Wednesday, March 16, 2005 | 9:15 a.m.
We hope all members of the Nevada Legislature were listening carefully Monday as more than 100 nurses and nursing students arrived in Carson City to talk about their careers. The issues facing the nursing profession throughout the United States, and especially in Nevada, need urgent attention from lawmakers if there is to be any turnaround in the rapidly declining quality of health care.
Most of the issues can be traced to a glaring shortcoming that has become common over the past decade in nearly all hospitals -- there simply are not enough nurses to meet the needs of an increasing number of patients. Among the specific issues discussed Monday was Assembly Bill 183. This measure would protect nurses from disciplinary proceedings when they refuse an assignment "in good faith" because they are already overburdened. A Nevada law already gives nurses the right to refuse assignments in such situations, but does not protect them from being fired or otherwise disciplined if they assert their right.
A pediatric nurse from Las Vegas told legislators that she was fired after refusing to take one more patient under her care during one of her shifts. She said she was already caring for seven babies and small children, five of whom were in critical condition, one who had just been taken off a respirator and another experiencing frequent seizures. She said taking on one more patient would have put the other children at even greater risk.
The need for AB183, a bill that we support, is just a symptom of a health care system severely undermined by the nursing shortage. There are approximately 130,000 nursing positions that are unfilled nationally, and estimates show that this number will grow to 400,000 by 2020 as the baby-boom generation puts increasing pressure on hospitals. The problem is more acute in Nevada than any other state. We have about 520 nurses for every 100,000 residents -- the worst ratio in the country. The national average is 782 nurses per 100,000.
"When there are too few nurses, patient safety is threatened and health care quality is diminished. Indeed, access even to the most critical care may be barred," wrote the Joint Commission on Accreditation of Healthcare Organizations in a 2002 study of the nursing shortage. A University of Pennsylvania study that same year concluded, "More nurses at the bedside could save thousands of patient lives each year."
Nurses generally cite their inability to provide sufficient personal care to their patients as the No. 1 problem caused by the nursing shortage. But national surveys have shown a multitude of other problems as well. Emergency-room overcrowding, reduced hospital services, diversion of patients to other hospitals and reductions in hospital beds can all be traced to the shortage of nurses. The problem just feeds on itself when practicing nurses, emotionally and physically exhausted because of nonstop shifts followed by mandatory overtime, leave hospitals for higher-paying and more stable jobs in other fields, such as the insurance and drug industries.
California thought it could solve the problem by mandating nurse-to-patient ratios, but in November Gov. Arnold Schwarzenegger relaxed the mandate because hospitals, unable to meet the ratios, began cutting back on services. This month a judge overruled Schwarzenegger and now the issue has devolved into a conflict between the judicial and executive branches -- with no relief in sight for patients or nurses.
Nevada has taken a better approach by successfully increasing the number of nursing students in its university and college system. More needs to be done, however. The Legislature is in a position to hold hearings and cooperate with the state's hospitals on ways to create a better working environment for nurses. Mandatory overtime that leaves nurses exhausted, mountains of paperwork that leave them stressed, lack of continuing education opportunities, lack of nurses' aides, barely livable salaries, lack of career advancement potential -- all of these and more -- are issues that face nurses today. More nurses won't help much if they leave the profession after a few years. Because health care is affected, there is a legitimate public interest in reinventing hospitals as places where nurses want to work -- and remain.
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