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Nurse bill draws opposing views Uherbelau's legislation would set staffing levels at hospitals By PETER WONG SALEM -- Two Rogue Valley Medical Center workers took opposing sides last week on a bill by Rep. Judy Uherbelau, D-Ashland, for Oregon to specify nurse staffing levels at hospitals. Jay Strazdas, whose nursing career has lasted eight years, thinks it is a good idea. "If you have inappropriate acuity, the mix of nurses to patients, sometimes the needs of patients are put on the back burner," he said in reference to such non-medical tasks as cleaning and grooming. "They eventually get taken care of, but not in a manner that I wish my mother would be taken care of. Acuity needs to be determined by registered nurses and the physicians caring for them." Like most of the nurses who testified at a hearing of the House Human Resources Committee, Strazdas did not identify his workplace. The Oregon Nurses Association, which asked Uherbelau to submit House Bill 3415, identified him during an introduction as an RVMC nurse. The state Health Division, which licenses hospitals, has minimum staffing requirements. Nurses say that standards should be more specific because fewer of them are working longer hours with sicker patients. But Gay Andrews, who is in charge of staffing at RVMC, said the Medford hospital is not cutting costs through reducing care. "Maybe not known to the nurses are all the things we have done and are doing to work on this problem so as not to affect caregivers at the bedside," she said. "Having standardized nursing guidelines for each unit and for each hospital would be impossible. How would they address the support services that go into nursing? It would be a nightmare to try to figure out in order to define such a bill." Andrews testified on behalf of the Oregon Association of Hospitals and Health Systems, which opposes Uherbelau's bill. Ed Patterson, a lobbyist for the association, said 14 complaints had been filed with the state in seven years and seven were found justified. The bill is unlikely to advance in this session, but a Health Division task force is looking at the issue. Uherbelau, who remains a registered nurse in California but does not practice actively in Oregon, said the nature of hospitals and their patients is changing. "What we end up having in hospitals now are the acutely ill," she said. "I have become increasingly incensed by a system where the more acutely ill you are, the more skilled care you need -- but what we have done is draw down the level of skill that is available." She attributed the cause to hospitals' attempts to cut costs in an era of managed care, which shifts the basis of payments from reimbursement for individual services to advance per-capita allowances. Fewer registered nurses also supervise the work of assistants and technicians who do many of their former tasks. "When I practiced, there was a different way of providing health care," she said. "The bottom line was not such an important element as it is today because of the new way we deliver health care. "It's become a competitive market. Everyone looks for a way to save a dollar. But what gets lost sometimes in the shuffle is the patient." Andrews said what complicates the issue is the shortage of nurses. "We do not have unlimited resources waiting outside the hospital door willing to come in and work," she said. "We have to plan as much as we can -- and therein lies our problem." Uherbelau also has introduced House Bill 3414, which would protect hospital workers against retaliation by management for speaking out on what they perceive are unsafe conditions or practices. Committee Chairman Jeff Kruse, R-Roseburg, said the issue of nurse staffing is not dead even though he does not plan to advance Uherbelau's legislation. "I am interested in what the state (Health Division) is going to do with its task force, so we will be keeping an eye on it," he said. "I think we have come to an agreement that while we cannot mandate some things, we have to figure out a way for the system to address its needs." The hearing did produce one surprise witness in favor of Uherbelau's bill -- House Majority Whip Mark Simmons, R-Elgin, whose wife is a nurse. So is the wife of House Majority Leader Steve Harper, R-Klamath Falls. Both hope to move up the ladder to majority leader and speaker in the 2001 session. "If this problem is not solved, they may not be going home on weekends next session," said Rep. Tim Knopp, R-Bend, only half-jokingly. "So I think we will see some action on this." Mail Tribune Copyright � The Mail Tribune 1999, Medford, Oregon USA