Davis Releases Minimum Nurse Staffing Ratios for Hospitals
Gov. Gray Davis (D) released first-in-the-nation rules yesterday that establish mandatory minimum nurse-to-patient ratios at general acute care hospitals, the Los Angeles Times reports. The announcement, which comes more than two years after legislation was passed calling for the minimum nurse staffing ratios, could lead to similar efforts in other states (Bernstein, Los Angeles Times, 1/23). California already sets staffing ratios for five hospital departments, including intensive and critical care and neonatal intensive care units (Benson, Wall Street Journal, 1/23). The state Department of Health Services' proposed regulations, which are subject to public hearings and could be changed, would initially establish a ratio of one nurse for every six patients on general medical floors, "where the majority of nurses are employed." Eighteen months after the expected July 2003 implementation of the rules, the standard would be narrowed to 1-to-5 (Russell, San Francisco Chronicle, 1/23). The rules would also set a 1-to-1 ratio for nurses and patients in trauma centers, a 1-to-4 ratio for pediatric nurses and child patients and a 1-to-2 ratio for obstetric nurses and women in labor (Los Angeles Times, 1/23).
Flanked by members of a nurses' union, Davis announced the new rules at a Los Angeles hospital, saying they would bolster the quality of care for California hospital patients. "We're doing it for a simple reason, to improve patient care. The more nurses, the better the care," he said. Although the California Nurses Association, the union that wrote the legislation creating the staffing standards, was hoping for a ratio of one nurse to every three patients, union leaders were nevertheless satisfied with the proposed regulations, "believing that the overriding issue was getting the unprecedented rules implemented in the first place," the San Francisco Chronicle reports. Proponents of the standards say they will help to alleviate the state's nursing shortage by making the profession "more tolerable," thereby enticing trained nurses who have left their jobs to return to work. They also say it will improve quality of care by allowing nurses, whom Davis called "overworked and overstressed," to care for less patients at a time (San Francisco Chronicle, 1/23). Rose Ann DeMoro, executive director of the nurses association, said, "This is the most sweeping systemic health care reform that you're going to see. This measure will affect every hospital in the state of California" (AP/New York Times, 1/23).
Hospital representatives, however, said that the new ratios could actually do more harm than good, as many hospitals are already losing money and cannot find enough nurses to staff their facilities, even without minimum standards (Los Angeles Times, 1/23). Davis estimated that the new guidelines would expand California's hospital nursing work force of 197,400 by 5,000 (Wall Street Journal, 1/23). Duane Dauner, president of the California Healthcare Association, which had sought a standard of one nurse for every ten patients, said, "Several thousand new nurses must be employed to meet these requirements. But are they available? And is there money to pay them?" (Los Angeles Times, 1/23). The association estimates that the regulations will cost hospitals at least $400 million a year in extra wages and benefits (AP/New York Times, 1/23). Joanne Spetz, a University of California-San Francisco professor and associate director of the Center for California Health Workforce Studies, estimated that figure at $137 million a year (San Francisco Chronicle, 1/23). Dauner also said that hospitals are "particularly concerned" that the new ratios for emergency rooms could force hospitals to turn away ER patients if not enough nurses are on hand.
In addition, the Los Angeles Times reports that the new rules will increase pressure on the managed care industry, in which efforts to hold down reimbursements to hospitals has "help[ed] fuel the reduction of nursing staffs." Walter Zelman, president of the California Association of Health Plans, said, "Increasing the number of nurses relative to patients is going to raise hospital costs, and ultimately raise health plan premiums. In many cases, that may be appropriate and necessary ... to improve quality, but it doesn't get around the reality that we're facing cost increases that many people are having difficulty paying" (Los Angeles Times, 1/23). Meanwhile, California's rules could spur similar nursing ratio requirements in other states, including Massachusetts, where lawmakers are discussing minimum standards. Julie Pinkham, executive director of the Massachusetts Nurses Association, said, "Nurses across the country are waiting for this. California has put it out there. Now it's going to go across the nation. It's long overdue" (AP/New York Times, 1/23).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.