‘Demands of County Nurses’

Gamble’s argument that the demands of the county nurses will further weaken the whole health-care system assumes that nurses must subsidize the health-care system or be responsible for the demise of low-occupancy or poorly managed community hospitals. This argument, though appealing to hospital executives, is unrealistic.

Would anyone argue that it is morally wrong for talented high school graduates to enter educational programs other than nursing based on their assessment of career potential, for nurses to accept promotions for out-of-hospital jobs that offer more career opportunity, or for nurses to enroll in administration and law schools rather than in graduate nursing programs in order to use their talents? Those nurses staying on the job and alerting us to staffing inadequacies may have more moral courage than the others and be less interested in financial gain!

The important salary question is not the adequacy for entry-level community college nurses, but the inadequate differentials for education, experience or responsibility. If hospitals choose to remain in the 1950s and rely on recruiting rather than retention strategies, they are ignoring the changing expectations of women about their work, and demographics of an aging nursing population.

Unfortunately, the success hospitals have had in blunting competitive forces and moderating wage increases for nurses in all hospitals over the past 20 years causes recurring cycles of modest wage increases followed by above average increases for all nurses regardless of performance or potential. The Hospital Council could take a leadership position by encouraging performance-based pay and regular wage adjustments based on a competitive rather than an industry-managed pay system.

LOIS FRISS

Los Angeles