The historic actions taken in California that establish the maximum number of patients a hospital can assign to a nurse are sending shockwaves across the country. Finally, at least one state took the proper action to protect the health of patients and nurses.
This action by the legislature would not have taken place without the militancy and determination of nursing unions and members. Nurse-to-patient ratios are crucial to forcing shortsighted administrators to put patient care first. Now, national action is needed to make the California law a federal requirement.
These new regulations were established at the same time a national nursing shortage is endangering patient care in hospitals. According to federal figures there were 1.3 million registered nurses working in hospitals in 2000; in 1988, the figure was 1.1 million. Health care professionals would be quick to add, however, that present conditions in hospitals are much graver than 10 years ago.
Insurance companies and their HMOs are forcing far more out-patient care and limiting in-hospital care. This has created a situation where doctors and nurses have to face an in-hospital population that is far sicker than ever before and where each patient requires more, not less, attention.
When the Institute of Medicine reported that over 100,000 die in hospitals each year due to hospital mistakes, the authors pointed to the misapplication of prescription drugs as the main culprit. While that may be true, the other reason is that the number of nurses needed to administer these drugs and care for other patient needs has been dramatically reduced in recent years.
The answer to this crisis in nursing and patient care ratios and nursing shortages is to dramatically increase the number of registered nurses. That will require more training programs and will meet with resistance from existing nursing schools and their related hospitals.
Some experts claim there are enough nurses, but that many nurses won’t work in hospitals due to the crushing amount of work. Although many will return to work if less stressful workloads are established, either by law or union contract, there is still a need for more nurses.
A state-by-state, piecemeal approach cannot solve the fundamental problem. Rather, federal action by Congress is required.
Under existing law the Public Health Service Corps program has the ability to handle this training load. The program pays full tuition of all nursing students. The repayment commitment of matriculating students is an agreement to serve in a geographic area of need. The program has been cut in the past decades, but the apparatus is still intact and can be regenerated with the infusion of federal dollars.
All labor unions, professional organizations and community groups concerned about patient care should make sure that all candidates for Congress in the upcoming elections support the expansion of the Public Health Service Corps and its nursing training programs.
The author can be reached at pww@pww.org
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