Fewer-Than-Anticipated Violations of Nurse-To-Patient Ratio Rules Reported

State regulators received "relatively few complaints" of violations of new nurse-to-patient ratio rules in the first quarter despite "dire warnings" from some who said the rules would "hamstring hospitals," the Sacramento Business Journal reports (Robertson, Sacramento Business Journal, 5/7). Under the rules, nurses do not have to care for more than eight patients at a time. The rules also call for one nurse per five patients in medical-surgical units by 2005, as well as one nurse per four patients in specialty care and telemetry units and one nurse per three patients in step-down units by 2008. In addition, the regulations 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 (California Healthline, 3/30).

Between Jan. 1 and March 31, the California Healthcare Association received 49 complaints related to hospitals' failures to comply with the rules, and hospitals reported 68 noncompliance events. None of the complaints alleged that patients had been harmed as a result of a violation, but state regulators have issued citations against Riverside County Regional Medical Center in Moreno Valley and Kindred Hospital in San Leandro for violating the rules. The hospitals' correction plans submitted to the state include improvements in daily monitoring, daily meetings to assess staffing needs, attempts to increase their nursing pools and greater efforts to find supplemental staff to work the shifts of absent nurses. In addition, the state received 60 requests for waivers to address "unexpected high numbers of patients" or develop new triage systems, the Business Journal reports. State regulators denied 29 waiver requests, approved 23 and ruled that eight were unnecessary.

Despite the low number of complaints, hospitals "fear [the] consequences" of not meeting requirements "at all times," including during nurses' meals and breaks, the Business Journal reports. CHA spokesperson Jan Emerson said, "Even though DHS is not actively enforcing 'at all times' -- that's why the numbers are so low -- that doesn't absolve hospitals." Emerson added that Medicare and Medi-Cal can audit the hospitals and deny reimbursements on a retroactive basis. California Nurses Association spokesperson Jill Furillo said, "At a given moment in time, we may be out of compliance, but it's such a fluid, moving situation. Staffing is actually better" (Sacramento Business Journal, 5/7).