RENO, Nev. (AP) - The two biggest hospitals in northern Nevada are suffering from a nursing shortage and both - Washoe Medical Center and Saint Mary's Regional Medical Center - have been cited over the past year for having fewer nurses on duty than planned.
Nevada has the worst nurse-to-population ratio in the country, 520 nurses per 100,000 population, compared to the national average of 782 nurses per 100,000, the Reno Gazette-Journal reported Monday.
Hospital officials acknowledge the shortage, but insist patient care has not been compromised.
"It's Saint Mary's, and it's every hospital in America," said Becky Swanson, spokesperson for Saint Mary's. "Some of the issues that we have today are very much the same as issues that we have had in the past. It's just the lack of the nurses, and how do you cover the shortfall?"
Becky Haase, nursing director of the pediatric unit at Washoe Medical Center, concedes staffing is not always at proper levels.
"Is there occasionally a time when staffing levels are not at par? Yes," she said.
More than 80 nurses at Washoe Med staged a one-day strike in June, in part to demand a voice in staffing issues. The nurses said the nursing staff levels at Washoe Med were unsafe. They want to set up a committee of nurses and administrators to review staffing conflicts.
The state cited Washoe Med on Oct. 13 and Saint Mary's last April 17 for having fewer nurses on duty than specified in the hospital's own staffing plans.
While many states, including California, mandate certain nursing staffing levels, Nevada state law requires hospitals only to create and follow their own staffing plans.
Investigator Patricia Thunder, a registered nurse with the Nevada Health Division, said both hospitals received "level two" citations, meaning the problem would most likely eventually cause harm to patients if continued.
Haase said Washoe Med disputes the inspection finding.
"Staffing was not dangerous," she said. "I don't think the way they got information was accurate of how staffing was done."
Swanson agreed, saying Saint Mary's patients were not at risk.
"When we received the deficiency from the department of health, we took it very seriously, but at no time did we believe we put patients in danger," Swanson.
The division issues citations for staffing deficiencies but does not determine whether the staffing levels are appropriate. If the hospitals don't fix the problem, they can be fined or forced to submit plans to fix the problem. In these cases, the hospitals submitted new plans that included hiring and were approved by the state.
The Health Division reviews hospitals when a complaint is lodged with Medicare, Medicaid or state officials. Northern Nevada Medical Center in Sparks received no citations during 2000.
State investigators were called to Washoe Med in January 2000 after a 12-year-old boy suffered cardiac failure during preparation for a gastroscopy, a diagnostic procedure.
During an onsite investigation several months later, a state investigator determined Washoe Med's pediatric unit fell below target staffing by one nurse for at least six hours for a little less than one-third of time between November 1999 and January 2000. The pediatric intensive-care unit fell below for about a quarter of the shifts during those months.
The hospital denied there were any staff shortages on the day of the incident involving the boy, Dec. 12, 1999. And state investigators concluded that staff shortages did not directly contribute to the incident.
"I believe that what was concluded in the complaint was that there was a continual staffing problem," Thunder said.
Haase said the Health Division could not accurately assess the staffing ratios because the review looked strictly at the numbers of employees listed on the staffing sheets.
At Saint Mary's, Thunder examined hospital records for a week and found some units didn't have enough nurses working during the week of Jan. 2 to Jan. 7 last year.
Experts say there are many reasons for the shortage. Nursing, once one of only a few career options for women, now competes with many professions open to women and men. And many longtime nurses are reaching retirement age, exacerbating the shortage.
No national guidelines for nurse staffing exist, said Doreen Begley, executive nurse for the Nevada Hospital Association.
"It's because it's a complex issue," she said. "You have to match the nurses skill level to the (needs) of the patient."
Information from: Reno Gazette-Journal