State health panel discards plan to impose nurse ratios

Michelle Swafford

Wednesday, April 14, 2004 | 10:36 a.m.

A Nevada legislative subcommittee rejected unanimously Tuesday a proposal to require nurse-to-patient ratios, which was welcome news to many in the health care field who testified against the proposal.

The Legislative Committee on Health Care Subcommittee to Study Staffing of the System for Delivery of Health Care in Nevada rejected mandatory ratios after several health professionals testified that ratios tied only to the number of patients and nurses don't necessarily improve the quality of care and would cost both hospitals and patients. Currently, Nevada hospitals say they set staffing based on patients' conditions.

In the last subcommittee meeting held in February, staff nurses -- some of which were members of the Service Employees International Union Local 1107 -- and contract nurses, who work for several hospitals, testified that ratios would alleviate some of their high-patient loads and long shifts, which is why the recommendation was being considered by the subcommittee.

"We're going to fight to win this in the corporate board rooms through contracts and we're going to fight to win this at the state capital because it ought to be legislated," said Jane McAlevey, executive director for SEIU Local 1107. "The truth of the matter is there is nobody more qualified to talk about how to improve the quality of care than bedside nurses. Bedside nurses are overwhelmingly calling for ratios."

The SEIU fought to have ratios passed in California for 10 years, McAlevey said.

The Legislature's health subcommittee did recommend other proposals that will be referred to the Legislature's full health committee. Staffing ratios could be debated again by the full Legislature -- a debate welcomed by nurses favoring the proposal along with nurses' union officials.

Mandatory nurse-to-patient ratios were implemented in California Jan. 1 to improve the state's nearly last rank for its nursing ratios. Nevada currently ranks last in the nation with 520 nurses per 100,000 people.

Bill Welch, president and chief executive of the Nevada Hospital Association, has been studying the impact of ratios in California and has been speaking publicly against ratios for Nevada.

California hospitals invested $5.3 million per hospital to implement ratios and they've had to close 39 percent of their beds because there weren't enough nurses to meet the ratios, Welch said.

"If California's health care industry is experiencing these types of challenges, what can we expect in Nevada, given the fact that our growth is faster and our nurse shortage is far more critical?" Welch asked.

He added that Nevada is doing a better job of recruiting nurses than California based on the net gains each state has experienced.

In Nevada, mandatory nursing ratios would require 2,348 additional nurses, or a 33 percent increase to 7,046 full-time equivalent nurses, Welch said. The cost for salary and benefits for those nurses would be $164.4 million to meet existing patient volumes, he said.

He estimated that another $9 million would be needed to recruit the more than 2,000 nurses and $974,420 to retain the nurses.

If the nursing requirements could not be met, which was the case with 39 percent of the beds in California, Nevada hospitals would have to close 2,625 of their 6,729 beds, which equates to about $48 million in lost revenue, Welch said. Closed beds would also mean 6,500 ancillary jobs would have to be cut, totaling $325 million in lost salary and benefits.

McAlevey said nurses in California are returning to the bedside like never before and ratios also are doing well in Australia. She added that there's not really a shortage of licensed nurses, but rather a shortage of nurses willing to work in hospitals.

The Nevada Organization of Nurse Leaders, which represents nurse managers and nurse executives, also opposed mandated numerical ratios because they cannot guarantee a safe work environment or quality patient care.

Michele Nichols, president of the Nevada Organization of Nurse Leaders and chief nurse executive for Valley Hospital, said education and retention efforts are "paramount," along with improving the work environment.

Dee Hicks, chief nurse officer at Sunrise Hospital, said retaining nurses is the key to solving the shortage of nurses in hospitals.

"More effort should be placed on retention," Hicks said.

Sunrise implemented a team approach to care that enables other health professionals to do some of the work done by registered nurses such as respiratory therapists helping with therapy sessions, which improved Sunrise's work environment, she added.

Sandra Cromwell, chief nurse executive for St. Rose Dominican hospitals, said they've been able to retain their nurses by changing the compensation structure and providing additional educational opportunities.

The hospital's turnover rate for nurses dropped from 24 percent in fiscal year 2002 to 18 percent in fiscal year 2003, Cromwell said. To date this fiscal year, the hospital's turnover rate has declined to 12 percent.

Chris Salm, research director for the SEIU Local 1107, said there is a lack of available information on nurse vacancies with local hospitals and more dialogue needs to occur among all the parties.

University Medical Center and Sunrise, Desert Springs and Valley hospitals are represented by the SEIU. There is an effort under way to unionize the nurses at St. Rose Dominican hospitals.

Joan Wells, medical intensive care nurse at Valley Hospital and a member of the SEIU, said nurse ratios have worked in some health care programs in Australia, but she didn't provide any specifics.

She said without nurse-to-patient ratios, "hospitals take additional patients to maximize profits."

Although the Legislature's health subcommittee didn't recommend staffing ratios, it did recommend four other proposals, which will be researched further and presented to the full health committee.

Those proposals include: