Friday, December 6, 2002

Nurses have been picketing in front of St. Francis Medical Center since Monday.

St. Francis seeks nurses

Bullet Hospital says dialysis care will be
jeopardized if nurses won't return

Bullet Nurses union says St. Francis
refuses to answer questions

Isle shortage may ease

By Lyn Danninger

St. Francis Medical Center charged yesterday that if the Hawaii Nurses Association does not release striking nurses to go back to work in the hospital's kidney dialysis and organ transplant areas, patient care may be compromised in the next few days.

"The health of the patients is now being placed in jeopardy," said Dr. Jared Sugihara, St. Francis medical director and also a specialist in the treatment of kidney diseases.

Dialysis patients at St. Francis are now being cared for by management nurses and dialysis technicians.

Even prior to the strike, there was a shortage of nurses trained in the field, Sugihara said. It also takes six weeks to train a dialysis nurse, he said.

Newly diagnosed kidney patients requiring dialysis are being referred to the Fresenius Medical Center which has six dialysis clinics on Oahu and a small clinic on Lanai.

St. Francis asked the union to release some nurses to return to work under an agreement it had made with the Hawaii Nurses Association.

The hospital said it needs 16 nurses for kidney dialysis patients and an additional seven nurses for the organ transplant unit. About 340 St. Francis nurses have been on strike since Monday.

The union said it still needs questions answered regarding insurance coverage for nurses who return to work and specific information about what care is needed.

"In the 10-day strike notice, we gave St. Francis the parameters under what circumstances it would be appropriate for an RN to cross the picket line. In its request yesterday, St. Francis did not address the two issues of insurance and specifically the details of what kind of care was needed," said Scott Foster, a spokesman for HNA.

The union also questioned the timing of St. Francis' request, since it came a day after the hospital filed a request with state Circuit Court seeking a temporary restraining order to require needed nurses to return to work.

Sugihara said he is concerned over prolonging shortened treatments for the approximately 1,000 kidney dialysis patients who would normally received dialysis three times a week.

On Monday the hospital said it was shortening the duration of each dialysis treatment by about 30 minutes because of limited numbers of staff available. Patients were also advised to go on an emergency diet limiting fluid intake, minimizing weight gains between treatment and limiting foods high in potassium.

But Sugihara says he can't be sure how long such an arrangement can sustained.

"It's been OK until now but if it goes on longer I can't be assured," he said. "Going beyond three to five days on shorter hours is uncharted territory."

Sugihara said he chose to speak out about the situation now because he initially thought there would be a quick resolution to the strike. Now he's not so sure, he said.

"Back in 1976 (during the last strike) I don't recall it being this stalemated without any breakthrough," he said.

Meanwhile, nurses continue to picket at neighboring Kuakini Medical Center and the Queen's Medical Center. No new negotiations have been scheduled for either hospital.

St. Francis Healthcare System
Queen's Medical Center
Kuakini Health System

Hawaii Nurses Association

Zenaida Same, a California registered nurse for 23 years, helped patient Debra Jackson recover from hip surgery.

Nursing shortage
grows but Hawaii
may be past the worst

By Robert Jablon
Associated Press

LOS ANGELES >> Lark Galloway-Gilliam is convinced California's nursing shortage contributed to her father's death.

The Los Angeles health care advocate believes the stress of poor care during a hospital stay about a month earlier caused his heart failure in August at the age of 89. At one point, Galloway-Gilliam said she went to the nursing station and found no one there.

"You'd hear the little machines beeping, beeping, beeping, the alarms, and nobody was watching," she said.

Galloway-Gilliam said the family became so concerned, particularly after her father fell out of bed, that they hired someone to watch him when relatives weren't there.

Earlier this year, Los Angeles County health officials found the hospital had improper staffing.

As California faces one of the nation's worst nursing shortages, state officials are pondering how to close the gap while patients and their families worry about its effects on the quality of care.

The state Employment Development Department estimates an additional 30,000 registered nurses will be needed in the next four years, far more than can be obtained through nursing schools and the hiring of nurses from other states and countries.

By 2010, there will be a demand for 109,600 additional registered nurses.

Federal statistics from March 2000 ranked California 49th out of 50 states in the number of registered nurses per capita, at 544 per 100,000 population. Nevada was last with 520 per 100,000. The District of Columbia, by comparison, had the best ratio at 1,675 RNs per 100,000.

California is also facing a shortage of licensed vocational nurses, who can perform more limited hospital duties.

Thirty states suffer from a nursing shortage, a number which will grow to 45 by 2020 if nothing is done, according to a study released last summer by the Health Resources and Services Administration, part of the U.S. Department of Health and Human Services.

In 2000, 6 percent of nursing posts were vacant, the study said. That number is expected to balloon to 12 percent by 2010 and 29 percent by 2020.

(Hawaii may have already passed the worst of its nursing shortage. According to the same federal report, Hawaii was 762 nurses short in 2000, about 9 percent of demand. But, the report says, Hawaii will have a surplus of 1,180 nurses by 2005, with more than 1,000 more nurses than needed each year through 2020.

(Hawaii's hospitals last year told a legislative hearing that they were having trouble finding enough nurses. At the time, the Hawaii Nurses Association said, there were at least 150 isle job openings for registered nurses.)

The situation is particularly troublesome in California, the nation's most populous state.

"There's no question that my work is made harder and there's much more of it because of the nursing shortage," said Dr. Marcy Zwelling-Aamot, an internist and critical care specialist who is president-elect of the Los Angeles County Medical Association

"Nurses are such an important adjunct to what we do," she said. "They are our eyes and our ears and our fingers at the hospitals when we're at our offices."

Hospitals officials deny that patient safety has been compromised. But while no studies have linked California's shortage to worsening patient care, "no one can dispute the idea that more nurses are going to lead to quality outcomes," said Jan Emerson of the California Healthcare Association, which represents all 470 acute-care hospitals in California.

St. Francis Healthcare System
Queen's Medical Center
Kuakini Health System

Hawaii Nurses Association

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