Rebuttal to Presentation of the Nevada Hospital Association on Nurse Staffing Ratios and Acuity

Nevada RNformation, May 2004 by Gonzalez, Lillian

(The opinions presented are solely the opinion of the author and do not necessarily reflect the views of the Nevada Nurses Association)

The NHA mischaracterizes what is really happening in its hospitals as it relates to the profession of registered nurses. It's positions as to why Nevada should not impose nurse-to-patient legislation, fall short of being objective and forthright.

Specifically, I rebut the following statements made by the NHA.

NHA Statement: Current Nevada Hospital Association data shows that there are over 1,300 vacant RN positions in the state.

Rebuttal: The NHA, like the AHA, has made it abunvdantly clear to the public that there is a "nursing shortage." What they fail to convey, however, is that the shortage is not of registered nurses per se, but rather of hospital staff nurses. According to recent statistical data, there is surplus of registered nurses available, but a deficit of nurses willing to be employed by hospitals. As a career registry nurse, I can attest to the fact that registry nurses are routinely canceled by Nevada hospitals, making me question the validity of this "1,300 RN deficit." Does Nevada need more nurses? Or does the NHA need more staff nurses?

NHA Statement: Registry staff is being overused because the employers need the staff on hand to meet our patient demand. Any hospital administrator will tell you this is not an ideal situation.

I question the NHA's definition of the term "overused" to describe registry usage. Registry nurses are the first to be cancelled during low census periods. While serving as a charge nurse on a Nevada medical-surgical floor, I was instructed by the nurse manager to keep close track of patient census (not acuity) and, should the census decrease, I was instructed to send registry nurses home first. The business goal was to keep one nurse for every 10 to 12 patients on this medical-surgical floor during night shift. Short of that goal, my nurse manager said, "We'll be in the red."

NHA Statement: The high use of Registry usage drives up the cost of care, which is already skyrocketing due to various other factors, such as pharmaceutical price increases, doctors' malpractice insurance increases, and the declining use of the managed care model.

To compare registry nurses as described above is a deliberate mischaracterization of an important group of registered nurses. Registry nurses often earn as much as or less than their staff nurse counterparts, and typically do not have benefits enjoyed by their staff nurse counterparts. Agencies that supply registry nurses typically keep between 25 to 50 percent of the monies paid to them by hospitals. Registry nurses are motivated to work for staffing agencies because they have control over their work schedules, less exposure to hospital politics, and unique opportunities for professional growth. Career registry nurses, like myself, are committed to giving excellent quality care to the patients we serve. Registry nurses must prove their excellence to hospitals immediately, or risk being blacklisted from hospitals. It is unfortunate that the NHA would imply that registry nurses are hurting patient care the way it is being hurt by the cost of pharmaceuticals and malpractice insurance, and by the declining use of managed care models.

NHA Statement: as the fastest growing state in the nation, Nevada simply cannot keep up with our patient demand, and add to this a decrease of new nurses coming into our state, or being produced in our state by the educational system.

Rebuttal: I initially came to Nevada to complete a 13-week travel nurse contract. I was lured to this assignment by the excitement of this great state. My travel nurse recruiter warned, "Nevada nursing is difficult." After some research, I discovered that the State of Nevada has the most acute shortage of hospital staff nurses in the US. A colleague in another state commented, "Sounds rough. But I bet you made a lot of money." The fact is, I made less money per hour working as a traveling nurse in Nevada than I did in the majority of my other traveling nurse contracts. Registered nurses across the country are hearing that Nevada nursing pay is not commensurate with its difficulty and danger. Pay and work conditions are key to any nurse shortage. If numbers of nurses coming to Nevada are disproportionate to its population growth, we must question: Why?

In the year 2000, nationally, over 5,000 qualified nursing students were turned away because of the lack of space and faculty. Further, in my own nursing school in another state, about one-third of all students either dropped out, flunked out, or were subjectively failed. I feel an objective study of Nevada's nursing education is warranted to evaluate why there is a decrease of nurses "being produced in our state by the educational system."

NHA Statement: ...the Nevada Hospital Association formed the Nevada Nurse Task Force, a group of multidisciplinary stakeholders who share a common vision - to help alleviate and solve the severe nursing shortage. [It] has evolved to become the Nursing Institute of Nevada containing [subcommittees] made up of volunteer individuals such as nursing students, staff nurses, nurse executives, nurse recruiters, and others, and are addressing three critical areas to the profession of nursing in regard to the nursing shortage. Those three subcommittees are: Attraction, focusing on recruitment; Professional Development, whose focus is education; and Retention, working on the workplace environment.