This Editorial from Debra Burger, RN, CNA President, was published in the The Daily News of Los Angeles on April 27, 2004
HEADLINE: DON'T STOP PROGRESS RIGHT IN ITS TRACKS;
NURSE-TO-PATIENT RATIOS HELPING CALIFORNIANS WHO ARE HURT, SICK
BYLINE: Deborah Burger
WILL safer patient care put San Fernando Valley hospitals out of business?< It sounds like a ludicrous question. But some hospital industry executives joined by a few politicians, like Assemblyman Keith Richman, R- Granada Hills, are peddling the notion that a law mandating minimum ratios of registered nurses to safely care for patients threatens the survival of hospitals.
Their goal is to erode public support for improved nursing care, and thus bestow political cover to roll back the patient protections that are already making our hospitals safer and increasing the number of registered nurses in California.
A recent dire report by the Economic Alliance of San Fernando Valley, written by hospital CEOs, is part of the hue and cry. It's missing several salient facts:
--California hospitals reported $3.9 billion in profits in 2002 to the Office of Statewide Health Planning and Development. The largest hospitals were especially well off, listing average profits of about $48 million each. Hospital profits nationally totaled $240 billion from 1986 through 2000.
--Hospitals play a central role in skyrocketing health care costs, the effects of which include the recent grocery strike and the workers' compensation debate. California hospitals marked up their prices by 300 percent over costs in 2000-01, according to a study by the Institute of Health and Socio-Economic Policy last year.
--The nation's 20 biggest pharmaceutical corporations racked up $60.7 billion in profits in 2002. Ten health-care industry chief executives held nearly $8 billion in stock wealth in 2002. Over $732 billion was consumed by hospital, pharmaceutical, Health Maintenance Organizations and medical device corporate mergers from 1993 to May 2003 in an industrywide scramble to muscle up on market share.
Don't stay up nights worrying about the financial health of these moguls. What should concern people instead are the gaping holes in the patient safety net.
A March 2004 Commonwealth Fund survey found 45 million Americans were without health coverage in 2003. Nearly half the insured cited increases in their premiums and their share of medical bills, or cuts or new limits in benefits. Further, 41 percent of adults, age 19 to 64, had trouble paying medical debt; of those, 27 percent were unable to pay for food, heat or rent due to medical bills and 44 percent had to use all or most of their savings.
Quality of care varies widely with those relegated to public hospitals and clinics forced to endure longer waits and fewer resources while others can count on boutique care in specialized facilities for the wealthy.
Too many hospitals put a premium on revenue enhancement while skimping on care standards. Poorer hospital nurse staffing is directly linked to higher rates of urinary tract infections, post-operative infections, pneumonia, pressure ulcers and increased lengths of stay, the Agency for Healthcare Research and Quality affirms. Even the private, hospital-funded agency that accredits hospitals, reports that inadequate staffing precipitated one-fourth of preventable patient deaths, injuries or permanent loss of function the past five years.
The response by too many corporate interests to this grim data is to fight any meaningful reforms to expand access to care and assure one standard of care for all, and to wage a campaign to reverse California's landmark safe staffing law.
In addition to a media push, the California Healthcare Association, the hospital industry's lobbying arm, has filed a lawsuit to throw out the requirement that patients should be entitled to safe nursing care "at all times" - meaning the ratios would apply only at the beginning of a shift. The logic seems to be that it's acceptable to put your loved one who has suffered a heart attack or been in a serious accident at risk of unsafe care most of the time they're in the hospital.
The staffing law has already improved staffing in 70 percent of hospitals surveyed by the California Nurses Association. And it's fueling an infusion of new nurses into the state. In the four years since the law was signed, the number of RNs licensed to practice in California has grown by 10,000 annually. The number of nursing students and nurses from other countries taking RN exams to work in California has doubled, and the state agency that licenses RNs has a waiting list of 4,200 additional nurses seeking employment here.
Those who profit off pain and suffering would do lasting damage to all Californians who will one day be hospital patients if they derail this progress now. We should be deploying ways to ensure the success of this law, and promoting new mechanisms to provide quality health care for all.