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Union, Non-Union Nurses Differ on Depth of Problems, Fixes

Nursing in California isn’t what it used to be, with politics a bigger factor than ever.

On the political front, Gov. Arnold Schwarzenegger has raised the ire of the California Nurses Association, which has emerged from its battles as a vocal, assertive labor union.

Schwarzenegger took heat for his attempts to delay a law that required hospitals to maintain a certain number of nurses per patient. Nurses also challenged his now-scuttled idea to disband the state’s Board of Registered Nursing.

The staffing ratio law was a pet project of the nursing union. The California Nurses Association argued that years of cutbacks brought on by profit-oriented managed care companies and hospital operators led to untenable working conditions and an exodus of nurses away from the bedside.

Hospital industry representatives, however, argue that ratios don’t work because the county and state simply don’t have enough nurses to meet demand.

Non-union nurses are mixed on the ratios.

Meanwhile, the state’s nursing shortage, which has led hospitals to offer signing bonuses and other methods for attracting enough nurses, has sent salaries higher. In 2004, OC nurses made an average $67,156, according to the state Employment Development Department.

The Business Journal interviewed local nurses to gauge the pulse of the industry. Nurses were asked three questions: What is the state of nursing in California? How do you feel about nursing becoming a political flashpoint? What should be done to solve nurses’ concerns?

You’ll see responses from members of the state’s nurses union and from others who are not. Their views of nursing often diverge.

Following are their edited comments.

DONNA NASH

Registered nurse,

executive director of cardiovascular services

Anaheim Memorial Medical Center

What is the state of nursing in California?

Nurses are much less subservient to physicians now. There’s much more of a team approach to patient care.

Benefits for new nurses, such as shift scheduling, are different now. I entered the profession in 1976, and at the time you had to work nights,no day shift jobs for new grads.

But obviously the major change is that we just do not have enough nurses, and there are not enough schools to ameliorate the situation.

How do you feel about nursing becoming a political flashpoint over ratios and other issues?

The intensity of this is increasing because it can be spun that hospitals are not complying with the ratios to save money, when the reality is that there aren’t enough nurses.

I feel nursing unions are making us push and pull against our own profession. And I feel like nurses are less loyal to one hospital and often are just seeking the best deal, making themselves open to unions.

What should be done to solve nurses’ concerns?

We must make funding of nurse training programs a priority (federal and state financial aid and other sources, for example). And we need more nursing schools to increase enrollment capacity.

We also need to do a better job marketing and promoting the profession.

SUE SPENCER CANNON

Registered nurse

UCI Medical Center

Member, California Nurses Association

I graduated from nursing school in 1997. The hospital that initially hired me gave me further training.

I spent two months partnering with expert nurses who helped me get the hands-on training and confidence I needed to safely care for critically ill patients.

This firm foundation was my springboard into a profession that has brought me personal satisfaction, and with much hard work, economic stability.

I entered the profession at a time when nurses were in demand. Now, eight years later, some of the steps taken to alleviate the nursing shortage are beginning to make a difference.

But many elements that interfere with recruiting and retaining good nurses to a hospital still exist.

The nursing shortage, to a certain degree, is artificial. Enough nurses are out there, but market forces are at play here. Nurses gravitate toward the job positions that best suit their professional, economic and personal goals.

Nursing careers, including those in hospitals, that best match up with nurses’ needs have the best recruitment and retention success.

Included in my professional goals is working in a place that considers patient safety of paramount concern. At UCI Medical Center we have many layers of oversight that are meant to ensure patient safety.

However, the strongest safeguard for patient protection and safety in the hospital is having enough nurses on the job.

Patients’ lives and well-being are on the line here.

For the public good, nurse-to-patient ratios should be considered a must. Hospitals in California make billions of dollars of profit.

As a society, we need to decide that, in the realm of healthcare, patient safety and patient needs must come before profit.

To continue to attract nurses to the bedside, hospitals need to offer better working conditions and benefits.

