With 4,500 nurses among the last holdouts to a comprehensive labor settlement between L.A. County and its workers last week, the county finds itself in a bind.

The nurses want more money and greater levels of staffing, but the county insists it can't afford either, at least not at the levels that the Service Employees International Union Local 660 is demanding.

"The SEIU has spent the last year convincing employees that everyone in local government has lots of money," said David Janssen, the county's chief administrative officer. "But the surpluses are in Sacramento and Washington, not here."

The county health department just received a $1.2 billion five-year bailout from the federal government for indigent services, and it must find ways to cut costs by nearly $1 billion when the bailout ends. Even if it could come up with the money, an acute nationwide nursing shortage is making it nearly impossible to find nurses.

"We face an $884 million shortfall over the next five years in the Department of Health Services," said Gail Anderson, acting associate director for clinical and medical affairs for the county DHS and medical director of Harbor-UCLA Medical Center. "That underscores the problem we have as we try to be competitive with salaries. Meanwhile, the nationwide shortage means there is a much smaller pool of nurses to draw from. That's the dynamic tension we have here."

Anderson said DHS has mounted an aggressive recruiting campaign to reverse a 14 percent decline in county nursing staff over the last five years. But he said that bringing the current staffing level of 4,325 nurses up to anywhere near what the nurses are demanding would take several years.

County nurses acknowledge that there is a nursing shortage, which makes it more difficult to attract nurses. But the solution, they say, is for the county to staff up and offer higher salaries and benefits so that nurses will want to work for the county.

A registered nurse employed by the county makes an annual salary slightly above $30,000.

"The county is finding it difficult to recruit and retain nurses because the working conditions are so poor, the staffing levels are so poor and the pay is so low," said Grace Corse, a critical care nurse at Los Angeles County-USC Medical Center and head bargainer for county nurses. "If nurses were offered decent staffing levels and decent pay, then they wouldn't be so frustrated in their inability to provide quality care and they would want to stay."


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