California's Nurse-to-patient Ratio Law -- Update - page 4
As predicted by many, California's nurse-to-patient ratio law (also known as AB394) may not go into effect after all. Bowing to the serve nursing shortage in the State and at the suggestion of both... Read More
Jul 2, '02All hospital patients need safe care, with safe RN staffing.
Urge Gov. Gray Davis to protect RN practice and California patients.
Dear Gov. Davis,
___I urge you to support all RN ratios to ensure patient safety.
___I urge you to oppose SEIU's efforts to include LVNs and RTs in the ratios.
___I urge you to oppose the hospital industry proposal to increase the ratios for the ER, Psych units, and night shifts.
Number of years as an RN ___________________________
Email the Governor directly by clicking here email@example.com
You can cut and paste the sample letter above into the body of the email or write your own message to the governor explaining how the SEIU and the Hospital Industry proposals will harm patients at your facility.
Or send your letter via regular mail to:
Governor Gray Davis
State Capitol Building
Sacramento, CA 95814
Please send a copy to:
CNA Safe Ratio Campaign
2000 Franklin St.,
Oakland, CA 94612
Jul 3, '02<one union (CNA) had supported the Calif. Nurse/Patient Ratio law, the other (SEUI) had suggested that other professionals be included in the ratio figures. (SEUI represents both RN's and others and wanted to extend its membership; while CNA covers only RN's)>
The above seems to infer that the safe staffing law was established by unions out to just serve themselves but this was not about anybodys membership. It was about providing safe quality pt care & the RN union that brought it into existence would like to see it remain so.
However, the SEIU saw an opportunitiy to increase its membership by filling those positions with the larger categories of workers it represents & the hospitals will do anything to be able to avoid hiring RNs & hire less expensive staff instead - so they teamed up together to lobby for a counter-proposal that would serve themselves. While the RN union who initated the drive for safe staffing ratios kept pt safety & pt care as its focus.
Safe staffing was an issue first brought to the legislature by the RN union. RNs were being overloaded with an unmanageable number of pts & that presents unsafe conditions for both RN & pt. The staffing ratio law was sponsored by the RN union. Their INTENT of the law was that it pertained to RN staffing ratios.
Once it looked like the law had a chance of passing, the SEIU in partnership with Kaiser Hospital system which had been vehemently opposing the bill, suddenly changed its tune & proposed a different version of ratios using the word "nurse" - with the plan of filling those positions with less costly LPNs - members of the SEIU. Since the LPN cannot function as an RN & the RN would still be responsible for any pts assigned to the LPN, the SEIU/Kaiser proposal does nothing to solve the problem - it STILL overloads the RN with too many pts to safely care for.
According to their proposal, a 'nurse' on med surg can be assigned 6 pts. If theres 12 pts that means the 1 RN gets 6 & the 1 LPN gets 6, but the RN is still responsible for the total care of all 12 pts & everything an LPN is not allowed to do - for all 12 pts. And since those numbers is what we're already handling now & are saying its too much, & is what initally caused RNs to ask the legislature to put a stop to in the first place, SEIUs proposal is no improvement & is of no help to RNs or pts.
Its solely to put the less expensive SEIU members into jobs & cost the hospitals less money. In the meantime, SEIUs RN members, a smaller group than the rest of its membership, get sold down the river with their own union insisting on higher numbers of pts for them to care for. The only ones thinking about the pt, the RN, quality care & safe staffing - not money - is the RN union. The only ones fighting back for RNs & for pt safety is the RN union. How any RN can be against that is beyond me.
May 26, '03She calls it "Whineorrhea"
But their lobby did not get away with it!
RN to Patient Ratios Update
Hospital Industry's Attempt to delay 1:5 ratios in Med/Surg areas unsuccessful.
SB 847 Aanestad (Hospital Association) Bill defeated April 9, 2003
Today, the bill that would have delayed the implementation of
the 1:5 nurse to patient ratio in med/surg was soundly defeated
in the Senate Health and Human Services Committee.
Senator Sam Aanestad (R-California State Senate - 4th District)
and the Hospital Association were in support of the bill and
argued that there was a need to prove that the ratios should go
from 1:6 to 1:5 before they were allowed to improve and that the
hiring of RNs was too costly for the hospitals.
Malinda Markowitz, RN, representing CNA spoke against the
bill. Markowitz spoke eloquently and forcefully of the deleterious
effects on patient care that delaying of the 1:5 ratios on
Med/surg floors would have.
Sheila Kuehl (D-Los Angeles Senate District 23) original author
of the Safe Staffing Bill AB 394 argued against Senator
Aanestad's bill as unnecessary and unworkable.
The Committee was not swayed by the hospital industry's well
worn and redundant arguments against the staffing ratios and
voted the bill down with little debate.
