Governor Announces Nurse-to-Patient Plan
BY MARION WEBB
Staff Writer
Local hospital officials said they already are near compliance with Gov. Gray Davis’ proposed mandatory minimum nurse-to-patient staffing ratios.
Those officials, however, warned the proposed minimum staffing levels, which still face legislative approval, will raise health care costs and pose challenges in terms of implementation.
“As hospitals assess (the proposed regulations) and decide priorities, I do have a concern that given the nursing shortage, we could see units closing within hospitals,” said Steve Escoboza, president and CEO of the Healthcare Association of San Diego and Imperial Counties, which represents more than 30 hospitals in the two counties.
Under the proposal announced by the governor Jan. 22, California will be first state in the nation to adopt minimum staffing ratios for nurses.
The California Nurses Association, the state’s largest nurses union with 45,000 members and a longtime champion of the law, hailed the proposed ratios as a “quantum leap forward for public health and safety.”
Nurses said the 1-to-6 ratio , one nurse for every six patients , proposed for medical-surgical units is especially significant. If approved, that number is expected to eventually drop to five patients per nurse.
Nurses In Short Supply
Geri Jenkins, an intensive-care nurse at the UCSD Medical Center in Hillcrest, who is also a board member of the nurses association, said the new guidelines would “significantly improve conditions for patients in hospitals.”
That is considering California has the second-lowest nurse-to-resident ratio in the country with 2.27 nurses for every 1,000 residents, well below the national average, she said.
Hospital administrators however, are quick to point out California also faces the most severe nursing shortage in the nation.
According to published reports, the state would have to hire an estimated 5,000 nurses to meet the new standards. Local hospital officials say aside from the long list of nursing vacancies, they are faced with an aging nursing population, as many near retirement age.
“Half of the practicing registered nurses are over (age) 50 (and) there aren’t enough nursing students in California,” said Liz Mullensky, assistant administrator chief nursing officer at Kaiser Permanente in San Diego.
Kaiser adopted its own staffing ratios in August, which she said will be adopted in the medical-surgical units by June.
Mullensky said Kaiser officials are working with union representatives to develop guidelines, but couldn’t give a cost estimate.
To meet the new regulations, Kaiser may hire less-skilled licensed vocational nurses to work under the supervision of registered nurses, she said.
Scripps Health President Chris Van Gorder said it would cost the five-hospital system between $4 million and $8 million to comply with the ratios by July 2003.
He said it’s too early to say how many more nurses Scripps would need to hire to meet the requirements. As of last week, the system had 200 job vacancies for nurses.
Hospitals Critical Of Ratios
Van Gorder echoed Escoboza’s concern that in the wake of the nursing shortage, health care access may be limited.
“If we don’t have enough nurses (we) can’t open up all the beds and once we get to that point, we can’t admit patients,” Van Gorder said.
This could exacerbate an emergency-care system already in crisis, especially if more patients have to be diverted to other hospitals.
Maryann Cone, chief nursing officer at Grossmont Hospital, a Sharp Healthcare facility, was also critical of the new standards.
Cone agreed with Van Gorder that staffing decisions should be made based on needs of patients at any given time and not according to a mandated formula.
To have one’s nurse-to-patient ratios dictated takes away “flexibility to look at the patient’s individual needs,” Cone said.
“Some patients need higher ratios, others need less,” she said, adding that different hospitals have different needs.
The California Nurses Association, however, said in a written statement that mandatory guidelines are needed to ensure the same level of protection.
Under existing law, five hospital units have minimum staffing requirements for nurses.
They are one nurse for every two patients in the critical care and neonatal intensive care units; one nurse per patient in the operating room; and one nurse for eight patients in the well-baby nursery.
The new regulation would extend the minimum requirements to many more units.
“The ratios that were proposed are just the beginning of what will likely be a lenghtly state regualtory process,” said Jan Emerson, spokeswoman for the California Healthcare Association in Sacramento.
In April, the California Department of Health Services, the agency responsible for implementing the new nurse-to-patient ratios, will publish the proposed regulations, she said.
This will then open mandatory public hearings and comments for at least 45 days, she said.
Emerson estimated the entire process will take 12 to 15 months.
