Schwarzenegger Administration Responds to Criticism of Proposed Delay To Nurse Staffing Rules

Health and Human Services Agency Secretary Kim Belshe at a news conference in Sacramento on Monday said "there has been some confusion" about changes in the implementation of nurse staffing rules in state hospitals, the Sacramento Bee reports (Rapaport, Sacramento Bee, 11/30).

Department of Health Services officials earlier this month proposed to delay until at least January 2008 a decrease -- originally scheduled for Jan. 1, 2005 -- in the nurse-to-patient ratio for medical-surgical units from 1-to-6 to 1-to-5. DHS also would allow hospitals to suspend temporarily compliance with nurse staffing rules for EDs in the event of an "unforeseeable influx" of patients. In addition, DHS proposed reversing a requirement that hospitals replace nurses on bathroom breaks.

DHS has submitted the proposals to the Office of Administrative Law, which is expected to approve them. DHS likely will hold a public hearing on the proposals in mid-January (California Healthline, 11/23).

Belshe said, "Patient safety is a top priority for this administration" (Sacramento Bee, 11/30). She added, "The nurse-to-patient ratios have to be considered in the context of the nursing shortage. The shortage is real and cannot be ignored." Belshe said that the nursing shortage would be made worse if the staffing requirements took effect Jan. 1.

Officials for the California Nurses Association recently began airing radio advertisements saying that the move to delay the rules' implementation by the administration of Gov. Arnold Schwarzenegger (R) is harmful to patient care.

CNA Executive Director Rose Ann DeMoro said, "Nurses are outraged. I've never seen anything like it before" (Chorneau, Associated Press, 11/29).

Members of the Service Employees International Union Local 250 on Wednesday plan to strike at 13 Bay Area Sutter Health hospitals. CNA members also plan action at some of the hospitals in which nurse staffing issues are a "central topic" in contract negotiations, according to the Bee. SEIU and CNA on Wednesday plan to also rally at the state Capitol (Sacramento Bee, 11/30).

Schwarzenegger's executive order to delay implementation of the nurse-to-patient ratio rules "spells real trouble for patients and could deal a serious setback in the efforts we have made to keep experienced nurses at the bedside and recruit new registered nurses," CNA President Deborah Burger writes in a San Diego Union-Tribune opinion piece.

According to Burger, after being enacted in 1999, the staffing law contributed to safer conditions in 70% of state hospitals and slowed the rate of nurses leaving the state. Citing a 2002 Journal of the American Medical Association study that found the risk of death within 30 days for a hospitalized patient increased by 7% for each patient above the one-to-four ratio for which a nurse is responsible, Burger writes, "That's the risk the governor is asking California families to accept" (Burger, San Diego Union-Tribune, 11/30).