Schwarzenegger Not Planning To Change Nurse-to-Patient Ratio Requirements This Year, Spokesperson Says

Gov. Arnold Schwarzenegger (R) "has no plans" to get involved in the controversy over the state's nurse-to-patient ratio requirements this year, and "no timetable exists for determining whether the law should be rescinded, adjusted or left alone," according to Health and Human Services Agency spokesperson Nicole Kasabian Evans, the Los Angeles Daily News reports (Drucker, Los Angeles Daily News, 3/22). Under the rules, which took effect Jan. 1, nurses do 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 only registered nurses can care for critical trauma patients and that at least one registered nurse must serve as a triage nurse in emergency departments (California Healthline, 3/19). According to an anonymous weekly survey launched in January by the California Healthcare Association, nine of 10 California hospitals are not complying with the rules. "For [hospitals] to be in compliance, they would have to reduce access to care every single day," Jan Emerson, a spokesperson for CHA, said, adding, "Shutting down beds, closing entire units, turning ambulances away; these things are happening, but not to the degree they would be if" all hospitals in the state were in compliance. The San Fernando Valley Industry & Commerce Association is calling for Schwarzenegger to make changes to the rules or rescind them, saying that local hospitals will go bankrupt without help. However, the California Nurses Association says the new ratios will improve care and reduce medical errors. Evans said, "There may be a need to make some adjustments to the regulations at some point, but that has to be based on specific, quantified data" (Los Angeles Daily News, 3/22).

The nurse-to-patient ratio rules are "seriously testing the ability of hospitals across California" to provide quality care as they are required to "close beds, deny patient transfers, increase ambulance diversions and require longer waits" in emergency departments, Duane Dauner, president and CEO of CHA, writes in a San Francisco Chronicle opinion piece. According to Dauner, hospitals are "doing all they can to recruit the nurses needed to comply with these regulations," but complying with the rules "is proving to be nearly impossible" because of the " nature of the nursing shortage and the rigid 'at all times' interpretation of the ratio regulations by DHS." Dauner concludes, "All stakeholders in this debate ... must remain focused on the ultimate reason our health care system exists -- to provide high-quality patient care to anyone who needs it, anytime they need it" (Dauner, San Francisco Chronicle, 3/23).