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Think about this: Hospitals in Western New York and around the country are laying off nurses even as a nursing shortage stares them in the face. If that doesn't make your head spin, add in this fact: The trend occurs as the nursing profession, itself, grows at an energetic pace.

Something is drastically out of whack, and that something is the financial condition of cash-strapped, overextended hospitals. The nursing contradiction is a flashing red light on the health of the institution, a phenomenon that affects patient care in ways that run the spectrum from trivial to fatal.

While hard numbers on nurse layoffs in Western New York are unavailable, figures from the Western New York Hospital Association showed the region lost 10.1 percent of all hospital jobs -- more than 32,000 positions -- between 1994 and 1998. Many of those losses were among nurses, and as financially unavoidable as they may have been, they come at a price.

A series of articles in the Chicago Tribune last fall documented medical errors and even deaths that occurred because of declining levels of nurse staffing and the simultaneous trend toward hiring lesser trained care-givers -- mainly licensed practical nurses and nurse's aides -- to perform functions previously assigned to registered nurses. And in Britain, a four-year study linked staff workloads to mortality rates in adult intensive care units.

Moira Gallagher Schorr, executive director of the Professional Nurses Association of Western New York, said that while she knows of no deaths here attributable to reduced staffing, she has no doubt they have occurred.

Staffing horror story

Schorr has personal experience with the impact of under-staffing. Her brother-in-law, who underwent heart transplant surgery in New York City last year, called her in tears from his hospital bed, she said, because no one was giving him the life-preserving anti-rejection medicine he needed. Schorr called the nursing supervisor on duty, who explained the problem: The nurse responsible for her brother-in-law's post-transplant care was a temp; she did not have a key to the drug supply.

Schorr's brother-in-law eventually got his medicine, but not everyone has a relative who can work the system, and problems that serious definitely occur here, Schorr said, and not infrequently. "I think patients have no idea," she said. "It's just like a crap shoot."

Over the short term, at least, matters don't look to get much better. Consider a couple of telling facts from a study done for the New York State Nurses Association by Carol Brewer, a nursing professor at the University at Buffalo: The mean age of nurses in New York is high -- 42.9 -- while enrollment in nursing schools is declining.

It's a crisis in the making and to some extent, a self-perpetuating one. As struggling hospitals have laid off more and more nurses over the past several years, greater responsibility and pressure have fallen on those who remained. Many are near the breaking point.

Nurses' income, meanwhile, has remained more or less flat. Who can be surprised that while nursing opportunities are flourishing in areas such as home care, fewer students are choosing the career and fewer still want to work in hospitals?

Hospitals have already begun to react, Brewer said, offering "signing bonuses" to attract nurses, and more recently, nudging wages higher. But hospitals cut nurses because money was tight. They won't have much room to fatten paychecks or increase staffing until they put their financial houses in order.

Hospitals can help solve their own problems

Increasing revenue is one way to do that, and while it is obviously an important strategy, it is also a long-term project that depends to a large extent on persuading the government and insurance companies to pony up more money. The hospitals shouldn't hold their breath.

Where hospitals can exert a more immediate influence is over their expenses, though one can only hope they will be able to avoid additional layoffs. More crucially, hospitals need to attack the structural inefficiencies that soak up health care dollars like a dirty sponge. With too many hospitals, each loaded with expensive equipment that is used by too few patients who are cared for by not enough nurses, something has to give. The only place to go is the buildings.

The number of hospitals in Western New York plainly is not the only issue driving the problems with nurse staffing, but it is one that can be attacked. Closing or redirecting hospitals will reduce costs and allow for increased levels of staffing in those that remain. That is in the interest of doctors, hospitals, nurses and, most of all, patients.

THURSDAY: A way out.

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