tiredfeetED: The Hospital association, governor appointed DHS officials, and your hospital seem to have no respect for the law. This is directly from the Title 22 regulations licensing hospitals -
" In a hospital providing basic emergency medical services or comprehensive emergency medical services, the licensed nurse-to-patient ratio in an emergency department shall be 1:4 or fewer at all times that patients are receiving treatment. There shall be no fewer than two licensed nurses physically present in the emergency department when a patient is present.
At least one of the licensed nurses shall be a registered nurse assigned to triage patients. The registered nurse assigned to triage patients shall be immediately available at all times to triage patients when they arrive in the emergency department. When there are no patients needing triage, the registered nurse may assist by performing other nursing tasks. The registered nurse assigned to triage patients shall not be counted in the licensed nurse-to-patient ratio."
http://www.bizjournals.com/sacrament...C-MJ1752087487
From the March 25, 2005 print edition
Nurse-rules fight may be mostly words
Kathy Robertson Staff Writer
California hospitals need 4,000 more hard-to-find nurses to meet the new nurse-to-patient ratios ordered by a Sacramento County Superior Court judge March 14, shrieks the hospital industry -- and that's on top of 14,000 vacancies statewide.
Stop trying to subvert state law and just do it, the California Nurses Association screams back at hospitals and the governor, who has sided with the industry in trying to relax the first-in-the-nation staffing rules.
But this noisy feud might be mostly a war of words. The temporary agencies that deliver nurses to hospitals when they're desperate for staff say they haven't seen a huge uptick in demand since the court put the stricter standard in place. It supports the claim by Sacramento hospitals that they're mostly meeting the rules.
"We haven't seen a tremendous change, quite honestly," said Steve Swan, business development manager of Valley Healthcare Systems Inc., a nurse staffing firm in Citrus Heights. "A lot of hospitals had these people anyway."
There hadn't been any reports of hospitals ignoring the stricter rules since March 14, either, until Wednesday, when one complaint was filed with the state. It wasn't clear if it involved a local hospital.
It gets complicated
The Schwarzenegger administration and the hospital industry aren't about to give up their fight, however.
They've filed an appeal seeking to overturn the March 14 ruling that threw out emergency regulations adopted by the administration last fall to ease the rules. On March 17 they also asked for a stay to again halt the stricter ratios until the court fight plays out.
Midweek, there was no word on the stay.
"We asked for expedited review," said Jan Emerson, a spokeswoman for the California Hospital Association, "but even that could take several days."
The hospital industry and the state Department of Health Services contend that the nurse staffing ratios -- which took effect at the start of 2004 and were supposed to get tougher starting Jan. 1, 2005 -- were harming hospitals, forcing reductions in available medical care, and exacerbating a serious shortage of nurses.
Emergency rules filed by the administration in November blocked the new minimum ratio that was scheduled to take effect in January, which would have required hospitals to have one registered nurse working for every five patients. The move also loosened rules for emergency rooms and a requirement that nurse-to-patient ratios applied "at all times," even during employee breaks.
The nurses' union went to court to get the emergency rules tossed. They prevailed March 14, when Sacramento County Superior Court Judge Judy Holzer Hersher signed a final ruling that said the governor overstepped his authority when he relaxed the ratios, and concluded that the determination of "emergency" was "arbitrary and capricious and entirely lacking in evidentiary support."
"They claim the hospitals need eight bazillion more nurses," said union spokesman Chuck Idelson. "There's no evidence of that."
The ratio law -- signed by former Gov. Gray Davis in 1999 -- followed a 10-year campaign by the California Nurses Association. The intent was to set minimum staffing levels in California hospitals to keep patients safe in the era of managed care. The law left specific numbers up to the state Department of Health Services, but they were issued by an agency that served Davis, not Schwarzenegger.
The politics have changed dramatically since then.
Meeting the ratios
State officials sent a letter to all California hospitals March 17 telling them the original rules are now in effect, pending further court action.
Local hospitals appear mostly in compliance. Some exceed the levels set by the rules.
Kaiser Permanente decided to gear up to staff one nurse to every four patients in medical-surgery units awhile ago. It doesn't always happen, but Kaiser often exceeds the strict new ratio of 1 to 5, said Terri Owensby, assistant administrator for patient-care services at Kaiser's South Sacramento Medical Center.
"And, for the most part, we are meeting the 'at all times' language," she added. "We have an assistant manager on duty 24/7, so if we get into trouble, there is another person around to help."
When staffing gets tight and additional patients enter the hospital, Kaiser uses its own per-diem pool of nurses or brings in "travelers," or visiting nurses.
There are six travelers on duty at South Sacramento, but they're generally there on 13-week stints and were placed before the recent court rulings, Owensby said.
"We made a decision to move ahead before it was mandated," said Kaiser spokeswoman Kathleen McKenna. Kaiser hired 329 new registered nurses in the Sacramento Valley in 2004 and another 82 so far this year.
Kaiser had 63 nurse vacancies last month; there were a total of 437 vacancies at hospitals across the region. That's down from almost 700 last year.
"There's definitely a nursing shortage; we do have positions that are open, but we are working very hard to get them filled," said Carole Gan, a spokeswoman for the UC Davis Health System. The university medical center already meets or exceeds the mandated ratios, she said.
UC Davis uses its own per-diem pool, floats nurses from one unit to another, or calls in folks from their day off when it needs more nurses, Gan said.
Sutter Medical Center in Sacramento meets or exceeds the new ratios, said spokeswoman Nancy Turner.
"We staff on acuity and our patients require more than 1-to-6 or even 1-to-5," she said. "We've been at 1-to-4 or 1-to-5 for at least four years."
Sutter, too, has vacancies. There were 151 across the region last month, but the health system fills open slots with registry or travel nurses as needed.
"CHW intends to comply with the law," said spokeswoman Mary Beth TeSelle. "We are staffing to meet the 1-to-5 ratio.
"However, we continue to be challenged by the 'at all times' provision which requires meal and break relief."
Per-unit staffing ratios are one thing. The all-times rule is harder to meet, especially in emergency rooms where patient numbers fluctuate a lot.
Nobody locally will state flat out that they meet that standard every minute of the day -- but all say they are trying.
"We have been and are staffed within the ratios," said T. Abraham, a spokesman for Marshall Medical in Placerville. The 105-bed community hospital does use registry and travel nurses when it has to, but even so it "still struggles ... at all times," he said.
"The nearest hospital is 30 miles away and the volume changes quickly in our emergency room," Abraham said. "We accept patients, even if it causes us to go above the ratios."
Staffing boom
Nurse staffing agencies that pick up the slack for hospitals, and send in warm bodies when there aren't enough to meet patient need, have scored big on the California ratio law and nationwide nursing shortage -- but say there hasn't been a big uptick since the recent court action.
"Yes, we are in overdrive and get a tremendous amount of orders on a day-to-day basis," said Cheree Love, president of Response I Medical Staffing in El Dorado Hills. "But most hospitals have been preparing for the last year. They started beefing up before January."
World Health Alternatives Inc., a publicly traded company in Pittsburgh that bought Citrus Heights-based Pulse Healthcare Staffing Inc. last year, gets daily calls for 10 or 20 nurses at this hospital or that one, but that's been going on for a while, said Paul Gunnoe, division president for World Health travel nursing.
What the ratio law has done is exacerbate demand elsewhere in the country because California hospitals are willing to shell out the dollars to get the nurses they need to meet the ratio law.
"California is the biggest consumer of services," Gunnoe said, "but I guess you can say we are in overdrive all over the country."
Would you like to comment?
