State Nurse Staffing Ratio Rules Upheld in District Court Decision
Sacramento County Superior Court Judge Gail Ohanesian on Wednesday dismissed a hospital industry challenge to recently enacted nurse staffing regulations, ruling that the California Healthcare Association's request to remove regulations requiring extra nurses during break periods would render the law "meaningless," the San Diego Union-Tribune reports (Berestein, San Diego Union-Tribune, 5/27). Traditionally, hospitals set a nurse-to-patient ratio at the beginning of a shift and maintain it throughout the shift, including during nurses' breaks. The new regulations, which took effect Jan. 1, make that practice a legal requirement. The new rules also state that nurses do not have to care for more than eight patients at a time. The regulations 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 law states that licensed vocational nurses can comprise no more than 50% of the licensed nurses assigned to patient care and that only registered nurses can care for critical trauma patients. The rules also require at least one registered nurse to serve as a triage nurse in emergency departments (California Healthline, 5/27).
CHA and 400 hospitals filed the suit to revise the regulations several days before they took effect (Wasserman, AP/Fresno Bee, 5/27). Hospital industry officials have said that the new staffing ratios are "impossible to maintain at all times" and leave some facilities "vulnerable to state sanctions and legal action," the Los Angeles Times reports. In addition, some hospital officials maintain that under the regulations, facilities may be forced to delay admitting patients; discharge some patients early; or cancel elective surgeries (Vran, Los Angeles Times, 5/27). Ohanesian declined to consider such statements, saying that such concerns were outside of the court's legal scope, according to the Bee (AP/Fresno Bee, 5/27).
Dorel Harms, CHA vice president, said, "The judge's ruling essentially handcuffs a hospital's ability to guarantee access to timely health care services to every patient who needs our care. The constant assigning and reassigning of patients to different nurses throughout a shift is both disruptive and not in the best interest of quality patient care" (Los Angeles Times, 5/27). The California Nurses Association said that the ruling was a victory for nurses and patients (Egelko, San Francisco Chronicle, 5/26). Rose Ann DeMoro, executive director of CHA, said that the hospital industry "tried this backdoor approach to essentially vacate the ratios" and "have lost in every venue." CHA spokesperson Jan Emerson said the association would consider its legal options following the ruling, including a possible appeal, the Union-Tribune reports (San Diego Union-Tribune, 5/27).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.