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| The
first of its kind in the nation, California’s
nurse-to-patient ratio law is undergoing intense
scrutiny from opponents and supporters alike—as
well as from states considering similar proposals.
|
The enactment of California’s nurse-to-patient
ratio law—the first of its kind in the nation—is
undergoing some political birthing pains. Key questions
are whether hospitals can find enough nurses or come
up with creative solutions to meet staffing ratios “at
all times,” including breaks and lunches, and
whether they can afford the cost of hiring additional
staff in times of financial uncertainty.
At least 28 other states are considering similar ratios
with the backing of some nursing organizations, according
to the National Conference of State Legislatures. Although
none of the pending proposals has been put to a vote,
ratios are most likely to be enacted in Massachusetts,
New York, Florida, Michigan and Oregon.
Karen Higgens, RN, president of the Massachusetts Nursing
Association, which has 22,000 members, said the group
was backing a state legislative bill, HB 182, that would
ensure quality care and safe RN staffing through improved
RN-to-patient ratios similar to California.
The proposal calls for one nurse for every four patients
in medical/surgical units, where most patient care takes
place, whereas California requires a 1-to-6 nurse-to-patient
ratio this year, and a 1-to-5 ratio in 2005.
In emergency departments, the Massachusetts bill asks
for a 1-to-1 up to a 1-to-3 ratio depending on the severity
of the patient’s conditions. Ratios would be 1-to-1
in labor and 1-to-2 for intensive care units.
Charles Stefanini, director of legal and government
affairs for the Massachusetts association, said the
bill is supported by a majority of the state’s
legislators and more than 200 advocacy groups. “Things
look promising and the law could be passed here before
the legislative session ends in July,” he said.
Although many large hospital systems in California
were prepared to meet the minimum nurse staffing ratios
when the mandate took effect Jan. 1, other acute care
facilities have scrambled to comply in the face of a
statewide nursing shortage. Some otherssmaller hospitals
with budget deficits—have sought waivers because
of their difficulty in meeting ratios, which get tougher
next year.
Kaiser Permanente, for example, met or exceeded the
nursing ratios in 2003 in its 27 California hospitals,
voluntarily adopting a 1-to-4 nurse-to-patient ratio
in all medical and surgical units by investing nearly
$200 million to recruit and hire 1,300 new nurses. Another
model of compliance is the University of California,
Davis Health System, where most nursing units are fully
staffed and even have waiting lists of RNs seeking jobs.
Although some large facilities have fared well, the
implementation of ratios has been “pretty rough”
for most hospitals in California, said Barbara Patton,
a senior vice president of The Camden Group, which specializes
in hospital operations, management and nursing services.
“Most of the hospitals we’ve worked with
have had to tighten their belts and look at ways to
effectively provide care under the new guidelines,”
Patton said. “This sometimes entails cutbacks
in services. Because of the severe nursing shortage,
even if they want to hire nurses, there are very few
available.”
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