Coverage of the nursing shortage in the Sept. 12 issue of Arizona Capitol Times was much needed and touched on many key issues. The article, however, did miss important perspectives offered by practitioners of direct-care nursing, the role most extensively affected by shortages. [Health Care’s ‘Perfect Storm’ — Answer To Nursing Shortage? Educate More Men, Minorities, Improve Working Conditions And Make Room In Accredited Programs, Experts Say, Sept. 12.]

The Southern Arizona Nurses Coalition represents direct-care nurses from every major hospital in the Tucson area. The Coalition was recently affiliated with the California Nurses Association, a professional group and union with a membership of more than 55,000. Direct-care nurses are the first line of licensed nursing personnel directly responsible and accountable for carrying out medical regimens or other bedside care for patients.

In contrast, the Arizona Nurses Association, and the director quoted in the story, represents fewer than 2 per cent of the state’s 41,000 registered nurses. The organization’s leadership is heavily weighted with nurse managers and administrators.

The effects of an unbridled, market- and profit-driven healthcare industry have weighed not just on direct-care nurses, but also patients, families and communities. Effective remedies must address the industry’s compromising incursion or hegemony in the following three areas touched in your story:

1. Compensation

Important evidence contradicts the statement that pay for nurses “is no longer a critical issue.” Compensation inequities contribute significantly to Arizona’s nursing shortage, currently the worst in the nation, according to a July 2002 workforce analysis by U.S. Department of Health and Human Services.

The report states that salaries are “likely playing a role in the declining supply of RNs.” Real earnings, what’s left after adjusting for inflation, have not changed since 1991.

Though the industry commonly and illegally bans discussion of wages, many Arizona nurses relate serious injustices regarding “wage compression” — entry-level practitioners making higher wages than those with 15 to 20 years of experience. Contrary to statistics in your story, experienced Tucson-area bedside nurses report wages of $20 to $22 per hour.

The use of contract “traveling” nurses is extensive in Arizona. Hospitals choose to use travelers and appear to cooperatively agree to avoid raising compensation for community-based nurses who are considered a “captured” labor market. Anecdotal reports indicate travelers can intermittently make up 50 per cent or more of hospital-unit staff, particularly during periods of peak patient volume.

The aging of the nursing workforce also hints at serious compensation issues in Arizona — the lack of guaranteed health coverage and pensions upon retirement. Many of Arizona’s nurses may retire not being able to afford the care they provided so competently and compassionately for others.

2. Regulation and Legislation

Sen. Robert Cannell, D-Dist. 24, alluded to the fact that many of Arizona’s direct-care nurses remain in the dark regarding important regulatory and legislative issues directly affecting nursing practice, their rights as employees and the safety and quality of care.

Self-education and organizing at the grassroots level among nurses through our organization have stirred others to take effective action on these important issues.

Organized representation for direct-care nurses that is fully independent of the industry now exists on the Arizona Department of Health Services (DHS) task force revising current hospital regulations. Through this representation, direct-care nurses are challenging hegemonic self-regulation by the Arizona hospital industry that compromises nurse and patient safety. New proposed DHS hospital rules will improve the RN-to-patient ratio in intensive care units from a substandard one-to-three to a safer one-to-two.

The Sept. 12 article also related that Marla Weston, executive director of the Arizona Nurses Association, “hails” recent passage of S1178, alleged whistleblower protection for health care professionals. The interests of direct-care nurses and patients were advanced with the initial version of this legislation, but amendments put forward by industry proxies gutted its effectiveness.

3. Direct-Care Nurse Leadership and Organization

Direct-care nurses lack influence to change the environment that helps create substandard, unsafe conditions for patients. Without contracts or effective whistleblower protection, nurses are unable to advocate for themselves or their patients without jeopardizing their job security.

Nurses are caught in a shortage-producing Catch 22. Through their licenses they are held accountable to the public for the safety of the care they provide. Yet, they have no means to influence the safety and quality of their work environment. This scenario is driving direct-care nurses from healthcare facilities and compromises care.

Contrary to Mr. Cannell’s assertion that “doctors and hospitals have to get nurses more involved,” direct-care nurses are not waiting for or asking for a greater voice to be “given to them.” The industry will not just give this to us; we must extract it by organizing the power to win it.

What direct-care nurses need are alliances with like-minded physicians, community leaders, elected officials and individuals who will join them in leveraging the industry to respect nurses’ legal and human rights to organize and bargain collectively.

Valerie Gomes, RN Coordinator, Southern Arizona Nurses Coalition — California Nurses Association