Nurses say shortages affecting care

[pickledpepperRN]

http://www.sgvtribune.com/Stories/0,1413,205%257E12220%257E1785395,00.html?search=filter

Nurses say shortages affecting care

By Michelle Rester , Staff Writer

It's a question on the minds of many: As hospital officials stumble over themselves to wrangle a serious nursing shortage, have patient safety and quality of care been sacrificed?

California ranks 49th out of 50 in nurses per capita, while hospitals statewide are short on nurses by an average of 15 percent, according to the Hospital Association of Southern California.

Hospital administrators throughout the San Gabriel Valley say patient care is not on the decline, but do warn that financial and access issues facing hospitals are sending health care into a dangerous storm where lives could be at stake.

Come Jan. 1, if hospitals cannot find enough nurses on any given day through registries or from other states to meet a new nurse-to-patient ratio, they will be required by law to close their emergency rooms to new patients. Ambulances will be diverted, left to find a hospital that will accept more patients.

Nurses and some patients are adamant the nursing shortage already has harmed quality of care.

With nurses carrying heavier loads, compromises must have been made in terms of patient care, say critics.

Members of the health-care advocate association, Hospital Watch, have been outspoken about their support of the new nurse-to-patient ratios. They say patients, and nurses, are put in dangerous situations every day because nurse caseloads are too big.

"One of the things we realized is that a lot of health-care advocates look at getting access to care, getting coverage or getting into hospitals, but it's important to look at what happens inside hospitals,' Hospital Watch spokeswoman Susan Fogel said. "Research shows a lot of patients die when they're short- staffed. There are more medical errors, infections, pneumonia ... and it's all avoidable.'

Juanita Martinez, 70, of Baldwin Park, says she has been fighting for two months to get the ear of the administrator at Citrus Valley Medical Center's Queen of the Valley Campus. She has filed a letter of complaint.

Martinez said the two weeks she spent there in September were riddled with nurse mistakes that could have killed her and still linger as nightmares she endures on a regular basis.

In 12 days, she allegedly was given only two sponge baths one of which was given with cold water at 4 a.m. Martinez says she was told the third floor where she was staying had been out of hot water. On other days, nurses said the hospital was out of dry shampoo.

Her complaints also include leaky IVs, inaccurate blood pressure readings, nurses leaving the room while she was vomiting instead of helping her turn to the side or even giving her a towel or new gown.

Martinez says she was also fed only carrots and rice a high sugar diet, which caused her to undergo insulin injections, which was a first for the longtime diabetic.

Inconvenience and safety aside, the problem is that doctors prescribe treatments based on the information they receive from nurses. If the information like her sugar level or blood pressure is inaccurate, the doctors' misdiagnoses could be dangerous, Martinez said.

"At one point, a doctor came in and said he wanted me on dialysis, but it turned out I didn't need it and he had been given wrong information from the nurses,' said Martinez from her kitchen table.

A spokeswoman for Citrus Valley Medical Center said she could not discuss the details of Martinez's stay, but did acknowledge that the hospital received her letter of complaint.

"I can tell you all patient complaints are looked at and we do follow up,' spokeswoman Irene Bourdon said. "In this case, the administrator is talking to several nursing supervisors.'

Bourdon denied patient care has declined or may decline anytime soon, regardless of the nursing shortage and new ratios.

"We don't hire every single nurse that applies,' Bourdon said. "We have standards that need to be met.'

New nurses also undergo eight weeks of probationary training before they're given a full patient load, Bourdon said.

Citrus Valley Medical Center operates 325 beds at Queen of the Valley Hospital in West Covina, 222 beds at Intercommunity Hospital in Covina and 106 at Foothill Presbyterian Hospital in Glendora.

Jim Lott, executive vice president of the Hospital Association of Southern California, says he does not believe patients have suffered, although nurses may be doing more and working harder.

"Those people who say quality of care has diminished are hard-pressed by factual evidence to show quality of care has diminished,' Lott said. "When you look at objective measures published by the state, morbidity rates have gone down and mortality rates have improved considerably over the last 10 years.'

Some patients say the debate has them concerned about what kind of care or access they might receive if they needed medical attention, especially if nurses are spread thin because hospitals have 15 percent fewer nurses than they need.

For Martinez, it is a constant worry that she might have to repeat the experience she had at Queen of the Valley. She says she is not after a lawsuit or money, but is worried for anyone that might one day need hospital services.

"I don't want this to happen to other people and I think something has to be done about this nurse situation,' she said. "I don't want anybody to die because a nurse can't get to them in time or isn't on top of things.'

-- Michelle Rester can be reached at [phone], Ext. 2127, or by e-mail at [email protected] .

[pickledpepperRN]

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Nursing crisis looms

Acute shortage feared when new rules take effect

By Lisa M. Sodders

Staff Writer

California's colleges have failed to produce enough nurses to head off a looming health care crisis that experts say could hit as early as January when higher, state-mandated nurse-to-patient ratios take effect.

