Las Vegas Sun

December 21, 2014

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Nurses ask lawmakers for mandatory ratios

Nevada nurses are calling for better working conditions and say one way to achieve that goal is with mandatory nurse-to-patient ratios.

Nearly a dozen nurses and nursing organizations testified before the Legislature's health care subcommittee Thursday with a request for state-mandated nursing ratios and other regulations that could bring former nurses back to the health field.

Improvements in working conditions could prompt nurses who left the industry, dissatisfied, to return.

Currently, Nevada ranks last in the nation for its nurse-to-patient ratio with 520 nurses per 100,000 people, compared with the national average of 782 nurses per 100,000 people.

"Staff nurses believe they are overworked, understaffed (and) with too many acute patients to care for," said Belen Gabato, president of the Philippine Nurses Association of Nevada. "Twelve-hour shifts are debilitating, physically and mentally."

Several studies and nurses say patients get better care when staffing ratios are based on the number of patients as well as the severity of their conditions versus Nevada's system of scheduling nurses based solely on patients' conditions. Neither the studies nor Nevada's nurses provided specific staffing-ratio suggestions, but California was the first state to mandate ratios on Jan. 1 and many nursing groups are waiting to see what happens.

Members of the Service Employees International Union Local 1107 and the Nevada Nurses Association were among the groups in favor of nurse-to-patient ratios.

Joanne Spetz, associate director of the Center for California Health Workforce Studies, said California has seen some negative effects from the mandatory ratios, but it's uncertain if they were directly related to staffing ratios because many of the hospitals were in compliance prior to the new law.

Potential drawbacks to staffing ratios include hospitals eliminating support staff and emergency rooms going on divert status when they are short of nurses, Spetz said.

Also, if nursing ratios are put into place, Medicaid payments and insurance reimbursements would need to be increased to offset the additional staffing costs, she said.

Lillian Gonzalez, a contract registered nurse who works for several Las Vegas-area hospitals, said a number of problems result from being understaffed and dealing with large patient loads. She described a typical night at a valley hospital, which often includes eight patients who need a combination of lab work, medications dispensed, vital signs checked and calls answered for various pains and assistance. In addition to caring for patients, nurses are required to fill out assessments on each patient, which can take a couple of hours.

She said sometimes nurses aren't able to respond to call lights quickly, medications are dispensed late and patients and family members feel neglected as a result.

Efforts are being made in Nevada to increase the number of licensed nurses working in their fields such as doubling the number of positions in Nevada nursing programs, providing scholarships and training foreign nurses to work in the United States.

The nurses at Thursday's meeting said the current efforts are a good start, but more needs to be done to retain current nurses.

Although everyone that spoke referred to a shortage of nurses in the hospitals, one Las Vegas-area hospital official said her hospital is doing well without state-mandated ratios.

Vickie Huber, chief nursing officer for University Medical Center, said the hospital's programs have kept nurse-vacancy rates low. The hospital has 1,200 registered nurses and a 3 percent turnover rate, which is one-fourth of the 13 percent turnover rate statewide. UMC's nurses have been organized by the Service Employees International Union Local 1107 since the 1980s.

Huber said UMC offers a 1 percent bonus for every year a nurse stays with the hospital after five years. It also offers tuition reimbursement and scholarship opportunities, which other Las Vegas-area hospitals also offer.

Other keys to UMC's success include decision-making councils with nursing representation, flexible scheduling with nurse input and a prohibition on mandatory overtime, Huber said.

Also, UMC's recruitment hours have been extended, daycare services are now available through a partnership and nurses receive a finder's fee for referrals, she said.

Each year, the Nevada hospital industry spends about $3.6 million annually in recruitment and retention of nurses, said Bill Welch, president and chief executive of the Nevada Hospital Association.

He said Nevada's average salary for nurses is $25.34 per hour, higher than the national average of $21.56 per hour. That indicates salary is one component, but not necessarily the key component to keeping nurses, Welch said.

Common complaints among nurses and why they are dissatisfied or leave the field include long shifts and high-patient loads. Gabato suggested a return to the eight-hour shift for those who want it and a prohibition on mandatory overtime for all nurses, not just those at UMC.

Currently, nurses can refuse to take additional patients if they feel it will endanger the patients or themselves without being disciplined by the Nevada State Board of Nursing, but an employer can still discipline or fire them for refusing care. The state board has no jurisdiction over employment decisions.

Once nurses accept an assignment, they can be disciplined by the State Board of Nursing for abandonment if they accept a patient's care, leave without getting replacement care and if the patient is potentially or actually harmed as a result of the nurse's departure.

"If we have the right to refuse an assignment, that right should be protected," Gabato said.

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