Examples include safe patient assignments (with the ratios as a guide for the minimum threshold), lift teams, clinical support nurses, appropriate pay so that nurses can live in the areas they work and appropriate retirement security so nurses can retire knowing they will be able to live in dignity and receive the kind of healthcare they provided to their patients.

PEGGY DILLER

Chief nursing officer,

vice president of patient care services

Anaheim Memorial

What is the state of nursing in California?

Nursing is more challenging than ever.

On one hand, nurses have more choices within their life’s work than ever before. The traditional options of hospital nursing, home health nursing, nursing education and working in doctors’ offices have been expanded.

New options include medical equipment sales, developing new healthcare technologies, becoming a nursing legal expert and managing implementation of information systems.

The hospital nurse of 2005 must be mentally and physically agile, a life-long learner and a collaborative communicator with a sense of strong teamwork.

That California continues to be No. 49 or 50 in the U.S. for number of registered nurses per 100,000 population should be a source of concern for all Californians.

That approximately half the nurses working in California have not been educated in this state speaks to a risky reliance on other states and countries for nurses.

How do you feel about nursing becoming a political flashpoint over ratios and other issues?

Implementation of nurse-patient ratios has not solved the shortage of registered nurses.

The hope that this would drive a dramatic influx of nurses from other states has not come to fruition. And the anticipated crowds of nurses (who had left hospital nursing) returning to work at the bedside has failed to materialize.

I am saddened that legislators have found it necessary to make decisions regarding how many nurses and at what skill levels.

Hospitals are forced to close beds to admissions because of insufficient nurses to meet “the ratios.” This greatly increases the strain on an already heavily burdened healthcare system.

What should be done to solve nurses’ concerns?

The number of nursing students graduating from programs across the country needs to be at least doubled immediately to prepare to compensate for the current and future needs for nurses in the U.S.

Here in Orange County, I have been told that 1,200 qualified nursing applicants who had their prerequisites already completed were turned away last year for lack of student nurse “slots” at our community colleges.

Also here in OC, we have no generic bachelor’s of science in nursing program (meaning no nursing student who wants to get their bachelor’s of science in nursing can do so from start to finish in our county).

It has been reported that the average length of time it takes for a nursing student to complete an associate’s degree program in nursing is 3.5 years. Availability of nursing faculty is also critical to being able to increase the number of available nurses.

Greater use of technology to decrease the physical burden of nursing will be even more important with aging of the nursing workforce. In California, the average age of a registered nurse is 47 years old, with only about 10% of the nurses younger than 30.

TAM NGUYEN

Recovery room registered nurse

Nursing care for patients and nurses’ working conditions have been drastically improved with the nation’s first safe staffing ratios law.

Nursing in California in the year 2005 has a bright future, since the ratios’ effect and the destructive effort of Gov. Schwarzenegger in attempting to eliminate the Board of Registered Nursing, undermining the safe staffing ratios law and sabotaging the public pension (system) are failing.

Thanks to the California Nurses Association, the nursing profession is no longer timid in being visible and vocal for patients.

Nurses are now much more comfortable in fighting for our patients,even in political arenas as evidenced in our campaign of nullifying the governor’s power to undermine the safe staffing laws.

Nurses have been showing our passion for patients’ safety by pouring out into the streets, visiting legislators and shadowing our governor who can no longer enjoy his power to undermine the safe staffing laws for the third time.

PATTI JEAN GRETZ

Western Medical Center-Anaheim

Member, California Nurses Association

What is the state of nursing in California in 2005?

The state of nursing in 2005, in California? I don’t know if I can answer this in writing. I’d rather talk with passion to release the fire inside of me.

How do you feel about nursing becoming a political flashpoint over ratios and other issues?

My profession is no longer a profession,we have been changed into a herd of clock-punchers.

We practice the science and art of nursing with handcuffs on.

Corporate big business took over our bedside care in the last 20 years. The state is bought off by the big bucks. The feds won’t touch the issue.

Nurses are the only ones who will be around to rebuild healthcare when it collapses.

The staffing ratios are only the surface. The ratios are 50 years behind the times. The only people willing to organize us to fight for our patients’ care is the California Nurses Association, and we finance the fight ourselves.

