Sick system

You don’t have to stay in the hospital long to figure out who’s running the show: the nurses. Physicians performing the latest lifesaving procedures may grab all the headlines, but the complex and often tedious task of taking care of patients falls primarily to the registered nurses who staff the hospitals. That’s the main reason California’s ongoing nursing shortage is being called a crisis.

So how did we get here, anyway? In a free market, the phrase “ongoing nursing shortage” is an oxymoron. If a nursing shortage develops, then the price paid to nurses for their services increases accordingly, until an equilibrium is reached—where exactly the right number of nurses are being paid exactly the right amount for their services, and—bingo!—no nursing shortage.

Why hasn’t that happened? Simple. Health care doesn’t occur in a free market. That fact was clearly underscored January 22 when Governor Gray Davis announced the implementation of a new state law that will limit the number of patients individual nurses can be assigned to. Many studies have shown that lowering so-called nurse-patient ratios, particularly on critical and acute care units, can lead to improvement in the quality of care received. Which raises the question: why hasn’t the health-care industry, vis-à-vis the free market, responded? Why has government intervention become necessary?

That answer isn’t so simple, but we suspect it has a lot to do with the sick system that has come to be known as managed health care. It seemed like a logical enough idea three decades ago. In response to escalating health-care costs, insurance companies, hospitals and health maintenance organizations began tightly monitoring the utilization of medical services in an attempt to increase efficiency and thereby control costs. It actually worked for a while. In the ’90s, health-care costs flattened out, before spiking back up at the end of the decade. Health-care executives reaping six-figure salaries patted themselves on the back, at least momentarily.

Meanwhile, the people who actually deliver the goods, the nurses, dealt with the ramifications of “increased efficiency.” In addition to caring for more patients, they found that the patients were predominantly sicker, thanks to new rules limiting the length of individual patient stays. Besides dealing with the occasional egocentric physician, nurses now had to contend with tight-fisted corporate bean counters who knew nothing about caring for patients. Nursing, never a glamorous occupation with its required shift and weekend work, lost much of its luster.

Which brings us to the present nursing crisis and the nurse-patient ratios proposed by Governor Davis. Hospitals, insurance companies and health maintenance organizations have argued that the ratios will wind up costing consumers money, and will do nothing to alleviate the nursing shortage. But that isn’t the purpose of the ratios. The purpose is to improve the quality of patient care, nothing more, nothing less. We’re not surprised that that point was lost on health-care industry executives. After all, if they really wanted to solve the nursing crisis, they could simply pay the nurses what they’re really worth, and the shortage would end tomorrow.