Effectiveness of nurse ratios debated in committee

Michelle Swafford

Thursday, May 13, 2004 | 11:03 a.m.

Health care professionals disagreed Wednesday on whether state-mandated nurse-to-patient ratios would improve patient care in Nevada.

Hospital officials, nurses and union representatives testified Wednesday before the six-member Nevada Legislative Committee on Health Care about the pros and cons of abandoning Nevada's current system in which hospitals schedule nurses based on their individual proprietary formulas. Those favoring ratios said ratios would bring more nurses into the Nevada hospital workforce, reducing the state's shortage of nurses. 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.

Those against ratios say such a system would force hospital departments to close and would be too costly to implement. "There's not a nursing ratio we can't meet," said Bill Welch, president and chief executive of the Nevada Hospital Association. "How do we meet that? We reduce access."

Even without ratios, Nevada needs between 800 and 900 additional nurses per year to keep pace with population growth and retiring nurses, Welch said.

When Nevada hospitals are short-staffed, they rely heavily on bringing in nurses from employment agencies or hiring nurses who work full-time at one hospital and on a per-diem basis at another hospital, health officials said.

Pamela Mitchell, a registered nurse in Washington state who participated in an Institute of Medicine national study on improving nurses' working conditions, said hiring agency-employed nurses and per-diem nurses should be halted so hospitals can improve their overall operations.

"While errors are made by human individuals, they are most generally the result of complex, not-working systems," Mitchell said.

She said the key is for the nurses caring for patients to have the power to increase efficiency by changing the layout of their work areas, providing input on their schedules and controlling the number of patients they can safely care for versus having government requirements imposed on them.

The institute's study researched nursing ratios, but didn't come up with a definitive answer on the issue.

"When the number of patients per nurse rises, so do the errors, but we don't have a magic number (of patients per nurse)," Mitchell said.

Donna Gerber, director of government relations for the California Nurses Association, said California's nursing ratios have worked well for the most part since they took effect Jan. 1. Her association is a professional group and union that represents about 57,000 of the state's 288,000 nurses.

"There are some bumpy spots and some hospitals having trouble recruiting a specialty nurse," she said.

California's ratios require a set number of patients per nurse, and that ratio varies by hospital department, Gerber said. A surgical unit, for example, has a ratio of six patients for one nurse.

In cases involving seriously ill patients requiring extra attention, the ratio allows for fewer patients per nurse, she said.

"It's very clear that workload staffing is the number one issue that results in dissatisfaction among nurses and determines if they stay in a hospital," Gerber said. "The turnover of nurses is a huge cost item. We would say hospitals can't afford not to have ratios."

Furthermore, it is a myth that nursing shortages prevent compliance because nurses are flocking to California, Gerber said. Emergency rooms won't have to divert patients any more than they already do and hospitals won't close as a result of the ratios, but some have closed alleging ratios were the reason, she added.

Gerber said the average age of California's nurses is 46, meaning that new nurses will need to be recruited to maintain the ratios.

Officials of the California Healthcare Association, which represents that state's hospitals, were unable to attend the hearing, but are scheduled to speak at the next meeting.

Sen. Barbara Cegavske, R-Las Vegas, said adding more staff would cost more money.

"It has to have an effect not only for the cost to the hospital, but (also) somebody has to pay for it," she said. "It always comes back to the taxpayer, the patient."

The committee has not voted on the ratio issue. A subcommittee of its members has been divided on ratios. The full committee will meet again in July to come up with recommendations for the full Legislature.