new hospitals face staffing woes
nursing shortage is 'reaching crisis levels in nevada'
by emily richmond
las vegas sun
a critical shortage of nurses plagues the las vegas valley at a time when hospital construction is booming, and projections show that the shortage may continue at a crisis level for at least five years.
five hospitals -- with a total of 676 additional beds -- are being developed for the las vegas valley with a sixth on the drawing board, but clark county already has problems finding enough nurses to run the current nine full-service medical facilities.
and health administrators fear new regulations in california, which would mandate fewer patients per nurse in hospitals, could drain workers from nevada's nursing pool, exacerbating the problem.
nevada already has the worst nursing ratio in the country with 520 nurses for every 100,000 people, far below the average of 782 nurses for every 100,000 people.
"the nursing shortage is reaching crisis levels in nevada just as it is nationwide," said richard schlegel, executive director of the nevada nurses association. "nurses are already pulling extended shifts just to keep the floors staffed. at the current staffing levels, not even looking at hospital expansion, we're already facing a very serious situation."
las vegas needs more hospital beds, and state colleges are trying to train more nurses to staff them but don't have the enrollment to meet the projected demand. hospital administrators predict a bidding war over nurses, with many likely going to california.
the california legislature has ordered the state's health division to come up with mandatory nurse-to-patient ratios, which means many facilities will have to hire more staff. even though the implementation of california's new regulations may be several years away, nevada is likely to see an exodus, said bill welch, president of the nevada hospital association.
"will there be an attempt by california to poach staff away from us and everyone else? absolutely," welch said. "they will be forced to pay whatever they have to, and then we'll be forced to counter with higher offers of our own just to keep the people we already have."
joanne spetz, an analyst with the public policy institute in san francisco, said the new staffing ratios may tempt nurses who left california for nevada to return.
"a lot of nurses chose nevada because of the lower taxes and they wanted to keep the warm climate," spetz said. "but california hospitals are going to have to offer higher salaries and better working conditions if they want to lure those nurses back."
the associations and administrators at las vegas valley hospitals agree that a premium must be placed on recruiting, developing and training nurses. some programs are targeting children as young as kindergarten for future nursing careers.
"if we don't move now to produce those professionals, we will not have the work force to accommodate new hospitals," welch said.
the state's six nursing programs graduated 277 students last year, and community college officials hope to double enrollment over the next few years. but the hospital association predicts that 662 additional nurses will be needed each year through 2008.
nevada's growth outpaces its production of new nurses, which means the state will continue to rely on bringing in professionals from other regions, experts say.
the issue is as serious as keeping hospitals open.
the valley is already struggling with overcrowded emergency rooms. the emergency room is supposed to serve as a hospital's hub, where patients are either treated and released or admitted to a ward. when there aren't enough nurses to staff the ward beds the patients must stay in the emergency room. eventually the domino effect forces the emergency room to close to all but the most critically injured.
from dec. 30 to jan. 5, sunrise hospital's emergency room was closed for 2,794 minutes or the equivalent of nearly two days, according to an emergency services database. umc was closed for 1,497 minutes -- the equivalent of a little more than a day -- during the same period. lake mead hospital's emergency room was closed for 120 minutes, the shortest period of all the hospitals.
sunrise spokeswoman ann lynch conceded that staffing shortages, not a lack of bed space, were the cause of many emergency room closures. at the same time, lynch said she is confident sunrise will be able to staff the new, 129-bed facility planned for spring valley at the corner of fort apache and sunset road.
"we are actively recruiting," lynch said.
nurses aren't the only supply running short in southern nevada -- more hospital beds will almost certainly be needed in the coming decades, analysts say.
clark county has nine full-service medical facilities, with a total of one bed for every 427 people in the county, the nevada state hospital association reports. the national average is one hospital bed for every 345 people, american hospital association spokeswoman alicia mitchell said.
nevada may have fewer hospital beds per population, but the statistics aren't always an accurate reflection of a community, mitchell said. for that reason, the association doesn't make recommendations as to acceptable ratios of hospital beds per population.
"all health care is local," mitchell said. "you can't compare the number of hospital beds in las vegas to the number of hospital beds in boston because the demographics of every city is different, and that's what determines whether there are enough beds."
a city with an older population would need more hospitals, mitchell said. similarly, an area with high rates of illness, disease or injury would also need more hospitals.
nevada has the nation's highest rate of adult-onset diabetes, heart disease and deaths related to cigarette smoking. the state's senior population is also growing faster than anywhere else in the united states, welch said. and the population soared over the last decade.
"you don't build to meet your needs of the day, you build to meet your needs of the next 10 years," welch said. "i don't doubt we'll need every one of the new beds by then, especially if we don't start making huge strides in preventative care."
it will all come with a price tag that could end up passed on to the consumer, welch said.
the new facilities may actually increase health care costs, at least initially, welch said. to staff the hospitals, administrators will have to offer benefits and salaries that are attractive enough to lure workers from other jobs, and consumers will likely foot that bill.
"if we don't start giving this situation the attention it deserves," welch said, "we'll find ourselves on the edge of a health care disaster."