Safe Staffing Ratios too?

rncopper · Nov 18, 2003

OOOOOH! Interesting!

"The Terminator" may have just put nursing in CA back a notch!!!

This will be interesting to see what some CA nurses say! ANYONE WORKING IN CA OUT THERE????

Comment????

sjoe · Nov 18, 2003

It was another good move by Arnold.

To pick and choose which regulations to suspend and which ones to continue before having this time to evaluate them all would be begging the original question. EVERYONE, not just nursing, thinks his/her favorite regulations are "special" and should be maintained. During and after the evaluation period there is plenty of time to look at and evaluate the merits of each regulation. That is what the period is for.

Give 'em hell, Arnold!

Noticing the current (Fall 2003) issue of "the BRN report" I had to laugh. The BON is complaining about its recent budget cuts (pre-Arnold, by the way) and how it had to cut staff, etc. All I can say is that they MIGHT begin to get some sympathy from me if and when (when pigs fly) they begin to work as hard at their jobs as hospital nurses work at theirs. They don't think we nurses realize that their job is to protect consumers, not provide a service to nurses.

pickledpepperRN · Nov 27, 2003

[http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/11/19/MNGUI35L1V1.DTL

Sacramento --

An executive order signed by Gov. Arnold Schwarzenegger could delay the implementation of dozens of environmental and consumer protection measures and give Schwarzenegger's political appointees unprecedented powers to rewrite regulations.

On his first day in office, Schwarzenegger ordered a six-month halt to the creation of new rules affecting hundreds of issues so he can review how they will affect California's business climate. The order could affect everything from the state's efforts to develop an unprecedented computer recycling program to a new law requiring hospitals to have a minimum level of nurses on duty.

Business advocates praised the move as a signal that Schwarzenegger is committed to building jobs in the state by streamlining burdensome regulations.

Some lawmakers dismissed the order as simply a way for the new administration to catch up on upcoming issues.

But others charged that the new governor is already doling out favors to business contributors and trying to overturn legitimate laws passed by the Legislature and signed by former Gov. Gray Davis. They also argued that Schwarzenegger, who campaigned on an open-government and pro-environment platform, is reneging on promises made before the recall election.

"This is a page right out of George Bush's playbook,'' said Assemblyman Mark Leno, D-San Francisco.

Schwarzenegger's order will affect hundreds of regulations that state agencies are writing to reflect legislation or new standards. Most of the regulations are details stemming from recently enacted legislation.

For example, the California Integrated Waste Management Board will implement a landmark law carried by Sen. Byron Sher, D-Palo Alto, and signed this year by Davis that will make California the first state in the country to mandate the recycling of computers and televisions. The board was expected to create the definition that will determine which pieces of equipment will be affected by the law.

Instead, according to the order, the board will be required to submit a report to Schwarzenegger's legal affairs secretary describing how the new law will affect California business. The board could ask Schwarzenegger's director of finance to bypass the report, however.

Recycling advocates argue that the executive order could delay the law, which is to go into effect in July. They also note that the order could take the rule-making process out of the hands of a board that meets publicly, instead allowing agencies to create internal reports for Schwarzenegger's top officials. It's unclear what will happen if reports suggest a particular issue is bad for business, but some advocates worry it could lead the administration to water down regulations and effectively nullify new laws.

"This is a governor who came into office saying he was all for open government, and one of the first moves he makes out of the box is to put important health and safety issues into the hands of political appointees,'' said Mark Murray, executive director of Californians Against Waste.

Margita Thompson, Schwarzenegger's press secretary, said the executive order was "common sense, allowing us to get a lay of the land.''

Some lawmakers agreed.

"If you take over from another administration and there's a whole lot of stuff in the hopper, you want to know what it is. It isn't a big deal,'' said Senate President Pro Tem John Burton, D-San Francisco.

But the order freezes hundreds of rule-making procedures, including efforts to force garbage haulers to use cleaner diesel fuel and new water- efficiency standards for washing machines that will save millions of gallons of water.

Schwarzenegger critics say the new governor is actually creating more bureaucracy and may be angling for a way to give business interests that opposed successful legislation a new avenue to win battles they couldn't win earlier.

"This is the wish-list for every special interest that lost in the Legislature,'' said Jamie Court, president of the Foundation for Taxpayer and Consumer Rights.