New requirements mean hospitals must have one nurse for every four patients in emergency rooms and one for every two patients in labor and delivery rooms.

Now hospitals set their own ratios, most of which are not as high, and officials say there simply are not enough nurses to meet the requirements. Currently, the state produces about 5,000 nurses a year, just half of what health officials say they need.

"Come Jan. 1, when the law goes into effect, I think you are looking at a potential meltdown of the system," said Jan Emerson, vice president of external affairs for the California Healthcare Association, the state's hospital trade association.

While lives may not be endangered, she anticipates fewer beds, entire units being shut down, ambulance diversions, longer emergency room waits and longer delays in scheduling elective surgery.

The Los Angeles County Emergency Medical Commission voted earlier this month to ask the Board of Supervisors to seek "legislative relief" from the law, but it is uncertain whether the pleas will have any effect.

Officials say they would not be facing such a huge shortfall had the state put more money into nursing education programs at community colleges and universities a few years ago.

Now the state's economic development department forecasts California's nurse shortage will hit 30,000 by 2006 and then balloon to 110,000 by 2010.

In addition to colleges not graduating enough nurses to meet increasing demand, a large number of nurses in the system will reach retirement age over the next 10 years.

Today, not one of the nine University of California campuses offers a bachelor's degree in nursing, and the University of Southern California -- which annually produced about 100 nurses -- will graduate its last class in May 2004.

"Were it not for the Cal States and the community colleges, there wouldn't be a nursing workforce in California," said Carol Bradley, chief nursing officer for Tenet California, which owns 39 hospitals in California.

While Bradley speculated that the University of California and USC may have a bias against professional nursing education because they view nursing as "a vocation instead of a profession," both the University of California and USC pointed to financial issues.

"We would love to bring it back but the UC can't, due to budget restrictions," said Hanan Eisenman, spokesman for the University of California office of the president. "The focus at the UC has been on graduate nursing. There is a shortage in that area -- nurses need the faculty to train them, and that's what we're doing."

Demand is high for nursing courses at Pierce College, Valley College and California State University, Northridge, and students can wait up to a year to get into the programs.

Pierce College has a waiting list of more than 100 students, and uses a lottery to determine entrance into the school's nursing program, which graduates about 64 students a year, said Dr. Marcia Solomon, director of the nursing program.

Valley College students can wait up to a year after they finish their prerequisite courses before gaining entrance to the nursing program, which graduates 88 students annually, said Carole Rosales, director of the nursing program at LAVC.

The demand for nurses has largely spared Pierce and Valley from the budget cuts affecting other programs, and Valley has secured several government grants, including a $190,000 two-year grant from the Los Angeles County Department of Health Services.

Pierce College recently got a $50,000 grant from Encino-Tarzana Regional Medical Center and Tenet Healthcare Foundation, which will provide funding for an additional 12 students.

Homer Marmol, 28, of Studio City, is a Pierce College student working toward a registered nurse credential at Encino-Tarzana's Encino campus. He currently works in rehabilitation, and loves helping patients regain their mobility, but said as registered nurse, he will have a wide range of career options, including his eventual goal of becoming a nurse practitioner.

"We're going to be in great demand," said Marmol, a licensed vocational nurse who has been working in the field for four years. "I'm glad I went into it."

CSUN offers an R.N. to B.S.N. (bachelor of science in nursing) program, and currently has about 71 students, who are mainly attending part time and holding down nursing jobs, said Helen Castillo, R.N., Ph.D., the dean of CSUN's College of Health and Human Development.

If CSUN could get the funding and hire additional faculty, Castillo said she could easily see the program doubling its enrollment, and even adding a master's degree component to help produce nursing faculty.

Unfortunately, there isn't a quick solution to the nursing crisis. New nursing programs are expensive to operate and don't spring up overnight, Emerson noted.

"Four or five years ago, if we had begun (expanding) the university system, we would have nurses today," she said. "We have the most serious nursing shortage in the nation -- we rank 49th out of 50 states in nurses per capita. Only Nevada has fewer nurses than we have, and it's going to get worse."

Emerson noted that attempts to jolt state lawmakers into action have so far proved fruitless.

In 2001, the California Healthcare Association sponsored a bill that would have pumped $120 million more into the higher education system for 10 years -- a plan designed to double California's nursing population. But despite a robust economy, the bill faced opposition both from those who didn't think the crisis was that bad and university officials who objected to being told what to do with state money, Emerson said.

"We think (the nursing shortage) is leading toward a disaster in terms of patient care and we believe it needs to be addressed," said Dr. Jack Lewin, chief executive officer with the California Medical Association and a family practice physician.

"Perhaps it's time for the larger hospital systems to go back to training nurses right in-house."

Lisa M. Sodders, [phone] [email protected]