Department of Health Services Issues Emergency Regulations To Delay Some State Nurse Staffing Rules for Hospitals
The Department of Health Services on Thursday proposed emergency regulations that would ease the state's new nurse-to-patient staffing ratio requirements in an effort to reduce "the heavy financial burden the rules have placed" on hospitals, the Los Angeles Times reports (Chong, Los Angeles Times, 11/5).
In 2003, DHS announced the regulations to implement a law signed in 1999 by former Gov. Gray Davis (D) that was intended to increase patient safety and ease the state's nursing shortage by improving working conditions. Under the new rules -- the first such guidelines in the nation -- a nurse will not have to care for more than eight patients at a time (California Healthline, 7/2/03). One part of the rules that lowered to six the number of patients each nurse in medical-surgical units could be assigned was implemented on Jan. 1, 2004 (Russell, San Francisco Chronicle, 11/5).
Under the regulations announced in 2003, the nurse-to-patient ratio for medical-surgical units was scheduled to be lowered to 1 to 5 by Jan. 1, 2005. In addition, the regulations stated that licensed vocational nurses could comprise no more than 50% of the licensed nurses assigned to patient care and that only registered nurses could care for critical trauma patients. The rules also required at least one triage nurse in an emergency department to be a registered nurse. In addition, the rules said that nurses in telemetry and step-down units could care for no more than three patients at a time by 2008 (California Healthline, 7/2/03).
Under the proposed changes, DHS would delay until at least January 2008 lowering the nurse-to-patient ratio in medical-surgical units to 1-to-5 (San Francisco Chronicle, 11/5). DHS also would give hospitals the option of temporarily suspending compliance with staffing ratios for emergency departments -- currently set at 1-to-4 -- in case of an "unforseeable influx" of patients (Feder Ostrov, San Jose Mercury News, 11/5).
In addition, the proposed changes would reverse a requirement stipulating that hospitals must replace nurses on bathroom breaks. Under the proposed changes, nurses would be considered on duty during bathroom breaks or while making telephone calls if they are physically located in the unit, according to the Contra Costa Times.
The proposed changes have been submitted to the Office of Administrative Law, which is expected to approve them within 10 days (Silber, Contra Costa Times, 11/5). A public hearing on the changes likely will be held in mid-January. The proposal also would move up the deadline for a planned study of the effect of the state's nurse staffing requirements to make results available to DHS by early 2007.
DHS officials said they believed it was urgent to revise the new rules after 11 hospitals cited the staffing requirements as contributing to facility closures or service reductions. According to the Los Angeles Times, 68 hospitals across the state have petitioned DHS for waivers from the ratios or greater flexibility to handle their implementation. The California Healthcare Association estimates that 85% of hospitals in the state currently do not meet the existing nurse-to-patient ratio requirements (Los Angeles Times, 11/5).
State officials said that hospitals that have complied with the new ratios have had to turn away ambulances, leave beds empty and reduce support staffing levels to make funds available for nurse salaries. "We never intended for people to be denied immediate care because the hospital could not meet the staffing ratios," Brenda Klutz, deputy director for licensing and certification for DHS, said (Rapaport, Sacramento Bee, 11/5).
DHS Director Sandra Shewry, who announced the proposed changes, said, "These changes provide common-sense flexibility for hospital emergency departments and clarify language in current regulations." She added, "Because we do not yet understand the impact of these groundbreaking ratios on the state's fragile health care delivery system, we must move forward cautiously" (Los Angeles Times, 11/5).
Jan Emerson, a spokesperson for CHA, said the proposed changes are "a step in the right direction," adding, "We've been having conversations" with the administration of Gov. Arnold Schwarzenegger (R) for "nearly a year about the overall fragile state of our health care system" (San Francisco Chronicle, 11/5).
Klutz said DHS decided to delay the new ratios until 2008 so that officials could perform a two-year study to ensure the requirements do not have unintended consequences. She added, "We really believe that the minimum ratios we've had in place since Jan. 1 are really good for patient care. (But) when we start to hear these signs and symptoms, we really have an obligation to slightly pause" (Contra Costa Times, 11/5).
However, Jamie Court -- president of the Foundation for Taxpayer and Consumer Rights, a consumer advocacy group that supported the nurse staffing rules -- said, "This is pure political payback for the governor's biggest contributors -- this from a governor who said he would not be beholden to special interests" (San Francisco Chronicle, 11/5).
Deborah Burger -- president of the California Nurses Association, which supports the existing regulations -- said, "We're furious that [Schwarzenegger] has bowed to the pressure of the hospital industry in weakening patient protections for the citizens of California" (Contra Costa Times, 11/5). Burger warned that easing the requirements will mean fewer nurses to care for patients, which could lead to longer waits in hospital EDs (San Jose Mercury News, 11/5). She also said that the revised regulations for EDs are "so vague that they can do virtually whatever they want" (San Francisco Chronicle, 11/5).