LPNs face tough choices with layoffs

Judy Hurt will lose her job in October.

It’s a startling situation to be in. She has been a licensed practical nurse at Sacred Heart Medical Center for 23 years, and never dreamed she and her co-workers would be laid off by the hospital in a targeted cost-cutting move.

With mixed emotions, Hurt is beginning to consider her options and doesn’t like what she sees.

“It’s bleak out there,” she said, “especially in Spokane with the same level of pay and benefits.”

Now 50 years old, Hurt and many of the other 87 LPNs facing layoffs at Sacred Heart have been at the hospital for more than two decades. They were trained, valued employees who now face a financial scramble late in their careers.

“I’m too old to start over and too young to retire,” Hurt said. “It’s an awkward position to be in.”

To be retrained as a registered nurse takes three years of full-time schooling with no promise of a job in Spokane.

Indeed, the job prospects anywhere for licensed practical nurses are poor.

Hospitals nationwide are using fewer LPNs. And unlike many cities, Spokane is not in the throes of a nursing shortage.

With Spokane Community College and the Intercollegiate Center for Nursing graduating a steady supply of nurses – coupled with the desirability of living comfortably in Spokane on a nurse’s salary – the region is not a hiring hotbed.

Stephanie Benefield, placement director at the Spokane County Medical Society, said she doesn’t have any LPN openings listed right now.

“They’re going to have to come up with a decision: Do I move and stay in a career that I’m passionate about? Or do I wait here and see if something else comes along?” she said. “It’s not easy.”

The 88 LPNs are among the 174 layoffs announced Monday by Spokane’s largest hospital.

Earlier this summer, Empire Health Services, the operator of Deaconess Medical Center and Valley Hospital and Medical Center, announced job cuts of its own. Empire said it would cut 150 positions, but didn’t specify whether or how many LPNs would be affected.

With charity cases on the rise, and more and more people unable to pay their bills or afford health insurance, hospitals say they are struggling to stay profitable.

The cuts at Sacred Heart are expected to preserve the hospital’s 3 percent profit margin – a number that executives consider prudent management.

Like other hospitals across the nation, Sacred Heart no longer will staff with LPNs. The hospital will replace them with a combination of higher-paid registered nurses and lower-paid certified nursing assistants.

In 2002, the average registered nurse made $48,090, according to the U.S. Department of Labor. That year, the average LPN made $31,440. Nurses’ assistants made less than $20,000.

The hospital has been moving away from LPNs for years, said Carol Sheridan, Sacred Heart’s vice president for nursing. She said the hospital hasn’t hired an LPN in 10 years and has encouraged LPNs to get more training and become licensed as registered nurses.

An LPN can give medications to patients, but only after an RN reviews the medication against what’s written in the doctor’s order. So LPNs must work under the supervision of RNs.

Sheridan said an RN caring for four patients and supervising an LPN, too, is really responsible for eight patients. That’s no longer considered efficient.

A different opinion comes from Jim Marsh, 57, who worked as a registered nurse at Sacred Heart for 13 years until he quit in frustration last March.

“It was a constant fight for patient care,” Marsh said Tuesday after reading about the LPN layoffs. The situation, he said, will only get worse if the hospital replaces 88 LPNs with 40 RNs and 20 to 25 certified nursing assistants, as hospital President Mike Wilson said Monday.

“Patients will see a nurse less often,” Marsh predicted. In addition, he said, the hospital gives up years of experience held by the LPNs he knows.

“I’d rather have some of them as my nurse than some of the new (registered) nurses coming out (of school) because they haven’t had the experience,” he said.

Hurt said the hospital has offered to hire laid-off LPNs for the certified nursing assistant jobs, but the pay cut is too steep. Sadly, she said she has begun looking for work outside the Spokane region.

“I never thought I’d need to do that. I promised to do a good job and they promised me job security,” Hurt said. “We’re all victims of the trends in medicine.

“You know, at Sacred Heart our mission is to take care of the poor, and here that’s the reason we’re losing our jobs because so many of these people are unable to pay,” she said.

Sheridan, the Sacred Heart nursing vice president, said most LPNs have qualified for $750 a year in tuition help from the hospital. Last year, Spokane Community College made spaces available to the LPNs for RN training. Although there are currently no openings in that program, the community college will help laid-off LPNs get any prerequisites they need for the nursing program so they can enter in the future, she said.

Although the hospital quit hiring LPNs, those at the hospital were given assurances over the years that their jobs were safe, said Bob Barker of the United Food and Commercial Workers Local 1001.

“There was never a threat that if they didn’t get retrained they would be gone,” he said. “LPNs were always given a sense of purpose at Sacred Heart.”

The UFCW and Sacred Heart officials will meet to discuss severance pay.

The hospital’s nurse-to-patient ratios will remain within national guidelines, Sheridan said. Those levels vary depending on the severity of a patient’s condition, but, in general, are one nurse to five or six patients in a medical surgical unit, and one nurse to one or two patients in an intensive care unit.

Evidence links adequate staffing with patient safety. A 2002 study by University of Pennsylvania researchers looked at data from 168 Pennsylvania hospitals and found that a patient’s risk of death within 30 days of admission increased by about 7 percent for every additional patient in a nurse’s workload.

When a nurse was responsible for six patients, rather than four, patients had a 14 percent greater chance of dying after surgery. Eight patients, instead of four, caused the death rate to increase by 31 percent.

The Washington State Nursing Association will work with hospital administrators to make sure nurse-to-patient staffing levels are adequate, said spokeswoman Anne Tan Piazza.

“We haven’t seen the new staffing guidelines,” Piazza said. “I don’t want to comment on something we haven’t had a chance to review thoroughly and give input on.”

Sheridan said the discussions with the nurses union will help determine the actual numbers of nurses and nurses assistants the hospital will hire to make up for the LPNs.

Both the hospital and the union want to ensure the quality of patient care, Piazza and Sheridan agreed.