Hospitals Struggle To Comply With New Nurse-to-Patient Ratios
As many as 80% of the 300 state hospitals that self-report each week to the California Healthcare Association say that they are not in compliance with the state's new nurse-to-patient staffing ratios, the Stockton Record reports (Goldeen, Stockton Record, 3/28). Under the new staffing rules, nurses will 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, 3/24). Hospitals are having problems meeting these requirements because of a statewide nursing shortage. There are currently 585 nurses for every 100,000 California residents -- the second-lowest rate in the country after Nevada. In addition, a lack of state nursing undergraduate programs, which are costly to administer, is making it difficult to recruit new nurses. CHA spokesperson Jan Emerson said, "The average age for a nurse is 47 years old," adding, "More nurses are retiring than graduating." CHA said that compliance is also hindered by the fact that there are no state provisions for funding. According to CHA, there is currently a 15% to 20% nursing vacancy rate in the state's 450 hospitals, and hiring more staff will cost hospitals between $422 million and $652 million in 2005 and $956 million in 2008.
The California Nurses Association, which represents 56,000 nurses in the state, "blames managed care and rising health care costs" for the lack of nurses, saying that "the inception of HMOs convinced hospitals that there would be little need for nurses because the preventive nature of managed care," leading hospitals and the state to think there was little need for nursing education, the Los Angeles Daily News reports (Leffall, Los Angeles Daily News, 3/28). CNA President Deborah Burger said that she does not believe CHA when it "makes its case that the burden on the hospital industry is too great, and they can't possibly comply" with the mandated ratios. According to the Record, between Jan. 1 and March 25, the Department of Health Services received 46 complaints about hospitals' noncompliance with the new laws, and hospitals themselves reported 68 noncompliance events. DHS spokesperson Robert Miller said that of the 114 cases reported, the majority are being examined, and the state has issued three citations for deficiencies (Stockton Record, 3/29).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.