Malinda Markowitz, RN
"My name is Malinda Markowitz. I am a
registered nurse and member of the CNA Board of Directors.
I work as a direct care RN on a surgical, orthopedic,
neurological unit of a major healthcare system in the San
Jose area. I have been an RN for 22 and a half years.
... Caring for the patient with complex diagnosis requires the
clinical judgment of the registered nurse. Registered nurses
utilize knowledge derived from social, biological and physical
sciences as she /he assesses, develops their nursing
diagnosis and implements the plan of care and evaluates the
care for each patient. It was for all these reasons that
several years ago it was decided that the use of LVNs on
our surgical unit was not beneficial due to the severity and
complexity of our patients.
Studies indicate that around the clock surveillance of
patients by registered nurses account for early detection and
prompt intervention when a patient's condition deteriorates.
The effectiveness of nurse surveillance is influenced by the
number of RNs available to assess patients on an ongoing
Nurses are required by law to be patient advocates. I feel
that to seemingly allow the hospitals to include LVNs in the
count up to 50 percent would not be in the best interest of
our patients. My job is to improve the healthcare provided to
my patients. This would be against the interests of our
patients."Last edit by pickledpepperRN on May 26, '03
May 26, '03Originally posted by Gomer
FMLA is the Family Medical Leave Act
I'm anti-union because I was born (many, many moons ago) and raised in the West. We are an independent lot, very rarely part of a group, strong believe in being self-sufficient, individual.
And I'm about as pro-union as you can get.
Jun 1, '03Gomer, good post.
It is in the Nursing professions favor to at least bring the discussion of patient safety/nurseatient ratios to the view of the public. The recently published studies by Linda Aikin at U.of P. and published in the popular literature re patient outcomes related to RN staffing have also increased public awareness and debate. CA's bill may get watered down for now, but 28 states have initiated similar legislation. The state of Nevada has one that I particularly like the wording of.
It will take time. State by state, and contract by contract. We will have safe ratios someday.
Kaiser-Permanente, from what I understand, is going to implement these ratios before the previously mandated start date. Is that still current info? As hospitals do, they will attract nurses and it will become an expectation on the part of nurses and consumers to have safe staffing levels in hospitals.
Re the nursing shortage We have never had the research done to know what nursing is, how much is needed, what costs, how much it weighs, what benefits it has on patient outcomes. This is just beginning to be done now. Think about shortage- how would you be able to tell if we had too many nurses or too much nursing? Medicare and Medicaid have been around since the 1960's, have spent billions of dollars but have no meaningful data re nursing costs. Where is the accountability on the part of M&M, GAO,or whoever?
Just my opinion, Edward, IL
Jun 2, '03Text of the law and other sites with information on the Safe Staffing Law.
The Board of Registered Nursing supported the bill.
AB 394 (Kuehl) Health Facilities: Nursing Staff
AB 394 prohibits acute care hospitals from assigning unlicensed personnel to perform nursing functions, in lieu of a registered nurse, or performing
certain functions that require a substantial amount of scientific knowledge and technical skills such as:
Administration of medication.
Venipuncture or intravenous therapy.
Parenteral or tube feedings.
Invasive procedures including inserting nasogastric tubes, inserting catheters or tracheal tubes.
Assessment of a patient's condition.
Educating patients and their families concerning the patient's health care problems, including post-discharge care.
Moderate complexity laboratory tests.
It also requires the Department of Health Services to adopt regulations that establish minimum licensed nurse-to-patient ratios, in acute care
hospitals, by January 1, 2002. It requires health care facilities to adopt written policies and procedures for the training and orientation of nursing
staff. (click here for bill)
Board Position: Support
Action: Chaptered 945
Effective Date: January 2000
Click above and scroll down to "Unlicensed Assistive Personnrl Acute Care" . Open to read the patient protections already in effect.
Below is an addendum to the University of California / CNA contract regarding RN to Patient Ratios
Above from the independant nurses union at El Camino Hospital in Mountain View, CA
Jun 2, '03For MUCHO on the law click on the right side then the "Initial Statement of Reasons" for the states position prior to the public comment process.
Jun 2, '03http://www.calnurses.org/cna/press/43003.html
Assembly Committee Approves Key Bill
to Enforce Landmark RN Staffing Ratio Law
The Assembly Health Committee late Tuesday approved a significant bill to strengthen hospital industry compliance with California's first in the nation RN-to-patient staffing ratio law. AB 253, sponsored by the California Nurses Association, next heads to the Assembly Appropriations Committee. AB 253 passed the committee on a 14-8 vote.
AB 253, introduced by Assembly member Darrell Steinberg (D-Sacramento), establishes tough penalties, including fines of up to $5,000 a day, on hospitals that continue to maintain unsafe RN staffing after final implementation of the ratio law. The law also extends the ability of state health officials to conduct unannounced inspections.
