Come Jan. 1, the State Will Tell Hospitals How Many Nurses They Must Have
Hospitals in OC and the state, already facing a shortage of nurses, are warily eyeing a looming state mandate that almost certainly will require the hiring of more.
The California Department of Health Services is working to meet a January deadline for developing first-ever minimum nurse-staffing levels for acute care and acute psychiatric facilities, imposed by a law passed in 1999.
The California Healthcare Association, a hospital trade group, wants the regulators to craft standards that would allow individual facilities some freedom to set their own staffing ratios. The association also has argued that if the ratios are set too low, California’s nursing shortage could be exacerbated.
Financial factors also come into play. According to the California Employment Development Department, the mean annual wage for registered nurses in Orange County was $50,810 in 1998, the last year for which figures are available. That covers only straight-time gross pay, not overtime, benefits or other costs.
On the other side, nurses’ groups have called on the state to establish ratios as low as three or four patients per nurse in certain units, which would increase the need for registered nurses statewide. But the California Nurses Association, which backed the staffing law, says such ratios will not aggravate the shortage, because they will keep nurses in the profession. The association long has maintained that heavy patient loads drive many nurses to leave acute-care hospital work.
As the debate rages, OC hospital nursing officers say they’re bracing for Jan.1.
“I’ve seen the preliminary standards that came out a year ago. We currently exceed those,” said Rick Martin, vice president of patient care at Hoag Memorial Hospital Presbyterian in Newport Beach. Martin added that he expects Hoag, which employs 590 full-time RNs, to “meet and exceed” whatever minimum ratios come down from the state.
“For other hospitals, it will be a challenge to try to find nurses. If they can’t find nurses, they will have to close beds because they’re not in compliance,” Martin said.
UCI Medical Center, which employs more than 500 full-time registered nurses, is in between some published ratio proposals, according to Lisa Reiser, the Orange hospital’s associate director for acute-care services and chief nursing officer.
Reiser said her facility is confident that it will meet any number that the Department of Health Services includes in its final regulation.
“If they go with low minimum numbers, a couple of medical-surgical (units) will have to add staffing, but not that much,” she said.
Determining those ratios is a “very complicated process,” said Lea Brooks, a department spokeswoman. “There is no reliable, complete baseline data on nurse-to-patient levels. It just doesn’t exist.”
It is “very difficult to separate out nursing from the total care package,” said Gina Henning, a registered nurse and coordinator of the department’s ratio crafting project. Many factors influence a patient’s outcome, including technology, the number of specialty physicians caring for the patient and access to caregivers such as respiratory therapists, phlebotomists and nurses’ aides, she said.
Henning said her task force is working with a University of California research team that is reviewing literature on the subject and visiting hospitals around the state to gather data on nursing issues.
Meanwhile, several groups already have submitted widely varying proposed ratios. For example, proposals from Service Employees International Union and the United Nurses Associations of California/Union of Health Care Professionals call for a 4-to-1 patient-nurse ratio in general medical-surgical units, while the UC hospitals are suggesting a 6-to-1 ratio for such units during the day and 7-to-1 at night. The California Healthcare Association called for a 10-to-1 ratio.
The original staffing law, as proposed by the Nurses Association, contained specific numbers, like a 6-to-1 ratio for medical-surgical units. In the face of industry opposition, however, the nurses’ association agreed to allow state regulators to set ratios in order to get the bill through the Legislature.
And as regulators work on crafting ratios, sniping has continued between the hospital and nurse trade groups.
“The industry realizes that their ratios are outrageous,” said Kay McVay, president of the California Nurses Association. “One nurse to 12 patients in behavioral health,is that safe? They are not safe.”
McVay, who received her training at UCI Medical Center when it was Orange County General Hospital, said that lower ratios are needed because, among other things, patients who stay in the hospital are sicker than they used to be.
The hospital association, on the other hand, says the ratios that nurses’ groups are proposing don’t take into account that “there is a real nursing shortage here,” said spokeswoman Jan Emerson. Emerson gave estimates showing that California’s RN deficit is projected to reach 25,000 by 2006.
“Then, you have ratios on top of that,” Emerson said. “If the ratios are too high, we will not be able to hire (nurses) and the DHS will have to close hospitals and beds.”
And the two sides do not appear to be ready for compromise.
Emerson noted that shortly after her group came out with its proposed ratios, the nursing association, “within hours, came out with a press release that attacked us.” She also criticized the nurses’ group strategy of “town hall meetings” to get suggestions from registered nurses.
“They’re trying to get public support,” Emerson said, adding that the time to get such support was prior to the Legislature voting for the law.
For her part, McVay said she believes the hospital industry is “very angry” about ratios because it created the nursing shortage with decisions made in the late 1980s and early 1990s.
“The industry devalues RNs. This is not about wages,” she said.
“The nursing union just won’t let go,” Emerson said. “(The past) is not the point. We’re desperately seeking nurses now.”
Meanwhile, Henning said she isn’t worried about meeting various deadlines. She said there are “many facets of a regulation package” and the department can work on other parts while awaiting the suggested ratios.
The new regulations will join directives already on the books that require hospitals to distribute staff according to patients’ levels of sickness. Henning said those rules will remain in force after the new nurse-staffing regulations take effect. n
