Question:

Are there other underlying causes of the nurse shortage?

Lott: Managed care organizations pressure hospitals and physicians to discharge patients sooner than our nurses have been trained that patients should be. Their level of frustration and disappointment is high. We acknowledge that is going on, but the ultimate decision is left up to physicians. Patients are not being discharged wholesale. But it's frustrating for nurses not to be able to see the complete cycle. I am not sure the industry can do more about that.

Kealey: What SEIU members have seen over the last decade is that hospitals have engaged in a race to the bottom line in order to cut their costs to turn a profit in the managed care environment. Health care workers and patients have both borne the brunt of that cost cutting. That is wrong. Hospitals should stand up for what is right for patients and stand up for their responsibility for the healing mission. The health care system in this country is unfortunately too geared to the profit motive. Everyone, nurses, other health care workers have a responsibility to fulfill their duties well, to not cut the corners.

Johnson: Many hospitals that are owned by the big corporate chains have made conscious decisions to focus on increasing profits at the expense of patient care.

Question:

Will mandatory nurse-to-patient staffing ratios improve the situation?

Lott: Ratios makes no sense unless you believe that all patients need exactly the same type of care. The other thing is that 20 percent of our budgeted positions money we have to hire nurses is going unspent. We simply don't see how nurse ratios are going to increase that pool of nurses. We are going to need 60,000 more nurses in California over the next decade, and I don't know where they are going to come from.

Kealey: Yes, mandatory ratios will help. Minimum nurse-patient staffing ratios will definitely bring back more nurses to the profession, attract new nurses to it and, most importantly, provide the quality and safety of care to all patients. There is a correlation between nurses leaving the profession with the era of cost cutting, and in fact pay cuts the hospital industry imposed in the 1990s. A recent study has found that between the early 1990s and the late 1990s real wages for registered nurses fell 10 percent in Southern California. They cut wages and they cut staff, and then they wonder why there is a nursing shortage.

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