E-mail Mark Martin at [email protected]

RNKPCE · Nov 27, 2003

Has anyone heard if he is actually suspending the implementation of the ratios?

pickledpepperRN · Dec 2, 2003

Originally posted by batmik
Has anyone heard if he is actually suspending the implementation of the ratios?

I only know what is in the paper. Seems we don't know yet.

http://www.pressdemocrat.com/opinion/letters/27letts.html

Letters to the Editor

November 27, 2003

Press Democrat Editorial

Safety on hold

EDITOR: Our new governor has placed a hold on 85 new regulations while he reviews them for "their effect on businesses." One such regulation is the Safe Staffing law, mandating hospital nurse-patient ratios. The California Healthcare Association, a hospital trade group, is concerned about the increased cost when the regulations take effect. Citizens should be concerned about the risks if the law is not implemented. The Department of Health Services conducted detailed hearings before determining the ratios. Other compelling medical research studies released during the past two years have reaffirmed the critical need for safe registered nurse staffing.

An Institute of Medicine study, released this month, recognizes "the importance of nurses in creating a safe environment for patients through the care they give and the defense they provide against errors by others."

This study follows the devastating 1999 Institute of Medicine report that as many as 98,000 patients die each year as a result of medical errors. Poor working conditions and too few registered nurses increases the risk of patient deaths and injuries. Urge Gov. Arnold Schwarzenegger to implement the Safe Staffing law.

Your life may depend on it.

TONI WINTER, R.N.

Sebastopol

pickledpepperRN · Dec 2, 2003

Los Angeles Daily News

Minimums for nurses necessary

By Deborah Burger

Monday, December 01, 2003 - FOR the first time in years, California patients and their families have a reason to look beyond the doom-and-gloom stories that have dominated reports about the decline in the quality of hospital care and a seemingly intractable nursing shortage.

As of Jan. 1, all hospitals will be required to maintain safe staffing levels -- minimum ratios of registered nurses to patients -- as a result of a law sponsored by the California Nurses Association, and the advent of the ratios is helping spur significant growth in the state's RN work force.

In recent weeks, some in the hospital industry, who have never liked the new law, have fanned fears of closures or ambulance diversions by hospitals unwilling to comply with the law by claiming a lack of available nurses. It's their hope that public alarm will encourage Gov. Arnold Schwarzenegger to delay or weaken the ratios.

Any such moves would be shortsighted, could abort the progress California has made in tackling the nursing shortage and put patients at risk.

Recent data show the landscape for nurses has changed in California. Since the Safe Staffing Law was signed in 1999, there has been a dramatic influx of RNs into the state. Coupled with the 5,100 new RNs graduated every year by state nursing schools, the number of active RNs is growing by 10,000 a year.

And the numbers will rise even more in the next few years due to increased millions the Davis administration allocated for expanded capacity in our nursing education programs, as well as initiatives to train other health-care workers to become RNs and promote retention.

Overall, California today has more than 30,000 more actively licensed RNs than the Board of Registered Nursing, which licenses RNs, predicted the state would have at this date -- six times the number the state health department estimated would be needed for the ratios.

Much of the growth can be directly tied to RNs' anticipation of safer conditions for patients and nurses in hospitals, along with significant improvements in retirement security, compensation and working conditions for tens of thousands won by RNs in CNA-represented hospitals.

The experience of hospitals in Victoria, Australia, where ratios were implemented in 2001, emphasizes the point. Victoria hospitals are able to staff with the ratios -- while other Australian states battle their own nursing shortage -- and demand for nursing courses is up 26.5 percent.

Hospitals that continue to challenge the law and look for excuses to defy it are planning a risky game with their patients' safety -- as numerous research by the nation's pre-eminent scientific and medical institutions and publications now attests.

In early November, for example, the Institute of Medicine of the National Academy of Sciences -- the same organization that two years ago reported that 98,000 patients die every year due to preventable hospital errors -- reported that insufficient monitoring of patients, caused by poor working conditions and the assignment of too few RNs, increases the likelihood of patient deaths and injuries.

The IOM study cited ample evidence that "makes clear that patient safety continues to be threatened; latent conditions in work environments are the primary sources of those threats" and "the work environment of nurses must be addressed if patient safety is to be improved."

