Labor has a lot of complaints these days about the way hospitals are run, but nothing crystallizes the debate more than the issue of "safe staffing." Unions contend that registered nurses are quitting hospitals because they are being forced to work ever-longer hours, with sicker patients and less assistance. Administrators counter that, if working conditions are tougher, it's because there are simply fewer nurses available to fill the jobs.

The result has been not only an impasse over philosophies, but a state law that requires the Department of Health Services to set nurse-patient staffing ratios. The hospital industry has sought ratios that are far less stringent than those advocated by labor.

With the health department expected to release its proposed ratios this month, we discussed the staffing issue with James Lott, executive vice president of the Healthcare Association of Southern California, the hospital industry trade group; Maura Kealey, health care coordinator of the Service Employees International Union, Western Region; and David Johnson, Southern California director of the California Nurses Association.

Question:

Are poor working conditions contributing to the nursing shortage?

Kealey: Short staffing is the chief cause of the nursing shortage. SEIU nurses are caring for too many patients and doing a terrific job under very, very difficult circumstances. The result is burnout.There is just the fact you can't do it that long. The nurse responsibility and job is to be a patient advocate and there are too many patients to provide for.

Lott: The unions are right about a part of what they are saying. It is hard working in a hospital today, more than it was even 15 years ago. Because managed care lets us only take care of the sickest patients, only when they are the most sick. But as far as the shortage of allied health professionals in general, and nurses in particular, 20 or 30 years ago women were told if you want to be employed be a nurse or school teacher. Women now run Fortune 500 companies. Ninety four or 95 percent (of nurses) are still women. With greater opportunities for women, that is undermining our base. For every three nurses that retire, only one nurse is graduating from nursing school today.

Johnson: It's important to keep in mind that nurses are incredibly committed, caring people. And if they are put in a position where they cannot provide quality patient care, many are not willing to abide that situation. Mandatory overtime is an example of a practice that is driving nurses away from the bedside. When hospitals instead of providing adequate staffing are requiring nurses to stay at the bedside when they are exhausted they are creating an environment that nobody would want to work in.

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