We pay dues to see that our patients are safe.

Let the nurses and the doctors and the economists put together a plan. Leave patient care up to the experts.

VICKI SWEET

nurse manager, emergency services

St. Jude Medical Center

California finds itself at the bottom of the list for registered nurses per capita. If you couple the shortage of nurses with closures of hospitals and emergency departments, you begin to see a domino effect resulting in saturated facilities that are unable to provide care for their communities.

I’m disappointed that political and organized labor leaders have tried try to fix the nursing shortage by imposing strict numbers.

Numbers don’t help determine the patient’s acuity or individual needs. For example, in the emergency department, a nurse could easily care for four patients with minor injuries or illnesses.

Her colleague in the same emergency department, though, might be overwhelmed at the same time with three patients with more complex needs.

What should be done to solve nurses’ concerns?

I’m fortunate to work at a facility that listens to the concerns of the bedside nurse. Nurses at our facility participate in decision-making processes in a variety of ways.

I think that is one of the keys to retaining staff,listening to them directly, not through a third party. When nurses know that their administration cares, I think they are more likely to stay.

Professional nursing organizations such as the Emergency Nurses Association and American Association of Critical Care Nurses are working with other groups to increase funding for nursing education at both the state and national levels.

I think more nurses need to at minimum join their professional organization to show support.

BARBARA MILLER

Registered nurse,

vice president clinical services

What is the state of nursing in California in 2005?

Overall, healthcare in California continues to face many challenges. However, despite unfunded mandates and the nursing shortage, there is hope.

With the nursing shortage being brought to center stage, awareness of nursing as a profession has never been greater. Many individuals now see nursing as a career opportunity and many creative strategies are being developed to fund nursing schools to increase enrollment over the next five years.

My hope is that this effort will result in better trained, highly motivated nursing professionals prepared to meet the challenges of healthcare.

How do you feel about nursing becoming a political flashpoint over ratios and other issues?

While I support the ratios that have been established, there are aspects of the law that create an unnecessary burden on hospitals, such as the “at all times” rule.

The “at all times” rule dictates that whenever a nurse is absent from her patient care assignment, including a restroom break, another nurse will be brought in to assume her assignment.

This is difficult to manage. While those in public office have a responsibility to the public, it would have been appropriate and helpful to include healthcare professionals in the early decision-making process.

One of the concerns that keeps me awake at night is will there be sufficient, well-trained, committed nurses to meet the care and technological challenges that lay ahead?

The requirements for the profession are at times overwhelming. The need for more highly educated registered nurses who can understand the complexity of care and provide leadership within the healthcare team continues to grow.

At St. Jude we are meeting this challenge by offering educational stipends of up to $5,000 a year in forgivable loans for any accredited bachelor’s or master’s of science in nursing program.

We are also beginning a professional advance program, which will recognize expertise and education of the registered nurse at the bedside.

LADONNA BUTLER

Chief operating officer,

registered nurse

Saddleback Memorial Medical Center

The year 2005 is challenged by not having enough nurses in the labor force.

California is 49th in the nation in nurses per capita. This places a burden for education systems to graduate enough nurses so that the pool is rich for recruitment opportunities.

In addition, acute care hospitals must provide training to ensure competency in a world which has many advances in new technologies, as well the introduction of many new pharmaceutical products.

Then there remains the competition between hospitals to ensure benefits and salary are commensurate to retain staff. The volleying that goes on between healthcare facilities continues to be an administrative challenge.

My feelings are mixed. While I appreciate the need to preserve the importance of a reasonable nurse to patient ratio, I believe that government mandates present challenges to hospitals, especially given our state’s nursing shortages.

My opinion is that the regulations lack a full appreciation of operations and the challenges that acute care hospitals face.

What should be done to solve nurses’ concerns?

My role at the present time is not as a bedside nurse. However, my role is to advocate for them.

We need to listen to them and hear their stories. Our obligation and commitment to them is to identify what they need, how we can support them and give them the training and tools to do their jobs well.

The bedside is where the integration of skill, knowledge, and heart take place. Our job is to support them in making this happen.

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