Nurse Shortage Raises Concern for Long Term
Health Care: An unusual holiday crunch may mean that San Diego can no longer sit
on its laurels as a desirable place to work.
January 07, 1990

Nursing staffs at several San Diego County hospitals--already stretched thin by a
national nursing shortage--were hit by a "triple whammy" during the holiday season,
forcing doctors at one hospital to admit their patients to other facilities.

Several hospitals asked available nurses to work double shifts and holidays.

The urgent lack of staff led some health-care administrators to predict a worsening
long-term nursing situation for the county.

Historically, the demand for hospital care falls during the holiday season, and most
local hospitals set lower-than-normal staffing levels. But in late December,
admissions unexpectedly rose, and many wards suddenly were filled, largely by older
patients with respiratory problems.

As admissions increased, the supply of nurses at some hospitals began to shrink as
nurses fell victim to a flu bug.

"What we experienced was different than every other Christmas, when (the county's
patient) census has gone down," said Sonya Healy, director of patient care services
at UC San Diego Medical Center. "The shortage, the higher patient census, the flu . .
. was like a triple whammy. The demand outweighed our supply."

The patient load created an especially heavy demand for nurses in intensive-care
and trauma units, Healy said.

"Many hospitals' critical-care beds were full, resulting in backup in the emergency
rooms," said Carrie Scott, Paradise Valley Hospital's vice president for patient care

At the same time, hospital staffs and nursing registries, which were hit hard by the flu
as well as nurse vacations, "were unable to supply additional nurses to meet the
increased demand," Scott said.

The nursing shortage seemed to hit hardest at Kaiser Permanente, which was forced
to admit patients to hospitals where nursing staffs could provide proper care.

Kaiser directed some patients to local hospitals that hold contracts to treat the health
maintenance organization's patients, said Marina Bareoff, an assistant administrator
at Kaiser's San Diego hospital. Kaiser also admitted patients to non-contract
hospitals, an unusual step, "so as not to jeopardize anyone's health," Bareoff said.

The shortage extended into January at Kaiser, which, at week's end, still had about
30 patients at other hospitals, she said, adding that Kaiser typically might have about
three patients at other hospitals.

Kaiser and at least one other hospital also asked doctors to postpone some elective
surgery until the shortage ended.

While UCSD Medical Center and Paradise Valley were not forced to admit patients to
other hospitals, nurses did work additional shifts. They "went the extra mile by
working extra shifts and additional holidays," Scott said.

Scripps Memorial Hospital in La Jolla experienced an unexpected surge in patients,
mostly from the flu, but the hospital had an adequate supply of nurses, according to
spokeswoman Edie High. Scripps turned to a pool of nurses who had not been
scheduled to work the holidays because their ward was closed for renovations.

Mercy Hospital had "some close calls," but no patients were turned away or admitted
elsewhere, according to Eileen Smith, director of nursing. "The (load) was very
heavy, the patients were sick, and some of the staff was sick."
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Health-care providers in San Diego disagreed on whether the seasonal shortage was
an indication that the long-term shortage is worsening.

Statewide, about 20% of hospital nursing positions are unfilled, said James Lott,
president of the Hospital Council of San Diego and Imperial counties. The shortage
has not been as deep in San Diego, where the vacancy rate is at 8%, he said.

That lower-than-average vacancy rate is linked to San Diego's reputation as an
attractive place to live, Lott said. Also, local hospitals benefit from the supply of
nurses that each year leave the Navy's large hospital in Balboa Park, Lott said.

However, San Diego's vacancy rate is expected to nearly double to 15% within three
years as the national shortage begins to make its presence felt, he said.

San Diego hospitals can "no longer sit back and rest on their laurels," Lott said. "The
(seasonal shortage) was really scary because there's not that much experience in
this town with a severe nursing shortage."

Elsewhere in California, the shortage is "like a car going downhill without brakes; it's
only going to go faster," said Maureen Anderson, a spokeswoman for the San
Francisco-based California Nurses Assn. Average patient stays in the state have
fallen in recent years, but patients "are sicker when they're in there," Anderson said.
"The intensity of the care they demand is greater."

As hospitals pare costs, they typically "are scaling down . . . the number of nurses
they employ," said Dr. Rosemary Goodyear, director of the University of San Diego's
graduate-level family-nurse practitioner program. The long-term shortage worsens
when "more intensive care is needed, because you have that one (nurse) to one
(patient) ratio."
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