County Nurses Say Staffing Shortages Peril Patients’ Lives : Health care: They assert that years of protests have failed to bring about a remedy. Representatives are preparing to testify before a labor arbitrator.

They have staged walkouts and sickouts, gone on strike and filed hundreds of formal complaints about poor conditions at Los Angeles County health clinics and hospitals. Yet county nurses say that despite their protests during the last four years, severe nurse shortages continue to threaten patient lives on a daily basis.

On occasions, one registered nurse has been responsible for caring for as many as 32 sick patients at a time, the nurses said at a news conference Friday.

“I’ve seen patients go into acute respiratory distress and die because nurses have lacked the time” to properly tend to them, said Kathy Daniel, a registered nurse at Harbor-UCLA Medical Center.

Next week, about 25 nurses represented by Local 660 of the Service Employees International Union will testify at a four-day hearing before an independent labor arbitrator to document their grievance that county health officials have failed to provide staffing “consistent with good patient care.”

Irv Cohen, director of administration and finance in the county Department of Health Services, acknowledged there had been severe nursing staff problems three years ago but insisted “we’ve done a heck of a good job in straightening out those problems. We feel we have fairly good coverage now.”

He said that by closing down wards at County-USC and Martin Luther King Jr./Drew Medical Center, the county has been able to reduce its patient load. At the same time, he said, the number of nurses employed by the county has climbed to 4,300--which he said is between 100 and 200 more nurses than two years ago.

The nurses work in the county’s six hospitals, which admitted an estimated 193,000 patients during this fiscal year, as well as in the county’s six comprehensive health centers and 42 smaller health centers, which received roughly 3.5 million patient visits.

Union officials said, however, that with more than 900 unfilled positions, nurses are unable to provide safe and adequate patient care. They said the nurse vacancy rate in county hospitals and clinics is 18%--twice the average statewide rate.

Cohen countered that the vacancy rate is about 11%--”not out of line with the private sector.”

The union has urged nurses to document unsafe workloads by filing formal written objections with their supervisors. Between 1987 and 1989, at least 315 objections were filed at the various county health facilities.

These complaints make clear “the massive scope and continuity of staffing problems in health facilities,” said Bob McCloskey, business agent for Local 660. He said these complaints have yielded few results and given nurses little satisfaction. He cited one instance in which a nurse called three times to report inadequate staffing to care for patients. “She was told there was no supervisor available and was hung up on,” according to a complaint she later filed.

Although McCloskey said that conditions have not improved, he acknowledged that fewer formal complaints were filed by nurses in 1990 and 1991, contending this is because the nurses have “voiced a more hopeless sentiment regarding the futility of making out a report or even asking for relief.”

McCloskey called the complaints “a small window into the absolutely intolerable and unsafe conditions under which nurses continue to work” at county health facilities.

The complaints he cited include:

* An instance in which a nurse reportedly had to handle clerical and administrative duties at County-USC’s Enteral-Intestinal Clinic as well as provide all nursing care and assist the doctors with procedures. In addition to assessing and discharging patients, she said she had to set up eight biopsy and other tests, act as the translator for four patients who needed to give informed consent for medical care, collect specimens, wash speculums, record the census, answer phones and make appointments--all the while training and orienting a new nurse to the area.

* An instance in which a nurse at County-USC reportedly was solely responsible for 23 acutely ill patients, including two on ventilators and four with tracheotomy tubes that needed suctioning. She reported that she had to administer all medicines and intravenous feedings, admit two new patients, discharge one and straighten out confusion over numerous doctors’ orders. Meanwhile, one of the patients had a seizure--and she had to fend off a doctor who wanted her to make room on the ward for another patient on a ventilator who needed intensive care.