State sets nurse-patient quotas

Two years after it was adopted by California voters, the so-called Safe Staffing Law to set nurse-to-patient ratios in the state’s hospitals finally has some numbers to back it up. On Jan. 22, Gov. Gray Davis announced the range of minimum ratios as adopted by the Department of Health Services. The law, AB 394, authored by state Sen. Sheila Kuehl, D-Santa Monica, and championed by the California Nurses Association, makes the state the first in the nation to set minimum ratios.

The law was triggered, supporters say, by the mass exodus in recent years of nurses from hospitals into private-care jobs or out of the profession completely. Hospital administrators say the law will be hard to enforce because of the nursing shortage. Supporters say the law will work to bring nurses back into the fold.

At a press conference coordinated to time with Davis’ announcement, Enloe Medical Center nurses gathered outside Cal Java near the hospital to speak with the media.

RN Kitty Courcier said a similar law passed in Australia four years ago led 10 percent of nurses to return to the field. “The key factor here is to protect patient safety,” she said. “That is why the public voted it in two years ago. The DHS has been very generous with the time it’s taken to review the options.”

The ratios are based on suggestions from the CNA, the union that now represents Enloe RNs, and the California Healthcare Association, which speaks for hospital administrations. As would be expected, the two sides varied—in some cases greatly—on the ratios they saw fit for the various hospital wards.

For instance, in the medical-and-surgical, telemetry (where coronary patients are monitored via television screens) and specialty-care units, CNA called for one nurse for every three patients, while CHA suggested a 1-to-10 ratio. The DHS announced ratios of 1-to-6 for medical-and-surgical and 1-to-5 for telemetry and specialty-care units.

Operating room patients under anesthesia must have a 1-to-1 ratio, as must trauma patients in the emergency room. Those in the labor-and-delivery, post-anesthesia, critical-care, burn and neonatal intensive-care units will be given one nurse for every two patients.

Courcier said she had heard complaints from nighttime nurses that in some areas of the hospital the ratios were as loose at times as one nurse for every 10 patients. She called it “a worse-case scenario.”

Ann Prater, director of public relations for Enloe, said the hospital needed clearer information on the ratios before it could speak specifically to the announcement.

“One thing that is not clear is, are the ratios just for RNs or do they apply to LVNs [licensed vocational nurses] as well?” Prater said. “That would make a significant difference.”

She said initially it would appear that “nothing is too far from what we are already doing here at Enloe” as far as nurse-to-patient ratios go.

“Our primary concern still stands,” she added. “They are reducing patient care to an equation that doesn’t work to a patient’s benefit. Ratios don’t tell the whole story.”

She said the law does not allow for the shortage of nurses state- and nationwide.

“We’ve heard that 85 percent of all the nurses in this state who hold licenses are working,” Prater said. “This is an unfunded mandate that comes when a majority of hospitals in California are losing money.”

Speaking of which, Enloe announced this week that it will be turning the Glenn Medical Center in Willows from an inpatient to an outpatient operation. The former Glenn County Hospital was reportedly losing $1 million per year when Enloe bought it. But things didn’t improve much, and Enloe has lost $3.8 million since taking over. Enloe said the center is averaging less than one new patient per day. The closure will leave Willows and Glenn County without a hospital.

The new nurse-patient ratios will not be official until after period of public comment, the date for which has not been set.