Nurses, Hospitals Disagree on Staffing Numbers

In accordance with legislation passed last year, the state Department of Health Services is trying to determine the minimum nurse-staffing levels required for California hospitals, but nurses and hospitals "can't agree on what the numbers should be," the Wall Street Journal reports. California has the country's lowest ratio of registered nurses to the general population, about 500 nurses for every 10,000 people, and at 84%, has one of the nation's highest percentages of registered nurses, according to the Board of Registered Nurses. The legislation, adopted last year after a lobbying effort by the California Nurses Association, makes the health department the first in the nation to have the power to draft nurse-to-patient ratios for individual hospital units. While nurse groups lobbied the Legislature to set the ratios in the law, the law does not include specific numbers.

So far, two nursing unions and one hospital group have proposed staffing levels, the Journal reports. The California Nurses Association is calling for the lowest possible ratios -- as low as four patients for every one nurse in medical-surgical units and 3-to-1 in telemetry units -- which would increase the need for nurses. In addition, the Service Employees' International Union of California has called for patient-nurse ratios of as low as 3-to-1 in emergency rooms and psychiatric-care units and as high as 6-to-1 in newborn nurseries. But the California Healthcare Association, which represents hospitals, health systems and physician groups, and the
Association of California Nurse Leaders, a group of nursing administrators, have submitted a proposal for higher patient-nurse ratios, claiming it already is difficult to find nurses. According to the Wall Street Journal, the CHA and the nursing administrators want the health department to set the minimum ratios needed to guarantee "adequate" patient care, while allowing hospitals the flexibility to set lower ratios in special circumstances. "Our approach was to avoid a one-size-fits-all ratio," Jan Emerson, CHA's director of media relations, said.

As the two sides continue to disagree over the ratios, nurse groups have criticized the numbers CHA is using to support its proposed ratios. CHA has said that the health department will be able to examine current staffing ratios and "their effect on patient care" by looking at data from the
California Nursing Outcomes Coalition, a University of California-San Francisco-based group. But nurses groups have questioned the coalition's objectivity because its research is financed by the 67 hospitals participating in the study and is sponsored by CHA and the nurse administrators group. In response, the health department has asked UCSF to assemble a separate research group, independent of the coalition. The health department is expected to propose draft ratios by the end of the year and give final approval to staffing levels by 2002 (Bayot, Wall Street Journal, 11/15).