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April 18, 2014

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Head of nursing group says ratios aren’t the answer

Nurse-to-patient ratios aren't the way to solve the state's nursing crisis, the president of the American Organization of Nurse Executives said Thursday at a speech in Las Vegas.

Some Nevada legislators and nurses have supported the idea of instituting nurse-to-patient ratios in Nevada's hospitals. Nevada ranks among the worst states in the number of nurses compared with residents.

But Karen Haase-Herrick told a group of doctors and other health care advocates Thursday that California instituted ratios on Jan. 1. Already, she said, nurses and hospitals have complaints.

"Mandated staffing ratios really imply that a one-sized solution fits all," she said.

Many factors go into figuring out how many nurses should be available for patients on any given shift, she said.

For example, nurses in smaller rural hospitals, who might provide more general care to patients, should have a different nurse-to-patient ratio than nurses working in a world-class university research center, where patients have complex and rare conditions.

Also, nursing supervisors might need to add more or fewer nurses to a shift depending on how much education each nurse on the shift has. And in states like Nevada, where the population increases in the winter, hospitals need more nurses in some times of the year than others.

California legislators passed the bill in an effort to alleviate the state's nursing shortage, hoping that nurses would enter the field if they felt they weren't spread as thin and could provide better care to patients.

In 2000, California had just 544 nurses per 100,000 residents, compared with the national average of 782. Nevada had 520 nurses per 100,000 residents.

But California hospitals also have encountered problems because they must always be in compliance with the nurse-to-patient ratio -- even while nurses go to the restroom or take a lunch break, Haase-Herrick said.

The costs of instituting nurse-to-patient ratios in California are not yet known, Haase-Herrick said, but already some health care groups have filed suit and are looking for relief from the Legislature.

Some rural hospitals may not be able to comply with the law, she said.

But the California Nurses Association reports on its website that "conditions are improved" at 68 percent of the 111 hospitals it surveyed since the ratio went in place, and that 59 percent of hospitals were in compliance with the law.

Haase-Herrick said the real cause of the nursing shortage results from a combination of factors, including low pay, tough work schedules, and less "time to care" that nurses get to spend with patients.

"The very things that enable nurses to have a feeling of control is missing," she said.

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