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How many nurses, how many patients?
Deferring nurse-to-patient ratios a dangerous gamble
Deborah Burger
Sunday, December 12, 2004
With his decree to roll back legislatively mandated registered-nurse- to-patient ratios in hospitals and emergency rooms, Gov. Arnold Schwarzenegger has compromised public-safety standards to please the corporate special interests he told Californians he was sent to Sacramento to fight.
To thank the governor, the hospital industry has spent millions on TV and radio ads, featuring a nurse hospital administrator to deceive the public into believing that nurses support the governor's decision. In fact, thousands of registered nurses have protested across the state, prompting the governor to reveal his true feelings with the crude declaration that RNs are "special interests" who "don't like me because I am always kicking their butt" -- a belligerence he does not extend to the corporations who have contributed more than $26 million to the governor in his first year in office, according to the records of Schwarzenegger's political team.
California enacted a law in 1999 requiring minimum RN-to-patient ratios to halt a serious decline in care conditions. The law went through four years of study before the ratios were implemented last January with the state Department of Health Services declaring "the public health depends on the availability of adequately staffed acute-care hospitals."
Unfortunately, Californians' health was never the top priority for top executives of the hospital corporations, who have long campaigned to overturn the 1999 state law that they believe cuts into their profits. With the election of Schwarzenegger, the industry anticipated that it had a governor who would champion corporate interests over public safety.
Arguments cited for eroding the safety law included: hospitals couldn't find enough RNs because of the nursing shortage; hospitals were closing because of the law; financial troubles in the industry; and the claim that nursing homes could not compete because RNs now preferred to work in more safely staffed hospitals. But let's examine these issues:
-- Nursing shortage: In the 1990s, hospitals helped create a shortage of nurses by systematically understaffing, which precipitated an exodus of RNs unwilling to work in unsafe hospitals. The ratios were part of the solution to keep RNs at the bedside and attract new nurses. Since the law was signed, the number of actively licensed RNs in California, according to the Board of Registered Nursing, has grown by more than 48,000 -- seven times the number the state said would be needed for the ratios. For the first time in a decade, more RNs are coming into the state than are leaving. The governor's order will reverse this progress.
-- Hospital closures: Fifty hospitals were closed between 1990 and 2000, predating the ratio law. Notably, Schwarzenegger vetoed a bill to help local communities that want to maintain a hospital facing closure, as in San Jose, where the city's only downtown hospital was closed by a giant chain, Hospital Corporation of America, which made $1.3 billion in profits last year and is spending lavishly on hospital construction in more wealthy neighborhoods in the region. Cutting the nursing-care safety net will not stop closures; it will only make hospitals more dangerous.
-- Financially ailing hospitals: While some hospitals lose money, most don't. From 2001 through 2003, California hospitals reported a total of $11.7 billion in profits, according to data reported to the Office of Statewide Health Planning and Development, hardly a sign of economic distress.
-- Nursing homes can't compete: Because they aren't subject to the same nursing-staff ratios as in hospitals, the nursing home contention shows the absurd reach of the order. The governor apparently wants hospitals to match the shoddy safety record of the nursing home industry, regardless of the consequences for patients.
Patients seem to be the governor's last consideration. His order gives hospitals a green light to suspend safe staffing in emergency rooms. The inevitable result will be longer waits, patients leaving without receiving needed medical attention and reduced standards of care. In general medical units, the governor has decreed patients must wait three years for more "study" before the original minimum ratios the state Department of Health Services deemed were needed for patient safety are enacted.
You could fill a library with the studies already done. The Joint Commission on Accreditation of Hospital Organizations, for example, states that inadequate staffing causes one-fourth of all preventable deaths and permanent injuries.
By using an executive order, one not based on facts, to rescind patient protections, the governor has set a dangerous precedent. If the decision is not reversed, the governor can vacate any health and safety regulations corporations do not like through emergency decrees without legislative or public support. If this governor will not stand up to the hospital corporations, be assured that nurses will.
At issue
-- In 1999, Gov. Gray Davis signed AB394, making California the first state in the nation to mandate nurse-to-patient ratios for hospitals.
-- The first phase of the legislation took effect Jan. 1, 2004, requiring hospitals to have at least one nurse on duty for every six patients.
-- Phase two was to have taken effect Jan. 1, 2005, lowering the nurse- patient ratio to 1 to 5.
-- Responding to hospitals' complaints that the targets for 2005 would be impossible to meet in the face of a shortage of nurses, Gov. Arnold Schwarzenegger recently ordered the deferral of the 1-to-5 requirement until Jan. 1, 2008. The ratio will remain at 1 to 6 until then. He also loosened the regulations to give hospitals more leeway when faced with surges of patients in emergency rooms.
Deborah Burger, is a registered nurse and president of the 58,000-member California Nurses Association (
www.calnurse.org), the union that sponsored the patient-ratio law.
Californians: Impeach Arnold
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