Sacramento Superior Court Judge Signs Decision To Bar Delay of Implementation of New Nurse-Staffing Ratio
A new nurse-staffing ratio took effect on Monday after Sacramento Superior Court Judge Judy Holzer Hersher signed a March 4 decision to bar a delay sought by the administration of Gov. Arnold Schwarzenegger (R), the Sacramento Bee reports (Benson, Sacramento Bee, 3/15).
The case involves a lawsuit filed by the California Nurses Association in December 2004 that alleged the Department of Health Services illegally delayed implementation of the ratio with the issue of an emergency order in November 2004.
The emergency order sought to delay until January 2008 the implementation of the ratio, under which nurses can care for no more than five patients at one time. Under the emergency order, nurses could have cared for no more than six patients at one time.
DHS officials have said that the delay was required to avoid fiscal emergencies at hospitals.
However, Holzer Hersher ruled that no evidence existed to support the use of the emergency order. She also denied a request by the administration for a stay of her decision pending appeal (California Healthline, 3/9).
Ken August, a spokesperson for DHS, said, "We will vigorously appeal the decision," adding, "We don't expect to get a response to our appeal until next week or even the following week" (Vesely, Oakland Tribune, 3/15).
August also said that the state "will comply with the law," adding, "We will respond to any complaints alleging a violation of the regulations in the same way we respond to all complaints."
California Hospital Association spokesperson Jan Emerson said the decision could cause a "major disruption of the health care delivery system." According to Emerson, many hospitals cannot afford to pay nurses overtime wages, and nurses also can refuse to work overtime (Wasserman, AP/Contra Costa Times, 3/15).
In addition, Emerson said that hospitals in the state would have to hire 4,000 additional nurses or close some wards to comply with the ratio (Sacramento Bee, 3/15). "If they can't comply, the hospitals may have to downsize the number of beds available, cancel procedures and deny admissions," she said.
Emerson added, "It's absolutely fair to say this whole issue is going to be tied up in litigation for some time to come" (Wasserman, AP/Contra Costa Times, 3/15).
Rose Ann DeMoro, executive director of CNA, called the decision "a victory for patients and the rule of law" (Oakland Tribune, 3/15). She said that many hospitals in the state currently comply with the ratio and that other facilities "know where to find the nurses" (Gledhill, San Francisco Chronicle, 3/15).
CNA officials said that the decision will make hospitals safer and that Schwarzenegger should not use "taxpayer money to fight the order" (Wasserman, AP/Contra Costa Times, 3/15).
In related news, Schwarzenegger on Monday at Stanford University said, "It is not the nurses. It is the unions that I'm against" (AP/Contra Costa Times, 3/15). He added that, although he "loves" nurses, nurse unions "want to stop progress, and we have to stop that, create a balance. They're beating up on businesses and chasing everyone away from the state."
Schwarzenegger also said that he would call a special election "very soon" to advance his agenda (Martin, San Francisco Chronicle, 3/15).
Modesto Bee: The new nurse-staffing ratio is based on an "unrealistic formula" that was discouraged by "even the American Nurses Association" amid "warnings that the nursing shortage would make the staffing levels unachievable," a Bee editorial states. According to the editorial, "The issue isn't the staffing level but who should be making the decision. It should be made by medical experts, not politicians." The ratio will "force hospitals to choose between turning away patients or knowingly operating out of compliance," the editorial states, adding that hospitals statewide have "widely varying estimates as to how many more nurses are needed to meet the staffing ratio." According to the editorial, "it will take years for there to be enough" new nurses to "meet the growing demand." The editorial concludes, "The staffing mandate is unrealistic and, with the current nurse shortage, will do more harm than good for California health care" (Modesto Bee, 3/14).
- Daniel Weintraub, Sacramento Bee: The debate over the new nurse-staffing ratio is "not about valuing nurses" or "about corporate interests versus the public interest," but whether hospitals should have the ability to make staffing decisions based on their "unique needs," columnist Weintraub writes in a Bee opinion piece. According to Weintraub, the ratio has prompted some hospitals to reduce the number of nurses' aides they employ, a practice that can increase workloads for registered nurses and make "overall care ... worse, not better." In addition, Weintraub writes, some hospitals have technological equipment that allows nurses to care for more patients at the same time, and if "hiring more nurses means reducing the technology budget, the job might be harder, not easier, and patient care could suffer." The decision by Holzer Hersher indicated that "none of these things can be considered when the state determines the ideal nurse-patient ratio," although the state did not provide "scientific evidence supporting a particular number," Weintraub writes. He adds that "such guesswork doesn't allow for fluctuations over time, for productivity improvements or for local judgment." Weintraub concludes that "Schwarzenegger should ask the Legislature to adopt a new law giving the hospitals more flexibility to serve patients as best they know how" if the state cannot convince the courts to overturn the decision (Weintraub, Sacramento Bee, 3/13).