Care Is Compromised by State’s Nurse Shortage

According to an American Hospital Assn. report, there are 126,000 nursing vacancies nationwide. A recent New England Journal of Medicine article links this nursing shortage with an increase in patient deaths and illnesses. KAREN KARLITZ spoke with a staff member of the largest registered nurses association in California to learn more about this problem and its resolution.



Labor representative, California Nurses Assn.


About 10 years ago, hospitals and medical corporations began buying up other hospitals; emphasis shifted to meeting the bottom line rather than providing quality patient care. That’s when unlicensed “assistive” classifications (groups of people given minimal training to perform various tasks previously done by nurses) began to sprout.

Economic changes and changes in insurance coverages have also resulted in people coming into the hospital who are sicker.

Registered nurses are supposed to be patient advocates, but because of working with large numbers of assistive personnel, nurses found themselves unable to advocate successfully for safe patient care. Nurses’ stress levels intensified as bad outcomes for patients increased; many RNs chose to leave the profession. At the same time, fewer people were starting nursing careers.

A big concern is the ratios regulating the number of patients assigned to each nurse. In critical care units, nurses follow one or two patients. But in other areas of the hospital, the number of patients cared for by each nurse keeps growing. Compounding this problem is that many patients who previously would have been placed in intensive-care units are shifted to other sections of the hospital.

The California Nurses Assn. initiated a drive for better ratios throughout hospitals with Assembly Bill 394. Gov. Gray Davis signed this bill, but because of a required period of public hearings the new ratios may not be implemented until as late as July 2003. In all of our contract facilities, we are demanding that these ratios be implemented now.

Today, many more nurses are becoming members of collective organizations like the CNA. Their issues include the problem of recruiting and retaining nurses and the implementation of livable retirement pensions. Most hospitals don’t provide pensions for nurses. But at the UC hospitals, RNs receive good pensions through the state. These hospitals also have the lowest nurse turnover rates. Retirement plans, nurse-to-patient ratios and salaries are key to bringing nurses back into the field and retaining them.

The nursing shortage affects patient care. At most hospitals, we see patients not getting the care they need. Nurses are working overtime to pick up the slack, but the workload of unlicensed assistive classifications has also dramatically increased.

Temporary or traveling nurses are being employed as well, but the people doing these jobs have no loyalty to the hospital, don’t come back the next day for continuity of patient care and may or may not have the skills necessary to work in the units where they are placed. Sometimes, however, they make up the majority of the staff.


Some nurses are advising people to stay with their loved ones in the hospital to augment patient care. This isn’t standard advice, but it is being given more often, especially for patients recovering from heart attacks or surgery in hospitals where nurses are assigned 10 or more patients. These family members or friends sleep in the hospital. Some hospitals have facilities for this. If they don’t, many just sleep in chairs. This obviously isn’t a long-term solution to the problem of an inadequate number of nurses.