Orange County hospitals have been scrambling to meet California’s nurse-patient staffing ratios for the past few years.
Now, with the law taking full effect this year, hospital officials say they’re up to speed in meeting the requirements.
“We knew this was coming when it first went into effect, so we’ve had like three years to prepare,” said Karen Ladley, chief nursing officer for Saddleback Memorial Medical Center in Laguna Hills and San Clemente.
The implementation of the law wrapped up last month, with the last of the ratios,broken down by hospital units,taking effect.
Nurses who work in specialty, transitional and telemetry units now care for fewer patients. Specialty units are those such as cancer care or dialysis. Transitional units are used between intensive care and general medical-surgical floors. Telemetry units are those where machines monitor patients’ blood pressure and heart rhythms.
There’s now one nurse for every three patients in step-down units,designed to provide care for those who need less monitoring than those in the critical care or intensive care units but still require more monitoring than those on the medical or surgical units.
The ratio for specialty care and telemetry units is one nurse per four patients.
Ratios for other units, which already were in effect, are higher. The law requires one nurse per five patients in general medical or post-surgical units, and one nurse per four patients in pediatric units and emergency rooms.
That’s forced OC hospitals to step up hiring,something that hasn’t been that easy.
The law comes into play at a time when hospitals are being forced to shell out more money to pay for nurses because of the state’s ongoing shortage. Figures from the state Employment Development Department show that registered nurses in OC made a mean wage of $73,944 a year, up from $50,810 in 1998.
“We’re having many of the same struggles as a lot of the other hospitals because of the nursing shortage,” Ladley said.
Saddleback has heavily recruited graduates, worked to retain its existing staff and uses nurses from local registries as well as traveling nurses.
The hospital also has focused on hiring local nurses.
“With the high cost of housing and living in South Orange County, it is very difficult to recruit in from the outside,” Ladley said.
Saddleback has some 900 registered nurses on staff between its two campuses and its hospice program.
UCI Medical Center, a teaching hospital in Orange, has steadily hired nurses to meet the ratios, said Lisa Reiser, its chief nursing officer.
“We do new grad recruitments twice a year,we’ve probably been doing that for the last three years,” Reiser said. “I’d say we’ve been successful.”
UCI gets about 120 nursing graduates from those events on a yearly basis, according to Reiser. Some 80% of the hospital’s nursing hires are from OC, with the remainder either from other parts of California or out of state.
UCI now has about 1,000 registered nurses on staff.
Most of them have been hired within the past five years because of a combination of ratios and more patients, Reiser said. UCI historically has ranked among the top three Orange County hospitals based on net patient income (see story, page 56).
The hospital has some traveling nurses, and has used local registry nurses,both of whom go from hospital to hospital. Reiser said only about 4% of its nursing workforce falls under those categories.
Both Ladley and Reiser said their hospitals are boosting their involvement with nursing education programs, including at the University of California, Irvine.
“We are so excited. We have started our program in nursing science,” Reiser said. “Our first class is going through. They will be starting their rotations in the spring.”
UCI has received 750 applications for its next batch of students in the registered nursing program, she said.
Saddleback has given money to Saddleback Community College so it could increase the college’s nursing faculty, Ladley said.
Saddleback also has worked with UC Irvine to develop the university’s bachelor’s program and is looking at the university’s program as part of its future labor pool, Ladley said.
‘Richer’ Ratios
Up in Anaheim, Kaiser Permanente’s hospital on Lakeview Avenue has nursing ratios that are “richer” than what the law requires, said nurse executive Denise Giambalvo.
“Kaiser Permanente decided in partnership with our nursing union (the United Nurses Association of California/Union of Health Care Professionals) to go richer,” Giambalvo said.
Kaiser, which employs 400 to 425 registered nurses at the Lakeview hospital, staffs its medical-surgical unit with one nurse per four patients, instead of the required one nurse per five patients.
“We’re always at (Department of Health Services) ratios, most times even richer,” Giambalvo said.
Kaiser’s been able to attract more nurses through word of mouth,”a lot of our own staff sought out people who they knew from other hospitals,” Giambalvo said, adding that benefits and the work environment also are draws.
Kaiser will apply its richer ratios to its Sand Canyon hospital in Irvine, which is set to open in mid-May, Giambalvo said.
That facility will open with about 300
nurses.
Half of that number’s been hired at this point, she said.
Giambalvo said it’s been challenging to find enough nurses to open Sand Canyon because of the overall nursing shortage and the cost of living,the Irvine area is more expensive than Anaheim.
Nearly A Decade
The nursing ratios were signed into law nine years ago by former Gov. Gray Davis, who was recalled from office in 2003. Getting ratios into law was a priority of unions such as the California Nurses Association, which argued that many nurses were leaving the profession because they were overworked.
The law faced legal challenges from the hospital industry, which argued it simply couldn’t find enough nurses to meet the ratios.
In addition, the Department of Health Services had to actually develop the ratios.
The law actually took effect in January 2004 with a five-year phase-in period. But the hospital industry then was able to persuade Gov. Arnold Schwarzenegger to issue an emergency regulation in November 2004 to overturn the emergency room nursing ratios and the beefed-up medical and surgical ratios.
Schwarzenegger’s decision led to vigorous protests against him spearheaded by the California Nurses Association that culminated in a crushing defeat of four ballot initiatives he proposed in a 2005 special election.
The governor later dropped his fight against the law, and the state Department of Public Health sent letters to hospitals letting them know about their obligation to meet standards by Jan. 1.
Additionally, officials also said that hospitals have to increase staffing if needed by patient acuity, or level of illness.
