leaving every year, and as the demand increases even larger numbers from the baby boomer generation of nurses will be retiring.

When asked about the actions taken by the 2001 Legislature, a well-informed Nevada nurse told me: "Nurses who voiced concerns about how downsizing and work re-design were affecting their ability to provide patient care were commonly told, "If you don't like it, leave." And many did. The Nevada Nurses Association has been telling lawmakers for over seven years that if changes were not made in working conditions and staffing levels, and nurses continued to leave at current attrition rates, we would have another nursing shortage.

The shortage of hospital nurses isn't a new problem. Almost 20 years ago the problem was discussed in the Legislature and in Nevada's press. The pressure was on but then the issue was put on the back burner. Why? According to the Nevada Nurses Association:

"In fact, the Nevada nursing shortage in the late '80s was never resolved; it was overshadowed by the downsizing in California hospitals that resulted in the layoffs of thousands of California nurses who then migrated to Nevada. It was also coupled by the downsizing and work redesign in Nevada hospitals, which decreased our need for nurses.

"California has recently passed a law requiring their State Board of Health to develop mandated minimum nurse-to-patient ratios to correct understaffing/patient care problems. When developed, these laws are likely to result in a mass migration of Nevada nurses TO CALIFORNIA. Adding fuel to this migration is the much higher pay scale for nurses in California."

The nursing shortage isn't just a Nevada problem, it is a national problem of great importance. Basically it is not a problem legislators, at any level, can solve completely. It can only be solved by hospitals meeting the needs of nurses who are employed by them. Large numbers of nurses are leaving hospitals and finding better working conditions and more professional satisfaction practicing in health care organizations, physicians' offices and home health care jobs.

The downsizing of nursing staffs in hospitals has put unbelievable pressure on the smaller staffs remaining on the hospital wards. One nurse told me that because of a lack of help in a local intensive care unit she was afraid she would eventually lose one or more patients. She is no longer a hospital nurse.

A 1999 William M. Mercer report tells us that the South and West have the most serious nurse turnover problems. The report notes the following:

"Asked the primary reason for nurse turnover, the largest number of respondents said, 'Increased market demand.' But while market demand makes it easier for employees to find a new job, it generally doesn't make them unhappy enough to start looking. In Mercer's experience the underlying cause of turnover is dissatisfaction with the job, the supervisor or career prospects. Therefore, employers concerned about turnover should examine their own practices and work environment in the context of corresponding factors in the external market."

State funding of nursing scholarships is a positive step forward, but in the long run it won't solve a problem created by large firms more concerned about the financial bottom lines of their hospitals than they are about the professional needs of nursing staffs.

Nevadans would be wise to watch between now and when the 2003 Legislature meets, to see the overall effect of the California law mandating minimum nurse-to-patient ratios. There's no doubt Nevada's nursing shortage will be greater in 2003 than it is today.