Similarly, studies in the Journal of the American Medical Association have found that nurses intercept 86 percent of all medication errors made by physicians, pharmacists and others, and that for each additional patient assigned to an RN, the likelihood of death within 30 days increases by 7 percent. A New England Journal of Medicine study documented that improved RN-to-patient ratios reduce rates of pneumonia, urinary infections, shock, cardiac arrest, gastrointestinal bleeding and other adverse outcomes.

As the IOM put it, the research affirms "what physicians, patients, other health care providers and nurses themselves have long known: how well we are cared for by nurses affects our health, and sometimes can be a matter of life or death."

Patient safety, of course, is precisely the reason California enacted the Safe Staffing Law. Recalcitrant hospital officials should abandon any plans to circumvent a needed law and join with RNs and patients in welcoming a new day.

Deborah Burger is the president of the 55,000-member California Nurses Association.

pickledpepperRN · Dec 4, 2003

Long Beach Press Telegram

Article Published: Wednesday, December 03, 2003

Protesting nurses support ratios

Picketers from union enter L.B. hotel hosting health industry conclave.

By Neda Raouf

Staff writer

LONG BEACH -- Nurses and union organizers rushed into a meeting of the hospital industry Wednesday and accused officials of trying to undermine a state-mandated law for new nurse-to-patient ratios that becomes effective Jan. 1.

About 50 people with the California Nurses Association who had been protesting outside the Hilton Long Beach rushed through the lobby and up an escalator about 9:30 a.m., waving picket signs on their way to the door of the meeting of the California Healthcare Association.

There, they chanted for a couple minutes in a call for ratios to be implemented, then left. Long Beach police arrived at the scene, but the protesters were already quietly exiting the hotel's lobby by then.

At the heart of the protest was a state mandate, effective Jan. 1, requiring hospitals to provide a minimum number of nurses per patient. For example, there must be one nurse for every four patients in an emergency room and one nurse for every two patients in delivery rooms. The ratio varies depending on the unit.

Several nurses marching with CNA and a CNA official said the ratios are an important part of quality care for patients. They said there are nurses available to meet the ratios but that hospitals are trying to find a way to get around the law.

"I think they ought to be arrested for what they're doing today conspiring to break the law,' said Jill Furillo, a registered nurse with CNA who spoke over a small bullhorn to the crowd.

Jan Emerson, with the California Healthcare Association, disputed the union's accusations and said that the meeting was to educate hospital representatives about the new guidelines, which will be expensive for hospitals to implement.

Emerson said that in 2004, it will cost the industry $422 million statewide to meet guidelines, and as more steps are required in 2005, the costs will increase to $652 million. She said the source of her figures was the state Department of Health Services.

Also, a nursing shortage makes it hard to meet the ratios, she said. Many nurses who will be retiring over the next few years also have to be replaced.

Margie Keenan, a registered nurse at Long Beach Memorial Medical Center in the coronary care unit for 30 years, said she participated in the protest because she is concerned about patient care.

"Citizens of Long Beach, citizens of California need to be taken care of the right way,' she said, adding that the expertise of nurses should be taken into account when it comes to patient care.

She added that she disagreed with hospital industry plans to bring in licensed vocational nurses to supplement the ratios because they still need to be supervised by RNs and that the money should go to hiring RNs instead.

Deann McEwen, a nurse at Long Beach Memorial for 29 years, said there are enough nurses graduating to meet the required ratios, even though the industry disputes that.

But according to Joanne Spetz, an assistant professor at UC San Francisco's Center for California Health Work Force Studies, there are some truths coming from both sides.

Spetz said that former Gov. Gray Davis' administration had announced that $60 million would be given to partnerships that included schools and hospitals to graduate more nurses, but only about $34 million to $36 million has been given out.

Spetz, who has been doing policy research on nursing for about a decade, also said there was validity to union comments that more staffing is better for patients.

Some studies have indicated that a higher staffing level helps reduce infection and deaths.

The Los Angeles County Board of Supervisors in a meeting this week said it plans to ask Gov. Arnold Schwarzenegger to delay the mandated nurse-to- patient ratios.

Despite four years to prepare, most hospitals do not expect to be in compliance by the first of the year, according to the Hospital Association of Southern California.