NURSE STAFFING: Davis Signs Bill Mandating Ratios
Gov. Gray Davis Sunday signed into law a bill requiring hospitals to meet mandatory nurse-to-patient ratios in all units. Under the bill, the state Department of Health Services will establish minimum licensed nurse staffing ratios for all hospital units, complementing requirements that already exist for intensive care units and operating rooms. The bill also:
- Prohibits hospitals from requiring unlicensed personnel to perform nursing functions such as invasive procedures, patient assessment, patient education or medication administration;
- Mandates additional nursing staff be used as needed based on individual patient acuity;
- Restricts "unsafe assignment of nursing staff" to areas for which they lack proper training.
Though nurses were "ecstatic" by the bill's passage, Scripps-McClatchy/Contra Costa Times notes that the new law is not as stringent as it could have been. Facing heavy opposition from hospital lobbyists -- who argued that staffing decisions are "too complex to be made by formula" -- AB 394 was amended several times before it finally passed the Legislature earlier this year. One version of the legislation, for example, included specific minimum nurse-to-patient ratios, a provision that was changed to allow DHS to set the limits after more careful study. In addition, Davis signed the legislation only after supporters agreed to extend the department's deadline for establishing the requirements "by at least one year," meaning the law will take effect no earlier than 2002 (Matthews/Capps, 10/11). Calling licensed nurses "a critical component in guaranteeing patient safety and the highest quality health care," Davis noted that he is "directing DHS to write the regulations so that the minimum required staffing does not exceed that necessary to comply with other existing standards," (Davis release, 10/10).
Hospitals Feel Squeeze
The state's health care industry opposed the measure, suggesting that it would impose strict requirements on hospitals and increase costs. "Hospitals are being put under tremendous pressure to lower costs," said Walter Zelman, president of the California Association of Health Plans. He added, "It's easier for the industry to function if it has to meet outcome goals, rather than specific means of achieving them" (New York Times, 10/12). Moreover, hospital administrators are concerned that the new law may set unrealistic staffing levels. "The fact is we are already in a nursing shortage, so what if they set a ratio that we can't meet?" asked Shawndra Nimtz, administrator at Sebastopol's Palm Drive Hospital. She said, "Hospitals would either be out of compliance or have to cut back on the number of patients" (Santa Rosa Press Democrat, 10/12).