"Enactment of this law would send a clear message to hospitals and the public that the state will not tolerate unsafe staffing and willful violation of the ratio law that puts patients at risk," said CNA President Kay McVay, RN.
The ratio law, AB 394, which was also sponsored by CNA, requires minimum RN staffing for all hospital units, and is a critical measure to restore the patient safety net in California hospitals. All hospitals will be required to meet the staffing levels by January 2004. A hospital industry bill to delay implementation was defeated earlier this month after extensive opposition and testimony by CNA RNs.
Last fall the Department of Health Services held public hearings on the specific ratios. Under the DHS proposal no RN would have more than 5 patients (after a one-year transition period) on general Medical or Surgical floors, with fewer patients per RN in most other units. The DHS has been reviewing testimony, including over 20,000 letters and cards submitted by CNA, and is expected to issue the final ratio regulations in the near future.
Presently, however, the DHS has only limited mechanisms to crack down on hospitals that violate the law, for example, fines of only $50 per patient in areas where violations occur. "The original bill did not address the enforcement mechanisms for this important patient safety law," Steinberg said upon introducing the bill. "It is essential that we provide the DHS with effective tools to ensure compliance with the regulations."
In addition to CNA, supporters of AB 253 Tuesday included the Congress of California Seniors, Gray Panthers, and the California Association of Nurse Practitioners. Opposition is led by the hospital industry.
Jun 2, '03Spacenurse, I predict that beds/units/maybe hospitals will close if this bill passes. I may be wrong, but we shall see in a few months how this economical effects Calif. healthcare.
Jun 2, '03Too bad if the richest country in the world and California with the fourth largest economy in the world cannot afford to staff safely.
Any chance the Insurance industry (with the BIG) buildings and ZERO caregivers has anything to do with it?
Maybe those CEOs $$$ taken from our tax and insurance payments have something to do with it.
How is the California economy at this time?
New York State Nurses Association
REPORT: December 2002
Study Shows Inadequate RN Staffing Harms Patients
by Anne Schott
In hospitals where RNs had to care for more than four patients, mortality rates rose significantly, according to a new study published in the Journal of the American Medical Association. Each additional patient a nurse had to care for led to a seven percent increase in the likelihood the patient would die within 30 days of admission. Patients of a nurse caring for six patients had a 14% greater chance of dying, and patients of a nurse caring for eight patients had a 31% greater chance of dying.
"These numbers are alarming when you recognize that nurses are routinely required to care for eight seriously ill patients," said NYSNA Deputy Executive Director Tina Gerardi. "Hospitals that have accused nurses of exaggerating and described their complaints about poor staffing as merely "anecdotal" need to open their eyes. A growing body of research is now substantiating exactly what nurses have been saying. Poor staffing puts patients at risk."
Staffing Affects Burnout -
The study also found that as the nurse's workload rose, job dissatisfaction and burnout rose as well. An increase of just one patient per nurse increased burnout by 23% and job dissatisfaction by 15%. Forty-three percent of the nurses studied had high burnout scores, and a similar proportion was dissatisfied with their current jobs.
Citing an earlier study, the researchers report that 40% of hospital nurses have burnout levels above the norms for health care workers in general, and that job dissatisfaction among hospital nurses is four times greater than the average for all US workers. One in five hospital nurses say they plan to leave their current jobs within a year. No wonder there's a nursing shortage.
The consequences of poor staffing radiate beyond patients and nurses. The researchers cite recently published figures that show replacing a medical/surgical nurse costs $42,000 and replacing a specialty nurse costs $64,000. "The heavy workloads that lead to nurse dissatisfaction and burnout are not only exacerbating the nursing shortage." Gerardi said. " They are also wasting precious healthcare dollars. It makes no sense to over burden nurses and drive them from the profession, when it is both difficult and expensive to replace them."
Thousands of Patients Studied-
To arrive at their results, researchers at the University of Pennsylvania, led by Linda Aiken, studied 232,342 general, orthopedic, and vascular surgery patients and 10,184 staff nurses at 168 Pennsylvania hospitals.
They examined risk-adjusted surgical mortality rates and rates of "failure-to-rescue," which is defined as deaths in patients who develop serious complications. The study controlled for hospital characteristics of size, teaching status, and technology. Patients in the study were discharged from the hospital between April 1, 1998 and November 30, 1999.
Research Receives Wide Publicity -
Newspapers across the country reported on this study, which is just the latest addition to a growing body of data that links RN staffing to patient outcomes. In an editorial, The New York Times suggested that "hospitals report their patient-nurse ratios so that prospective patients can decide where to take their chances." Since 1997 NYSNA has been lobbying for legislation that would require hospitals to disclose their patient-nurse ratios, a measure strongly opposed by the hospital industry. The full text of the research study is in the Journal of the American Medical Association, October 23/30, 2002; or on the Web: www.jama.com.
