Fiestynurse, tell us about the california staffing legislation for tomorrow

  1. fiestynurse,

    Can you fill us in on the staffing legislation that is suppose to take affect tomorrow?

    What were the final staffing limits agreed on and what is the penalty for non-compliance?
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  2. 13 Comments

  3. by   fiestynurse
    Don't know!
    Last edit by fiestynurse on Jan 2, '02
  4. by   NRSKarenRN
    december 30, 2001

    the state
    nursing rules not ready yet

    by daren briscoe, times staff writer

    http://www.latimes.com/news/printedi...e%2dcalifornia

    finding the right nurse-to-patient ratio for california hospitals is proving harder than expected, delaying the release of new state-mandated staffing guidelines.

    the state has yet to finish developing the regulations, which were supposed to take effect by tuesday. they may not be ready for several months, according to officials.

    "we're not going to meet the jan. 1 deadline," said lea brooks, spokeswoman for the state department of health services, the agency charged with setting the ratios. "it's a very complex, very time-consuming process and we're still analyzing the data we gathered." gov. gray davis signed a bill in 1999 requiring minimum staffing levels in hospital units, making california the first state to do so. such requirements already existed for some hospital areas, including intensive care units and operating rooms.

    nurses unions support requiring levels as high one nurse for every three patients, saying more nurses would ease excessive workloads, improve patient care and make the job more attractive amid a shortage.

    the hospital industry has proposed levels as low as one nurse for every 10 patients, saying that there aren't enough nurses available for blanket increases, that hospitals should have discretion on staffing levels and that there is no proof that more nurses equal better care.

    both sides have spent months waiting for the new guidelines.

    jan emerson, a spokeswoman for the california healthcare assn., said the hospital industry group is "philosophically opposed" to mandatory staffing levels, but would wait until the new rules are out before taking a position. "let's see what the regulations are and what the plan is," she said.

    jill furillo, director of government relations for the california nurses assn. union, was equally diplomatic about the delay.

    "i understand that [the state] is working really hard on them," she said. "we need them, but we also want to make sure that whatever they do, they do it right."

    the rules were supposed to take effect last january, but lacking an agreed-upon "magic number" of the optimal nurse-to-patient ratio, the state postponed implementation for a year to develop guidelines.

    the department of health services took proposals from the hospital and nurses associations, commissioned staffing-ratio studies by the university of california and made unannounced visits to 80 acute-care hospitals throughout the state to observe the quality of care at different staffing levels and different times of day, according to brooks. she said a public-comment period of at least 45 days will follow issuance of the draft regulations.

    "we're committed to holding meetings at sites throughout the state in recognition of the high interest in this issue," she said.

    gov. davis cited the "erosion in the quality of patient care" when he signed the bill, at a time when managed-care cost pressures led many hospitals to reduce nursing staff.

    california ranked next-to-last in a march 2000 federal survey measuring states' ratio of nurses per 100,000 residents, with 544. the national average was 782.

    nurse ratios

    the department of health and human services conducted a national sample of registered nurses in march 2000. california ranked 49th of the 50 states in the ratio of registered nurses to residents.

    most nurses per 100,000 residents

    1. massachusetts: 1,194

    2. south dakota: 1,128

    3. rhode island: 1,101

    4. north dakota: 1,096

    5. iowa: 1,060

    fewest nurses per 100,000 residents

    46. oklahoma: 635

    47. arizona: 628

    48. texas: 606

    49. california: 544

    50. nevada: 520

    national average: 782
  5. by   wildtime88
    So let's see.

    Legislation was passed with a set date to implement it. Nurses have said what the staffing ratios should be based on their professional judgement and experience. The nurses are the one directly affected by nurse to patient ratios. The nurses also know at what level safe and effective nursing care can be done at to insure optimum safety of their patients.

    The nurses ratios are being ignored even tough they have come up with statistical data and examples of the direct benefits of the staffing levels they suggested. In plain English, someone is stalling this legislation stating that nurses do not know what they are talking about. Nurses are not competent to determine staffing levels or control their own profession practices.

    As a side note maybe someone else should think about what happens to legislation that is proposed. Just because nurses might want it does not mean that it will come to pass especially when there is opposition to it. What you originally want and what you end up with can be very different.

    This is not to take anything away from the nurses in California. They worked hard and long for this legislation and even united non-union and union nurses together to get this far. It is the story similar to David fighting Goliath.

    I can say this much, as a ER nurse, I would not work under a 6 patient to 1 nurse ratio that has been recommended by the California Hospital Association. I personally know just how unsafe that is.

    Please keep us informed as to how the nurses in California are taking this literal slap in the face.
  6. by   Cascadians
    Stunning. Yes, a hard sharp slap in the face.

    " ... there is no proof that more nurses equal better care. ... "

    One of the most blatantly STUPID statements ever put in print.

    All nurses should vacate all hospitals and start their own, run by nurses for nurses and above all FOR PATIENTS.

    Funny how lately Joe Average with mom suddenly in the hospital with stroke is noticing that care is absent. Even Joe Average is figuring out that family members must sit bedside to ensure safety and care for mom.

    The appropriate doom for these idiot hospital corporate talking heads and pickpockets would be to find themselves disabled in a hospital bed with the 1:10 nurseatient ratios they are spouting.

    Has anybody noticed that corporate conglomerates have taken a downturn toward the brutal hardnose lately?

    Nurses must take a valiant stand and not let their goodness and innate caring be used against them for exploitation and manipulation any longer.
  7. by   Jenny P
    Wildtime, you are wrong when you say nurses are the (only) ones directly affected by this legislation. Patients are also affected by this legislation- they have less chance of medical errors, infections, aand re-hospitalization with appropriate nurse/patient ratios; and (here's the REAL kicker)the HOSPITAL BUDGET (read: upper management pay raises) is also affected by this legislation.

