There is more to the nursing shortage than meets the eye, say Judy Lerma and Diana Pirzada, two San Antonio registered nurses who are speaking up to help bring nurses' working conditions into the ongoing nursing-shortage discussion.

Texas won't solve much by throwing money at the expansion of health-care and nurse-training facilities, says Lerma, whose insight is based on more than 30 years — and a master's degree — in nursing.

To be sure, nurses face the same pay issues as other Americans who are struggling with rising food and fuel prices. But working conditions are a far greater concern for many bedside nurses, conditions that are eroding the quality of hospital care and lessening the likelihood of good patient outcomes, they say.

“We've said this over and over: There is no other reason to go to a hospital than to be taken care of by a nurse, 24 hours a day,” Lerma says. “If you need surgery, most of it can be done with day surgery; if it's a prescription, you can go to the office. But you go to a hospital to be cared for by nurses.”

Today's patients are more often afflicted by chronic conditions than acute ones. But those maladies require close attention and monitoring by nurses, who as patient advocates must also be the bridge between the sick and other caregivers.

That is why today's nurses are also expected to be the educators who counsel individual patients and their family members about best treatment and management options.

But as health-care costs escalate, Lerma and Pirzada say, too many hospitals are lengthening nurses' work hours and increasing their patient loads to make up budget shortfalls. Long hours and bigger patient-to-nurse ratios, they say, are rising to dangerous levels.

“Most nurses now work 12-hour days at the bedside, two on and two off, and on weekends, Friday, Saturday and Sunday, with Friday being an eight-hour day,” says Lerma. And even though hospitals post staffing plans that state that each nurse will be responsible for only so many patients of a particular type, many hospitals regularly violate their own plans by forcing nurses to work overtime and care for extra charges during a shift.

Nurses of her generation accepted such demands, Lerma says, but younger ones aren't.

Pirzada says that at one of two hospitals where she works, “they have new nursing grads that are going through the whole orientation, and then they're quitting right after going through orientation.”

Lerma cites other cases.

“They (nurses) are being given too many patients to be safe,” says Lerma, “and I hear them say, ‘I'm not going to let somebody die on my watch. I am not going to work a shift where I don't have a chance to talk to all my patients, to spend time with all of them.'”

Ironically, even technology is taking a toll.

“Everything is computerized now, so we're spending a lot more time charting things on the computer than in patient care,” Pirzada says.

“There is really a shortage of nurses who are willing to work under those adverse conditions,” says Jesse Romero, who is helping the two National Nurses Organizing Committee members lobby the Texas Legislature to require, by law, that hospitals observe minimal nurse-to-patient ratios.

Excessive patient loads, he says, are the biggest reason that of 187,373 of Texas' licensed registered nurses, 31,666 are working at other jobs or are unemployed and another 20,970 are only nursing part time. Were conditions better, the 2,374 of Bexar County's 14,417 licensed RNs who aren't working as nurses would return to the bedsides where they are needed.

“And don't forget that it takes a doctor's order to get into a hospital,” Lerma muses. “But if there aren't enough nurses, you may not get out of there alive."