State eyes mandatory ratio of nurses to patients

Friday, Jan. 9, 2004 | 11:05 a.m.

CARSON CITY -- In part because statistics indicate that Nevada has the worst nursing shortage in the nation, lawmakers are considering a mandatory ratio of nurses to patients at hospitals. But hospitals are fighting the idea.

The proposal came up at Thursday's meeting of the legislative subcommittee that is studying the health care staffing in Nevada. Most of those who testified Thursday were representatives of hospitals and they opposed mandatory ratios.

Assemblywoman Ellen Koivisto, D-Las Vegas, and chairwoman of the subcommittee, noted that many nurses favor the ratio. Koivisto said there was an "adversarial situation" where there should not be.

Koivisto said the state's goal is "to help with patient care" and that should also be the objective of all the parties.

Bill Welch, Nevada Hospital Association president, testified that was the reason for certain numbers of nurses in critical areas such as in emergency rooms and birthing centers.

But a mandatory ratio for hospitals overall could prove too costly, he said.

The new staffing ratio in California will require four extra nurses per hospital just to cover coffee and lunch breaks, and the California hospital group has filed suit against that regulation, Welch said. He estimated those extra nurses would cost public hospitals $60 million a year, and that does not include the cost to private hospitals.

He said there is no data that show that imposing ratios improves the patient care. But it does increase the cost of health care, said Welch.

Hospitals in Nevada, he said, have been spending $1 million a year in scholarships and grants and other programs for training for more nurses. The hospitals in the state already need about 800 nurses a year to keep up with the growth in population but there are only 400 available, Welch said.

And other health care facilities also take a share of the new nurses, he said.

Nevada, he said, has the lowest number of licensed nurses per 100,000 population in the nation. Carol Gilhooley, an executive of the Joint Commission on Accreditation of Health Care Organizations, told the subcommittee that no formula for nurse staffing "can be applied universally."

"Staffing is more than just numbers," she said, explaining that consideration needed to be given to the skills and competency of the staff and the severity of the patients.

And, she said, "ratios are not the best way to improve the supply" of nurses in the state.

It might or might not be the best way, but it is one way, some nurses from Southern Nevada told the subcommittee. The nurses said that establishing nursing-patient ratios could help alleviate the state's nursing shortage. They said it would increase the quality of patient care and prompt nurses to remain in the profession instead of leaving.

Assemblyman Joe Hardy, R-Boulder City, who is a physician, said that to lessen the state's shortage of nurses "we can't do any one thing. We have to do a lot of things. A single solution doesn't exist."

One step the Legislature took this year was it approved a plan to double the number of nursing students in state colleges. Lawmakers want to see 1,326 nursing students enrolled by the end of the next fiscal year. The state allocated some savings toward the program and the Nevada Hospital Association agreed to kick in $559,473 in equipment costs.

Richard Curry, vice chancellor of academic and student affairs at the University and Community College System of Nevada, told the subcommittee Thursday that he expects the goal to be reached by June 2005.

Curry said progress is being made and he "has not heard of any obstructions." But he was unable to provide the number of nursing students. He said that total was being compiled.

A Health and Human Services report based upon numbers from 2000 noted that Nevada had 520 employed nurses per 100,000 population, far below the national average of 782. The next lowest state was California with 544 nurses per 100,000 population. The District of Columbia had the highest number with 1,676 per 100,000, followed by South Dakota with 1,128.