WHO CARES FOR THE CAREGIVER? OVERWORKED NURSES OFTEN PUT THEIR PATIENTS' HEALTH BEFORE THEIR OWN.

Byline: Denise E. Swibold Staff Writer

CATHY CARTER is an expert in caring for others.

An emergency room nurse at Providence Holy Cross Medical Center in Mission Hills since 1991, Carter specializes in crisis health care. Her days are long, the pace is hectic, and the stress of making life-or-death decisions can be punishing. Carter thrives on it.

``I love emergency medicine. I like the fast pace,'' said the trim, fit, 38-year-old registered nurse. Rising patient counts - emergency-room staffers at Holy Cross have handled nearly 300 trauma cases so far this year - ensure a fast pace.

But the demands can take a toll.

``It is a very long day,'' Carter said. ``You go home pretty tired at the end.''

The current nursing shortage has made most nurses' lives even tougher. Twelve-hour shifts are the norm, and even back-to-back eight-hour shifts - doubles - are not uncommon. Mandatory overtime or on-call shifts are routine. And patients in hospitals demand more care than ever, since only the sickest are hospitalized under today's cost-saving policies. New state mandates require one nurse for every six patients, but nurses still find themselves stretched thin, nagged by a sense they've not done their best for patients or themselves.

Recovery time

The rigorous working conditions have forced Carter to become an expert in taking care of herself - something not easily done in a profession that puts patients first. ``I try to eat a big, hearty breakfast,'' she said. ``I never go all day without eating. There's no way to function. But if you have someone that really needs you, you know you have to be there for them.''

Although she may cover six or seven miles during a typical 12-hour shift, Carter still exercises regularly - running or walking - when she's home. On duty, she tries to resist the temptation of break-room junk food.

``You do see a lot of obesity in nurses,'' Carter acknowledged. ``I don't know why that is.''

Sue Albert, a nurse for three decades and now an administrator at College of the Canyons in Santa Clarita, understands why.

``The kind of person who goes into nursing tends toward placing priorities on others,'' she said.

Albert's body registers her years of putting others first - of gobbled meals, of the stress of responsibilities, of the strain of lifting patients and being constantly on her feet. Now in her 50s, Albert battles a weight problem and takes medication for high blood pressure and high cholesterol.

``I've worked out only once in six months,'' she said. ``I always seem to

have something else to do.''

That makes Albert typical of her nursing colleagues, she said. Only two of the seven faculty members she oversees at College of the Canyons, where Albert is assistant dean of allied health, are regular exercisers, she said.

That irony, of being health-care experts who neglect their own health, is not lost on them, she said.

``You do as we say, you don't do as we do,'' Albert said. ``We all sit here and we diet. We laugh at the fact that our feet, our backs hurt.''

A serious condition

Albert said the current shortage won't be relieved until working conditions improve. In a 2001 survey by the Federation of Nurses and Health Professionals, 56 percent of nurses who have considered leaving the profession over the past two years for reasons other than retirement said they wanted a less-stressful and physically demanding job. Only 18 percent said they wanted more money.

And nurses themselves need to better reflect the satisfactions of the job, Albert said.

``The reason we have no nurses, is we're not good examples,'' she said.

Karen Wilson, a registered nurse since 1987, knows why some nurses fail to provide good examples.

``This is my ninth day in a row,'' said Wilson, who sees patients in their Orange County homes, helping them with such tasks as administering medicine through IVs. ``Tomorrow, I'll be up at 4.''

Some days, Wilson is on the run all day, driving from patient to patient, with little or no break.

The temptation is to grab high-fat fast food or go without - and that can leave her fatigued, she said.

Work in a hospital can be just as unrelenting and hectic, she said.

Proof, she said, is in the phenomenon of ``nurse's bladder,'' infections or irritations brought on by too few bathroom breaks.

Wilson finds some time for exercise, swimming in her pool at home or working out on home cardio equipment. But that uninterrupted time is sometimes earned by simply refusing supervisors' requests that she work more.

``I'm not being difficult,'' Wilson said. ``I don't like to be taken advantage of. I'm just trying to take care of myself.''

At the end of a patient-loaded day, of juggling life-and-death responsibilities, eating the wrong foods can be soothing, Wilson said.

``(Nurses) do turn to food,'' agreed Celeste Bocian, a registered nurse since 1974. ``I have in the past.''

Bocian's long career has run the gamut from pediatric work to home health care to working with the elderly, and she's found it very rewarding.

``It's very stressful. But it is very stimulating,'' Bocian said. ``People who go into nursing like that kind of stress.''

Still, in today's short-staffed environment, stress has become too much of a good thing, Bocian said.

``There's not enough nurses,'' she said.

In January, there were 283,300 registered nurses in California, compared to 273,150 a year ago, according to the Board of Registered Nursing.

``Though there is an increase in registered nurses, it hasn't kept pace with the population of the state,'' said Susan Brank, assistant executive officer of the board.

California has the second-to-lowest number of working nurses per capita in the United States; only Nevada has fewer.

Self health

Bocian is program director for SAGE - Specialized Ambulatory Geriatric Evaluation - a program at Sherman Oaks Hospital focused on helping older people improve or maintain their quality of life.

Bocian doesn't believe nurses are any less fit than workers in other fields, but she recognizes that the job can create obstacles to good health.

That means it's up to individuals to take action.

``I just started a diet yesterday,'' she conceded. ``But this is me. I know some very thick nurses. We're just people like anybody else.''

Donna Moore, a nursing executive overseeing about 500 staffers at the Kaiser-Permanente Hospital Woodland Hills, said many among the new generation of nurses actually desire 12-hour shifts.

In fact, such shifts are viewed as a recruitment incentive, even at the Woodland Hills hospital, a union operation where eight-hour shifts are still the norm, Moore said.

Long or added shifts can mean extra money. And three-day work weeks allow some nurses to take on a second job, she said.

``It's really not a healthy thing to be doing,'' Moore said. But ``there are some people who have planned their lives around that extra money.''

To ease stress on nurses, Kaiser works to keep nurse-to-patient ratios at 1 to 4 in some areas - below the state mandate. The hospital has instituted lift teams, who will do the lifting of patients for nurses. And exercise classes are provided on-site to help nurses stay fit.

``I don't think nurses know how to take care of themselves very well,'' Moore said. ``We happen to be kind of driven.''

CAPTION(S):

5 photos

Photo:

(1 -- cover -- color) Nurses care for patients 24/7, often at considerable cost to themselves.

(2 -- cover -- color) Registered nurse Cathy carter works alongside trauma surgeon Bradley Roth at Providence Holy Cross Medical Center.

(3) Carter preps a patient during a recent shift in the hospital's trauma center.

(4) Although her job at Providence Holy Cross Medical Center poses physical demands - such as mopping up blood - registered nurse Cathy Carter says she still makes time to exercise.

(5) Cathy Carter, right, chats with fellow registered nurse Melanie Ridgly at the Providence Holy Cross Medical Center. ``It is a very long day,'' Carter says.

Photos by Andy Holzman/Staff Photographer