The eyes of the nation should be on Youngstown.
No, not because we have a colorful congressman who has gone and gotten himself indicted. Or because steel imports and what they've done to the industry here provide a lesson in what happens when fair trade becomes unfair trade. Not even because we have an auto plant that faces a turning point as people in Detroit make decisions that will affect the Mahoning Valley for another generation.
No, they should be looking at Youngstown and Warren because one of the realities of modern health care is making itself dramatically evident in the strike by members of the Youngstown General Duty Nurses Association against Forum Health.
It's everywhere: Forum, which operates hospitals in Youngstown and Warren, has come smack up against one of the most serious problems facing health care in the United States today: the shortage of nurses. At issue is how a hospital responds to that shortage -- specifically how it uses mandatory overtime to fill gaps in the staff that come up every day.
It's an issue that isn't likely to go away soon -- not here and not in any city in the nation where there's a hospital.
While nurses clearly resent mandatory overtime, what's a hospital to do when the end of a shift is approaching and, for one reason or another, not enough fresh nurses are coming in for the next shift? The hospital could let all the nurses go home. But it can't very well send the patients home. Or it could tell some of the nurses that they have to stay, and then the patients can stay as well. Given the choices, every day some nurses are told they can't go home when their regular shifts end.
That's a simplified analysis of a very complex problem.
The answer is more nurses, right? Well, not exactly. It is not that there aren't enough nurses. It's just that hundreds of thousands were driven from or chose to leave work in acute-care hospitals. Nationally, 494,000 licensed nurses are not working in their chosen profession, up from 387,000 in 1992.
Vicious cycle: Some left during the early days of managed care when hospitals adjusted to the need to cut costs by cutting staff. Others have left -- and this is where it gets to be a vicious cycle -- because of working conditions, including mandatory overtime. And for a really vicious cycle, consider this: some of the Youngstown nurses who went out on strike will find other jobs during the strike and won't come back.
In short, hospitals are going to have to come up with creative ways of maintaining the staff they need. Granted that some of the horror stories have been anecdotal, but if even one nurse works a 16-hour shift, gets four hours of sleep and then reports for another 12 hour shift, that's one nurse too many.
The only thing that would be worse would be to have no nurse at all.
Youngstown, Warren and America have a lot to think about while Forum and its nurses try to work out their differences.