Shortage Drives Nurse Contract Talks, But Solutions Elusive (5/7/2001 9:24:00 AM)
For Penny Kennealy, a nurse at Abbott Northwestern Hospital, being "on call" once meant just that -- knowing that the phone might ring at any time, calling her back to work in an emergency.
These days, though, every day is an emergency because there aren't enough nurses to go around. Being on call, she says, often means working an extra four hours on top of an already-stressful eight-hour shift.
The shortage of nurses and its effect on patients and staff are at the heart of contract talks between 13 Twin Cities hospitals and 9,000 members of the Minnesota Nurses Association (MNA). The nurses face a possible strike vote May 17 and, if they don't reach an agreement, a walkout after contracts expire May 31.
The nurses say they are frustrated because they're forced to do too much with too little staff, jeopardizing patient care.
"I love [nursing], but I can't do my job," said Kennealy, of Eagan, who has been a nurse for 20 years. "What choice do we have but to go to the public and say, 'This is what's going on, you need to be concerned.'?"
The nurses argue that hospitals must do something dramatic -- such as raising pay significantly and easing their workload -- if they want to attract new nurses and keep the ones they have. But hospital officials and some academics say that money alone won't solve the problem and that new ways have to be found of coping with a nursing shortage that's here to stay.
"There will never be enough nurses," wrote Joanne Disch, a nursing professor at the University of Minnesota, in the Journal of Professional Nursing last month. That means health professionals will have to rethink how care is provided "to make the most of what we have."
A futile search
Ironically, there are more nurses working now than ever before, but demand has outstripped the supply. As a result, hospitals around the country have been offering perks and signing bonuses in a desperate, and sometimes futile, effort to hire more.
Minnesota alone had almost 58,000 registered nurses (RNs) working in 1999 -- an all-time high -- but still had 2,900 vacancies last fall, according to the MNA.
The shortage is only going to get worse, experts say, as aging nurses retire and nursing school enrollments continue to drop. One study predicts an "unprecedented" national shortage of hundreds of thousands of nurses by 2020.
Even now, though, nurses on the front lines say it's undermining their ability to care for patients.
"The public doesn't understand what an RN is up against," said Joanie Pohl, 35, a cardiac nurse at Abbott-Northwestern in Minneapolis. When they're short-staffed, she said, "It can cause patient errors ... it can cause patient neglect. ... The patient doesn't get proper teaching, education, on the way out the door when they leave. It's kind of a spiral."
Members of the MNA filed 1,231 reports about potentially unsafe staffing at Minnesota hospitals from 1995 to 1999. Of those, 70 percent complained that they couldn't perform "fundamental nursing responsibilities," such as assessing patients on a timely basis, and half said they didn't have time to do basic care, such as bathing patients, according to a union analysis. One in five said patients either missed their medications, or got them late, as a result.
Other evidence of the nurses' frustration is mounting.
An international survey of 43,000 nurses, released today by the University of Pennsylvania, found that two-thirds felt there aren't enough nurses in their hospitals to provide "adequate" quality of care.
The shortages, meanwhile, have a domino effect. The more short-staffed they are, the more nurses like Kennealy talk about walking away for good.
"The morale is so low that you hear people going, 'I'm not going to work here anymore,'" said Kennealy, 43.
Others are cutting their hours because they can't handle the workload, she said. "If you had to work for eight hours and never sit down, never have a drink of water, never empty your bladder ... you would get really tired."
Kennealy, who works with high-risk pregnancies, says nursing has been "a wonderful career." Yet she is among those thinking about quitting, and she's looking to the contract talks for relief.
"Money's a fix for down the road to get people to come into the profession," she said, "but as a nurse for 20 years, it's not going to keep me there if something isn't done about providing safe care."
Abbott Northwestern, like other hospitals, agrees there is a shortage but says there's no evidence that patient care has been jeopardized.
A spokeswoman said the unionized hospitals remain hopeful about reaching an agreement with the nurses.
Arguing about money
Money, though, is a sticking point.
In their opening bid, MNA negotiators asked for wage increases that could raise starting full-time salaries from $38,000 a year to almost $50,000, and push top salaries to about $100,000 a year over the three-year contract. The union argues that hospitals can't attract new people to the profession unless they do something about the pay.
The hospitals say they'd go out of business trying to meet the nurses' financial demands, which they estimate would increase the average nursing pay by 60 to 100 percent. They countered with an offer of 4 percent the first year, and 3 percent in each of the next two years.
But beyond money, the hospitals say that union rules often stand in the way of potential solutions to the shortage. For example, because of seniority rules, they can't offer newcomers day shifts or prime vacation times, said Shireen Gandhi-Kozel of the Minnesota Hospital and Healthcare Partnership, which represents the hospitals. And that makes it tougher to compete for young nurses.
Experts on the nursing shortage, however, say the problem will be tough to solve across a bargaining table.
"I think both groups have a point, [but] they're both stuck in a hard position," said Peter Buerhaus, a national expert on the nursing shortage and associate dean of the Vanderbilt University School of Nursing in Nashville, Tenn.
"I don't see how hospitals, short of just making some huge painful decisions, can manage to meet all the demands," he said. "Yet the unions are right in saying if you don't meet these, you're not going to have nurses now, you're not going to have them in the future."
In the long run, the nursing shortage may well force hospitals to change the way they care for patients.
"I think more and more of your care may be overseen by nurses, but not necessarily provided by nurses," predicts Disch, of the University of Minnesota. It might even fall to family members to help with patients' bedside care, she said, much as is done in China and other cultures.
The key is to change the working environment and free up nurses to do what they were trained to do, she said. But nurses must have a voice in those changes and a sense that their contribution is respected, she said. Otherwise, "we can bring in five million more nurses ... and they will leave."
At the moment, though, the rhetoric may be too hot to make progress, Buerhaus says.
"The unions have just got to calm down with their emotional pleas and their attacks," he said. And "hospitals have got to realize they can no longer just ignore some of the legitimate complaints of nurses."
He added: "I would hope both sides would say we're going to have to solve this together."
-- Maura Lerner is at email@example.com .
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