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Seek full partnership in health care Nurses stand up Houston Imagine a nurse putting down Florence Nightingale. Next thing you know, doctors will be making sport of Hippocrates. Nevertheless, the Nightingale image of the self-sacrificing, noble handmaiden of the physician has fallen upon hard times. In fact, its rejection is the trend in nursing today. But despite the repudiation of “Nightingalism,” the new breed of registered nurse hopes to have as big an influence on the design and delivery of health care in the United States as Nightingale did when she returned from the Crimean War to take on the British hospital system and start the first school of professional nursing. Just whether and how the Texas RN will accomplish as much here is a matter of controversy between hospital administrators and doctors on one side and RNs on the other. But most everyone in Texas health care agrees that in this regard much depends on action to be takenor not takenby this year’s Legislature. Patricia Boydstun, assistant director says nurses coming to the state from the glutted RN markets on the East and West coasts are appalled at the practices of hospital administrators and doctors here. Nurses have little say in staffing patternsthey are often pulled from one place to another in a hospital and expected to perform without orientation or training. Gone are the days when a nurse is a nurse is a nurse. The intensive care nurse has a different set of skills than, say, the obstetrical nurse. Texas, she observes, is one of the last states to hear the call for “nursing power.” The good nurses leave Another dismaying thing about Texas nursing, reports Boydstun, is the pay scale. “Hospitals are usually very secretive about salaries here, whereas in other parts of the country pay scales are set according to levels of training and experience.” Perhaps, says Boydstun, the secrecy is meant to hide Texas’ nursing salaries, which are among the lowest in the country. “I talked to a nurse last week who dis 20 The Texas Observer By Wendy Haskell Meyer covered that her high school daughter’s per-hour pay as a checker at Safeway was more than the starting pay of an RN at the mother’s place of employment.” And what about all the nurse shortage talk? No truth in it, says Boydstun. “Nurses are angry. They are finding situations which are unsafe for patients, yet when they appeal to administration, they are ignoredoften they are fired.” “I’ll tell you what’s happening. The good nurses are so frustrated that they are saying ‘I won’t be responsible for these lousy levels of care. The hospital administrator won’t listen to me. I have the choice of losing my sanity or leaving.’ So the good nurses leave and the less-experienced, less-motivated nurses are left.” TNA officials have figures they say prove there are plenty of nurses available. for work. By TNA’s last count, close to 9,000 RNs were inactive while some 30,000 worked in professional health care in the state. Because there is little job satisfaction and so much frus tration in typically low-paying jobs, the turnover rate is extremely highas high as 80 percent a year in some Texas hospitalscausing many nurses to abandon their profession altogether. “When you consider the financial cost of orienting a new nurse,” Boydstun points out, “you see the fallacy of administrators who say they can’t afford to raise salaries.” Unlicensed nurses As a result of either a real or apparent shortage of RNs, hospitals are filling vacancies with foreign nurses who, under provision of an existing Texas law the TNA wants changed this year, have state licensing examination requirements waived. The TNA stand is that the Texas Board of Nursing Examiners should be empowered to pass on the qualifications of anyone who works as a “nurse” in any hospital. This, says the TNA, would bring nursing into line with the same licensing practices for physicians, optometrists, barbers, cosmetologists, dentists, podiatrists, and chiropractors. “You can’t expect intelligent nursing when you use unlicensed people,” says Sudie Cornell, a rehabilitation nurse specialist who claims her demands for changes in nursing care at the Texas Institute for Rehabilitation and Research’in Houston led to her dismissal in 1975. “You only have to make 350 out of 1,000 to pass the boards. You wouldn’t take airline pilots that way, would you? This also is a matter of life and death.” Foreign nurses recruited by Texas hospitals may sometimes be encouraged by their employers to seek licensure. The. State Board of Nursing Examiners says that each month about 200 apply to take the exams. However, only a minority pass: 121 out of the 541 foreign nurses who took the exams last July passed, according to Margaret Rowland, the TBNE’s executive director. Rowland says that poor English reading and writing skills are the greatest handicaps for foreign nurses taking the tests, but that differences in education present prok lems too. British nurses, for example, usually receive no training in obstetrics and psychiatry. “Hospitals have been very ‘creative’ in the names they use for unlicensed