Letters to the Editor

Take on nursing crisis now

It's National Nurses Week, but we should have been hearing about nurses all year, since health care was at the top of the agenda.

Over the last year, we've heard endless accounts of how health reform proposals will impact physicians, the insurance industry, hospitals, and pharmaceutical and medical equipment manufacturers.

Yet we have heard nary a word about how The Patient Protection and Affordable Health Care Act of 2010 will affect the largest profession in health care: registered nurses.

If we really want to celebrate nurses, we'd better remedy this problem and soon.

Happily, the new law will help some nurses - about 25 percent of them - deliver quality primary care. It has allotted funds to boost the supply of primary care providers needed to effectively care for the more than 31 million formerly uninsured patients. Nurse practitioners, who deliver primary and preventive care, will be helped most of all.

Unhappily, the act does little to address the plight of the more than 1.5 million RNs who work delivering hands-on care in hospitals, rehabilitation facilities, home care, schools, public health and the community.

Consider the plight of hospital nurses.

Today, these nurses, on average, suffer more stress-related illnesses and more depression than the rest of the population. These nurses also get more back neck and shoulder injuries than baggage handlers and construction workers. That's because a decade of hospital cost-cutting has dangerously increased the number of patients assigned per nurse.

In most states, hospital RNs may be taking care of as many as 16 patients on a 12-hour shift. And there is no effective regulation of either the nurse's workload or nurses' work hours.

California is the exception. It had the wisdom to legislate safe nurse-to-patient staffing ratios. For instance, on medical/surgical floors, nurses cannot have more than five patients.

But many hospitals in other states are going in the opposite direction. Even though they are doing quite well financially, they are using the excuse of the recession to lay off nurses and increase the patient load of those who remain on the job.

The average age of a nurse today is 47, and in four years - just as more baby-boomers will become sicker - older RNs will be retiring. Some will become patients themselves.

At the same time, 31 million new people will be entering the health care system. Many of these people will need nursing care because of poorly managed chronic illnesses, lack of prior access to preventive services and poor overall health.

Nurses can barely cope with the patient loads they have today. How will they cope with millions more patients in 2014 and thereafter?

An article in the Health Services Research journal verifies the positive impact of California staffing ratios on patient care outcomes. The study compared California's outcomes with those in New Jersey and Pennsylvania, states that have no safe staffing ratios. The research showed that fewer patients would have died in New Jersey and Pennsylvania had there been such ratios in those states.

To be effective, health care reform will have to do more than give patients access to physicians and nurse practitioners.

Even with the best health care maintenance and disease prevention, people do, in fact, get sick and then need direct care nursing. We must lighten the workload on nurses by putting a sensible limit on the number of patients they may treat at one time. Otherwise the promise of health care reform will remain unfulfilled.

Contact Gordon, the author of several books on nurses and the editor of a new book, "When Chicken Soup Isn't Enough: Stories of Nurses Standing Up for Themselves, Their Patients and Their Profession," at pmproj@progressive.org.

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