Nurses push to improve job ratios - Caring for too many patients is ongoing problem

By MELISSA McEVER
Valley Morning Star
September 19, 2008

A California-based nurses' organization hasn't given up the fight to improve working conditions and nurse-to-patient ratios in Texas hospitals, and local nurses have taken up the cause.

The National Nurses Organizing Committee, a union founded by the California Nurses Association, is pushing for legislation in Texas that would mandate certain nurse-to-patient ratios in hospitals.

Local nurses who have joined the organization say high ratios in hospitals - such as one nurse caring for eight to 10 patients at a time - are an ongoing problem in the Rio Grande Valley and statewide, and could affect patient safety.

"It comes down to whether we want to keep our job or keep our nurse's license," said Laura Dominguez, committee member and intensive care nurse at Valley Baptist Medical Center-Brownsville.

To retain their licenses, nurses must provide attentive care, and that's difficult to do when juggling a high number of patients, Dominguez said.

"You know what you want to do as a nurse, and you can't do it because you don't have time," she said.

The committee is encouraging Texas lawmakers to file a bill in the 2009 legislative session that would require hospitals to abide by strict nurse-to-patient ratios.

The bill would call for a 1-to-5 nurse-to-patient ratio on a hospital's regular medical floor, a 1-to-2 ratio in intensive care and a 1-to-4 ratio in pediatrics. These are the same ratios California adopted in 1999.

"Research shows that patients do better (with lower ratios)," said Joanne Thompson, a registered nurse in Houston and member of the National Nurses Organizing Committee.

Earlier this year, a Houston hospital became the first in Texas to unionize under NNOC. "Patients need a nurse to spend time with them, to educate them ... with lower ratios, patients benefit and nurses benefit."

According to the federal Agency for Healthcare Research and Quality, hospitals with low staffing levels tend to have higher rates of pneumonia, cardiac arrest, post-operative infections and shock. Other studies have linked high nurse-to-patient ratios to an increased risk of preventable deaths and medication errors.

Opponents of the legislation say they agree that nurse-to-patient ratios make a difference in patient care, and that hospitals have a shortage of nurses, but mandated ratios aren't the answer, they say.

Instead, the state needs to increase funding to nursing schools so they can hire more faculty and therefore train more nurses, said Jennifer Banda, senior director of government relations for Texas Hospital Association. According to THA, nursing schools turned away 8,000 qualified applicants last year because the schools didn't have enough faculty members to teach them.

"If we can get more nursing faculty, we can really make a huge difference (in the shortage)," Banda said.

The NNOC argues that hospitals are seeing a shortage because working conditions are poor and nurses are being asked to take care of too many patients.

"Many nurses would come back if things changed," Dominguez said.

Texas law currently does not mandate particular nurse-to-patient ratios for hospitals. Instead, each hospital is required to have a written staffing plan that takes into account several factors, including the severity of a patient's condition, staff members' experience level and the amount of care patients need.

A staffing plan is the best approach because it allows for day-to-day flexibility as needed, said Ann McDonald-Upton, chief nursing officer at Valley Baptist Medical Center-Harlingen.

McDonald-Upton said she'd heard few complaints from nurses about ratios at the facility. Nurses are encouraged to offer feedback to administration about patient care and issues like ratios, she said.

Dissatisfied with conditions in Valley hospitals, about 20 local nurses have joined the National Nurses Organizing Committee, and about 50 more have expressed an interest, Dominguez said. More must join for any Valley hospital to unionize, she said.

With or without union representation, something needs to change, Dominguez said.

"We're seeing the same issues all over Texas," she said.