Nevada’s nurses face ever-growing challenges

Michelle Swafford

Thursday, May 12, 2005 | 11:03 a.m.

When Marty Katz reports to work at Sunrise Children's Hospital, he never knows what the day will bring -- but he knows it will be busy.

As a registered nurse in the hospital's pediatric emergency department, he is in a profession that is in high demand in Nevada and nationally, and must maintain quality patient care while working in an understaffed field.

This week marked National Nurses Week, which ends today on nursing pioneer Florence Nightingale's birthday, and Las Vegas nurses and health care workers say there are significant challenges facing the area.

Nevada ranks last in the nation for its nurse-to-population ratios. According to a 2001 U.S. Census Bureau, Nevada had 517 nurses per 100,000 people. The national average was 793 nurses per 100,000.

Since that report the numbers have increased a little.

A 2004 report by John Packham, director of the Nevada Office of Rural Health, said Clark County had 9,449 actively licensed nurses in 2003, which equated to 5.8 nurses for every 1,000 people (roughly 580 nurses per 100,000).

It's estimated that the Las Vegas metropolitan area will have about 11,479 nurses in 2010 and 2.1 million people. That projection means that there would be 5.5 nurses for every 1,000 people.

In the past few years, Nevada has taken aggressive steps to bring more nurses to the state through recruitment fairs, doubling its existing nursing programs, adding nursing programs, offering sign-on bonuses and home-buyer assistance programs. Some hospitals also offer tuition reimbursement and training programs for in-house transfers.

Nevada nurses' hourly wage also is used as a way to attract nurses. The Nevada Department of Employment, Training & Rehabilitation reported in 2004 that the median hourly wage was $28.09.

"The greatest impact (on nursing) is the astronomical growth, especially in Southern Nevada, and just trying to keep up with quality health care," said Nancy Bridges, a registered nurse and chairwoman of the Nursing Institute of Nevada. "Finding nurses remains a challenge."

Nevada's nursing programs are obtaining qualified candidates, but the colleges and universities have a shortage of nursing faculty, Bridges said.

Population growth and a lack of nursing faculty are just a few of the many challenges plaguing the Las Vegas Valley health care industry. Las Vegas Valley hospitals -- employer of the majority of Nevada's nurses -- are competing for nurses against doctors' offices, outpatient surgery centers and nursing homes, hospitals in other states and an impending retirement for many nurses. The average age of a Nevada nurse is 47.

Nurses and national studies say the working conditions in hospitals also contribute to the nursing shortage.

Despite the challenges hospitals face in attracting and retaining nurses, some professionals like Katz are turning to nursing as a second or third career because they want to help people.

Katz became a registered nurse two years ago after 14 years working for various ambulance companies and 11 years working for a pharmaceutical company.

The Las Vegas Sun shadowed Katz through a little more than half of his 12-hour shift at Sunrise to better understand the working conditions and responsibilities of a Las Vegas Valley nurse. On May 5, Katz's day began with two patients waiting for available hospital beds and one patient waiting to be transported to a behavioral health facility.

Shortly after Katz's shift started at 7 a.m., he was part of a medical team that was trying to resuscitate a 20-day old boy, but the baby died. That was one of the more critical patients Katz treated during his shift, but other patients were in varying levels of discomfort and agony.

"Adult patients can talk," Katz said. "A large number of (my) patients can't tell us what's wrong. They just hurt and are crying."

While the Sun followed Katz from 9 a.m. to 4:30 p.m., he made numerous trips between the nurses' station, his block of patient rooms and the supply areas. During that time he had seven patients, some of whom were there for the duration, and assisted with a few other patients.

"It all happens at one time," Katz said. "You're quiet for a little bit and then you get several patients at once."

Many of the patients Katz sees have a fever or are vomiting and don't have insurance so they seek emergency room care because federal law prevents hospitals from turning patients away until they've been evaluated. He said some parents bring their children to the emergency department because they think it will be quicker than their doctor's office or they don't have a primary doctor.

He said nurses act as a buffer for the patients, explaining what is going on and caring for patients in between visits from doctors and technicians.

In Las Vegas Valley emergency departments, patients may be admitted to the hospital and remain in an emergency room because of the nursing shortage.

"If you don't have enough nurses you may have the beds but not the staff to take care of them," Katz said. "People don't understand that if we don't have staff they can't go lay in a bed. We try to keep the ratios safe."

When Katz isn't caring for patients, he is consulting with doctors, changing bed linens, stocking supplies and preparing rooms for the next batch of patients, some of which are duties often done by a nursing assistant.

The Nevada Nursing Institute is working to retain hospital nurses and attract additional nurses to keep pace with the additional hospital beds being added regularly in the Las Vegas Valley.

In the last two years, two new hospitals have opened and several others have added beds. Another hospital is scheduled to open next summer and three more are in various planning stages.

One thing the Nevada Nursing Institute -- made up of nursing groups, hospital officials, and nursing faculty -- is doing to increase awareness of nursing is to go into the elementary, middle and high schools to generate interest in the profession, Bridges said.

It has also launched hospital mentor programs to train new nurses in specialized areas, she said.

The Nevada Nursing Institute also is working on improving hospital working conditions through roundtables with nurses and hospital supervisors and executives.

"They've indicated they're being heard and are feeling more important," Bridges said.

Lisa Black, a registered nurse and the health policy administrator for the Nevada Nurses Association, said in an e-mail interview that her organization and Assemblywoman Sheila Leslie, D-Reno, are working on legislation to improve nurses' working conditions because that is a reason nurses leave hospital care. When nurses leave it costs hospitals an average of $40,000 to recruit a new one, she said.

The bill would "allow nurses to advocate for patient safety in the care environments in which they work without facing workplace retaliation," Black said in her e-mail.

She said that nurses are required by state statute "to decline any work assignment for which they do not possess the knowledge, skills, and/or ability to provide safe care" but they seldom decline assignments because they fear retaliation or termination.

Bridges said "hospitals are doing a myriad of things to make the nurse's life easier."

For example, some have added automated teller machines, on-site day care centers, concierge services, massages, on-site dry cleaning and take home meals.

"There's just so many services they offer just to make the nurse's life ease a bit while they're on their shifts," Bridges said. "Patients that are admitted to the hospital these days are so much sicker than they were years ago. The challenge is to provide each patient with the best quality care they can."