Nursing their wounds

Working as a nurse in a managed-care world isn’t easy: long hours, few breaks, short-handed staffs, too many patients. It’s enough to drive one out of the profession altogether.

At least that’s the position of the California Nurses Association (CNA). They blame the current shortage of registered nurses on a health care industry bent on cutting costs regardless of the consequences.

This scarcity of nurses led state officials in 1999 to intervene with a first-of-its-kind legislation requiring minimum nurse-to-patient ratios. The battle now is over what those ratios should be.

Unhappy with the numbers suggested by the California Hospital Association and the Association of California Nurse Leaders, the CNA is in the midst of a 21-stop series of town hall meetings around the state, which will culminate later this month when CNA will announce its own proposed numbers.

Later this year, the California Department of Health Services will announce its proposed numbers, which will be thrown open to public feedback and possible revisions this fall before being implemented Jan. 1, 2002.

Yet hospital managers believe the ratios are an improper way of battling the shortage, attributing the lack of registered nurses to reasons other than cost cutting: things such as increasing population, the aging baby boomer generation, technological advances and more nurses leaving than entering the profession.

CNA officials counter that managed care-inspired cost-cutting is what caused the nurse shortage in the first place, dubbing it a “self-inflicted industry wound.”

Jan Emerson, the vice president of external affairs for the California Health Care Association, acknowledges that the industry contributed to the nursing shortage through flawed cost-cutting decisions that began 10 years ago.

“Hindsight is 20/20,” says Emerson, noting that over the past few years, “hospitals have desperately been trying to hire back nurses.”

Still, Emerson is concerned that mandated nurse-patient ratios is a flawed solution: “If the ratios are set too high … what is that going to mean if a department or if a hospital is in violation because they can’t find the nurses? Are they going to close the unit down? What are they going to do?”

At the recent CNA meeting in Sacramento, officials addressed a crowd mostly made up of registered nurses, announcing: “This is one of those times when the profession is on the line. You can either make history or be history.”

The intention of the CNA, meanwhile, is to compile the comments it gathers and include them with their own findings, which they will submit to the Department of Health Services later this month—probably amid great fanfare and a show of union strength by the nurses in the capital.