Department of Health Services Has Inspected Few Hospitals for Compliance With Nurse Staffing Rules
The Department of Health Services, which licenses the 451 acute-care hospitals in the state, has investigated only 28 of the facilities to determine whether they comply with nurse staffing rules, according to state data, the Los Angeles Times reports (Chong, Los Angeles Times, 11/6).
DHS in 2003 developed the nurse staffing rules to comply with a law signed in 1999 by former Gov. Gray Davis (D). Under the regulations, nurses must not care for more than eight patients at a time. DHS updated the rules on Jan. 1, 2004, to require that nurses in medical-surgical units care for no more than six patients at a time. Under the regulations, the nurse-to-patient ratio for medical-surgical units is scheduled to decrease to 1-to-5 by Jan. 1, 2005.
In addition, the rules state that licensed vocational nurses can comprise no more than 50% of the licensed nurses assigned to patient care and that only registered nurses can care for critical trauma patients. The rules also require at least one registered nurse to serve as a triage nurse in emergency departments. In addition, the regulations state that nurses in telemetry and step-down units can care for no more than three patients at a time by 2008.
DHS officials on Thursday proposed to delay until at least January 2008 the scheduled decrease in the nurse-to-patient ratio for medical-surgical units. DHS also would allow hospitals to temporarily suspend compliance with nurse staffing rules for EDs in the event of an "unforseeable influx" of patients. In addition, DHS proposed to reverse a requirement that hospitals replace nurses on bathroom breaks.
DHS has submitted the proposals to the Office of Administrative Law, which likely will approve them within 10 days of the date on which they were filed. DHS likely will hold a public hearing on the proposals in mid-January (California Healthline, 11/5).
DHS officials said that inspections have identified nurse staffing violations at 15 hospitals and that they have demanded a plan of correction from administrators at those facilities. In four cases, the inspections led DHS to cite hospitals for violations not related to nurse staffing.
DHS does not conduct random inspections to determine whether hospitals comply with nursing staffing rules. DHS reviews complaints from patients and reports from hospitals to determine whether the facilities comply with the regulations. Since the rules took effect, patients have filed 78 complaints with DHS.
DHS investigates complaints that "do not indicate immediate patient harm" as part of scheduled hospital inspections, which occur every three years, the Times reports. DHS officials said that they do not have the authority to fine or close hospitals that do not comply with nurse staffing rules.
According to the Times, the number of hospitals that meet the regulations "remains unclear." A California Healthcare Association survey found that 85% of hospitals do not comply with the regulations, and a California Nurses' Association survey found that 42% not do comply.
DHS Director Sandra Shewry said, "We consistently enforce all of the regulations that have to do with patient safety. Any time there's an allegation and that allegation could place a patient in immediate jeopardy of health or safety, we assign a nurse or regulator to visit the facility within 48 hours."
CNA Southern California Director Jill Furillo said, "Our feeling is ... the department should be more assertive" in enforcement of the nurse staffing rules.
CHA spokesperson Jan Emerson praised the decision by DHS to "not aggressively" enforce the regulations. She added, "The problem is, that doesn't alleviate a hospital's legal liability."
Brenda Klutz, DHS deputy director of licensing and certification, said, "What we want to do is be informed really by solid data we can verify." She added, "We really have an obligation, before we make further changes to the law, to get those answers" (Los Angeles Times, 11/6).
CNA President Deborah Burger said that group plans to ask the administrative law office to reject the proposed revisions to the nurse staffing rules. She said, "We had this law scrutinized for the last four years, and for the last 10 years it has gone through the legislative process."
John Zelezny, senior vice president for Fresno-based Community Medical Centers, said, "We have never opposed the general goals in the legislation, but I will say that we've not been happy, nor has any other hospital been happy, with the inflexibility in some of those regulations."
Emerson called the proposed revisions "common-sense recommendations" (Correa, Fresno Bee, 11/6).
CNA "ignores the fact that nurses are in short supply and that hospitals have limited resources" in opposition to the proposed revisions to the nurse staffing rules, a San Jose Mercury News editorial states.
The "unfunded staffing requirements ... have forced hospitals to hire thousands of new nurses at a time when more than half of California hospitals are already losing money," the editorial continues.
The proposal by DHS to revise the rules provides "a reasonable balance between securing patient safety and hospitals' financial health," the editorial concludes (San Jose Mercury News, 11/8).
KPBS' "KPBS News" on Friday reported on the proposed revisions to the nurse staffing rules. The segment includes comments from Burger (Goldberg, "KPBS News," KPBS, 11/5). The complete transcript is available online. The complete segment is available online in RealPlayer.
In addition, KPCC's "Air Talk" on Friday included a discussion about the proposed revisions. Guests on the program included Furillo; Dorel Harms, a registered nurse and vice president of professional services at CHA; and Klutz (Mantle, "Air Talk," KPCC, 11/5). The complete segment is available online in RealPlayer.