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State must invest in nursing education

BY PAUL M. ONG, JORDAN RICKLES and RUTH MATTHIAS

Hardly anyone in California is immune to the negative effects of the state’s nursing shortage. The reason is simple enough: Good hospital care depends largely on the number of nurses employed. On Jan. 1, AB 394, a bill aimed at improving hospital care by increasing the ratio of nurses to patients, took effect. The legislation, the first of its kind in the nation, will not be easy to implement in the current climate of increasing health care costs and state budget problems.

Newspaper articles over the past few months have amply documented the concerns of hospital administrators about the new regulations. The administrators face a difficult time ahead. They must evolve short-term and long-term strategies. To meet minimum nurse-to-patient ratios, hospitals must hire 1,500 to 6,000 new nurses. Still, as California’s population grows and ages over the next 20 years, demand for nurses could exceed supply by 25,000.

In the short term, hospitals will have to rely heavily on out-of-state nurses. While the number of registered nursing licenses issued to California-educated nurses has remained relatively steady — about 5,000 per year from the mid-1990s to 2002 — the number of licenses issued to out-of-state nurses has increased from about 5,000 in 1997 to more than 13,000 in 2002. Additional nurses could be imported through President Bush’s proposed immigration policies. Although aimed at expanding the numbers of temporary worker visas for lower-wage workers, the policies could also be extended to international nurses.

In the long term, however, dependence on out-of-state nurses is precarious. While it may appear that California benefits from employing out-of-state nurses, the fact is that the state pays more because hospitals must pay more. Current job postings for nurses advertise $5,000 signing bonuses, housing subsidies, travel reimbursements — even Costco memberships. All this contributes to higher health care expenses and insurance rates. Further, continued dependence on outside nurses leaves California’s health care system vulnerable to fluctuating immigration laws and international economies.

Policymakers, hospital administrators and the public must recognize that maintaining quality health care requires a long-term commitment that includes further investments in education and training. In 2002, Gov. Gray Davis allocated $60 million for the Nurse Workforce Initiative, which was meant to address the nursing shortage, plus support the recruitment, training and retention of about 5,000 nurses. But this measure was only for three years. At a time of fiscal crisis when Gov. Arnold Schwarzenegger has threatened severe funding cuts, additional state support for nursing education is hardly likely.

Yet nursing programs remain more crucial than ever. We cannot limit funds for nursing education in the short run without jeopardizing future health care. Funds for educational programs must be prioritized on the basis of need — and we indisputably need more nurses. Everyone shares the goal of quality health care, and everyone agrees that more nurses are crucial to meet that goal. But without solid commitments we may be left with little more than good intentions — and too few nurses.

Ong is director, Rickles research analyst and Matthias project director of the Ralph and Goldy Lewis Center for Regional Policy Studies. They have been researching efforts to address the nursing shortage.