Jun 2, '03Nurse-Staffing Levels and the Quality of Care in Hospitals
Jack Needleman, Ph.D., Peter Buerhaus, Ph.D., R.N., Soeren Mattke, M.D., M.P.H., Maureen Stewart, B.A., and Katya Zelevinsky
It is uncertain whether lower levels of staffing by nurses at hospitals are associated with an increased risk that patients will have complications or die.
Methods We used administrative data from 1997 for 799 hospitals in 11 states(covering 5,075,969 discharges of medical patients and 1,104,659 discharges of surgical patients) to examine the relation between the amount of care provided by nurses at the hospital and patients'outcomes. We conducted regression analyses in which we controlled for patients' risk of adverse outcomes,
differences in the nursing care needed for each hospital's patients and other variables.
Results The mean number ofhours of nursing care per patient-day was 11.4, of which 7.8 hours were provided by registered nurses, 1.2 hours by
licensed practical nurses, and 2.4 hours by nurses' aides.
Among medical patients, a higher proportion of hours of care per day provided by registered nurses and a greater absolute number of hours of
care per day provided by registered nurses were
associated with a shorter length of stay (P=0.01 and P<0.001,
respectively) and lower rates of both urinary tract infections (P<0.001 and P=0.003,
respectively) and upper gastrointestinal bleeding
(P=0.03 and P=0.007, respectively).
A higher proportion of hours of care provided by registered nurses was also associated with lower
rates of pneumonia (P=0.001), shock or cardiac arrest(P=0.007), and "failure torescue," which was defined as death from pneumonia, shockor cardiac arrest, upper gastrointestinal bleeding, sepsis, or deep venous thrombosis (P=0.05). Among surgical patients, a higher proportion of care provided by
registered nurses was associated with lower rates of urinary tract infections (P=0.04), and a greater number of hours of care per day provided by registered nurses was associated with lower rates of
"failure to rescue" (P=0.008).We found no associations
between increased levels of
staffing by registered nurses and the rate of in-hospital death or between increased staffingby licensed practical nurses or nurses' aides and the rate ofadverse outcomes.
Conclusions. A higher proportion of hours of nursingcare provided by registered
nurses and a greater number ofhours of care by registered nurses per day are associated
with better care for hospitalized
From the Department of Health Policy
and Management, Harvard School of
Public Health, Boston (J.N., S.M., M.S.,
K.Z.); the Vanderbilt University School
of Nursing, Nashville (P.B.); and Abt
Associates, Cambridge, Mass. (S.M.).
Address reprint requests to Dr.Needleman at the Harvard School of Public Health, Department of Health Policy and Management, Rm. 305, 677
Huntington Ave., Boston, MA 02115, or
at firstname.lastname@example.org.Last edit by pickledpepperRN on Jun 2, '03
Jun 3, '03Shortage article:
"Just as the industry has created this crisis, it can help to resolve it. The industry can do its part to alleviate the RN
shortage by adopting in word and practice a few simple principles:
* Value patients as human beings and not as "covered lives."
* Rather than expending resources fighting RNs and patients on safe staffing ratios, use those resources to
enhance the ratios. The market is not able to set ratios that are safe for patients or that will assure
adequate numbers of RNs.
* Trust in the professional judgment and skills of the bedside nurse to advocate for the patient.
* Terminate all contracts with management consultant deskilling programs and invest those hundreds of
millions into preventative care and improving nurse-to-patient ratios.
* When RNs testify that many health care restructuring programs are a form of patient endangerment -
* Accept that a profession dominated by women can and should earn a living wage commensurate with
skills and dedication.
* Promote direct caregiver role models as opposed to nurse executive models. The archetypal nurse
executive may appeal to an MBA student but is decidedly less appealing to those who value nursing as a
noble and hands-on calling.
* Adopt RN work schedules that allow RNs some semblance of a normal life.
* Provide RNs with adequate retirement and health benefits.
* Provide increased funding for RN scholarships.
* Expand educational and training opportunities for generalist RNs to learn specialty skills, and for LPNs,
LVNs and aides to become RNs.
* Work with nursing unions on projects to develop new programs for the future of nursing.
Most importantly, do whatever it takes to restore the traumatic loss of RN faith in the industry that they see as
having forsaken both them and their patients in the pursuit of private wealth over and above public health.
That trust must be earned. It cannot be purchased with sign-on bonuses and certainly not with broken promises.
The path back to that lost trust will be difficult. Common decency, an industry reaffirmation of the centrality of
patient health in its mission and a commitment to the nursing profession that has made the industry one of the
wealthiest in the nation demand it. "Last edit by pickledpepperRN on Jun 3, '03