    Cascadians, the fact that better nurse/patient ratios results in better patient outcomes has been studied and researched for several years. That is the most frustrating part of the deal.

    A study funded by the Dept. of Health and Human Services and conducted by the Harvard University School of Public Health was based on 1997 data from more than 5 million patient discharges from 799 hospitals in 11 states found that more RNs were associated with a 3%-12% reduction in the rates of 5 adverse outcomes: UTIs, pneumonia, shock, UGI bleeding, and length of stay. Higher staffing levels for all types of nurses were associated with a decrease of 2%- 25% in these outcomes. For more info on NURSE STAFFING AND PATIENT OUTCOMES IN HOSPITALS, go to http://bhpr.hrsa.gov/dn/staffstudy.htm

    My questions for the California Hospital Association is this: Do you have any studies that prove that higher salaries for executives improve patient outcomes? Or that greater numbers of consultants and upper and middle management does?

    One of the items that both the nurses and the hospitals probably agree on is that better nurse staff ratios will help solve their problems. But determining the "correct" numbers for those ratios is going to take some real work. It scares me that the hospitals think that 1:10 is a "good" ratio. What are they currently working with? And do they wonder WHY California has such a low number of RNs per 100,000 residents? (It would be interesting to know if these are total RNs in Calif. or if these are working RNs).
  8. by   Jenny P
    Just a couple of remarks from the study:

    According to the study, the costs associated with patient complications can be substantial. Reductions in the rates of adverse outcomes reduce hospital costs as well as significant financial and psychological costs to patients and their families.

    "Hospitals can use these findings to improve quality and performance measures across the board to ensure better nursing care for all patients," said Sam Shekar. M.D., M.P.H., HRSA's associate administrator for health professions.

    "We need to know more not "We need to know more not only about how nurse staffing affects quality, but also about the working conditions in which nurses provide care," said John M. Eisenberg, M.D., director of the Agency for Healthcare Research and Quality (AHRQ).
    "Excellent nurses may have difficulty providing excellent care if they are working in conditions that are not conducive to quality care."
    Last edit by Jenny P on Jan 2, '02
  9. by   wildtime88
    Jenny, I never used the word only. But, I must say I like seeing the thought process at work here.

    You will find the following interesting as well:


    California Nurses Association (CNA)
    Versus California Healthcare/Hospital
    Association (CHA) Proposals


    Proposed Nurse-to-Patient Ratios ____ CNA -- CHA



    Critical Care _____________________ 1:2 ---1:2

    Burn ___________________________ 1:2 --- 1:2

    Operating Room __________________ 1:1 --- 1:1

    Post-Anesthesia Recovery __________ 1:2 --- 1:3

    Emergency Department ____________ 1:3 --- 1:6

    Step-Down Intermediate Care _______ 1:3 --- 1:6

    Medical-Surgical __________________ 1:3 --- 1:10

    Telemetry _______________________ 1:3 --- 1:10

    Oncology ________________________ 1:3 --- 1:10

    Obstetrics-Perinatal ________________ 1:3 --- 1:3

    Active Labor ______________________ 1:1 --- 1:3

    Postpartum _______________________ 1:5 --- 1:8

    Pediatrics ________________________ 1:3 --- 1:6

    Sub Acute/Transitional Care __________ 1:4 --- 1:12

    Behavioral Health/Psychiatric __________1:4 --- 1:12


    Please keep in mind, float nurses are not being used to cover breaks or lunches or other 1:1 emergencies. Also some areas such as ER and Labor and delivery also have a need for dedicated triage nurses who need to be covered for breaks and lunches. This is also not dependent on availability of ancillary and support staff. Nor is it based on shift. As we all know patients do not stay stable after 4pm. And what if you have a last minute call in or no show or someone has to go home sick or because of a family emergency?

    This is also very interesting and show what can happen if the basic problems are solved:


    "Adoption of nurse-to-patient ratios in the state of Victoria, Australia, last year has brought an additional 2,600 RNs into Victoria's public hospital system, a 13% increase, while other Australian states continue to battle a nursing shortage. Additionally, many part-timers have increased their number of shifts. Further, there has been a 40% increase in the number of RNs in postgraduate specialty nursing programs. (The Age, Melbourne, Australia, Aug. 24, 2001, other sources.) "


    This information came from
    http://www.calnurse.org/lastab394/
    Please follow the links at the bottom right of the above website to see the whole story.
  10. by   Jen911
    We're already having to hold patients in the ER for up to 24 hours because we can't staff our floors with enough nurses to take care of the number of patients who are admitted. What's going to happen when those nurses actually take care of FEWER patients?? We're going to be holding MORE patients in the ER, tieing up ALL our ER beds, keeping the acute MI's and CVA's in the waiting rooms because the staffing ratio's say we can't take care of them? All the other hospitals in the area are the same boat we are, not like we can transfer out...

    This is California, we can't just pull more nurses out of thin air here....

    Jen911
    San Jose, CA
  11. by   fiestynurse
    Thanks Karen! I could not get any information from anyone about what the heck was going on! I should have known to look in the LA Times - they are usually on top of things.
    BIG! BIG! Disappointment that this will be delayed another year.
    It is what we all feared would happen. Nurses have been writing letters and attending rallies for over two years now. It's going to get difficult to keep the momentum going for this obvious long battle ahead. The only thing I can think of saying is "Oh S--t!"

    Jen911 - It will be hard in the beginning to meet these ratios, but it was anticipated to improve working conditions and attrack more people into the profession. When Australia instigated nurse-patient ratios, thousands of nurses returned to the bedside that had previously left. That was the hope in California!
  12. by   NRSKarenRN
    feisty:

    I browse healthleaders.com daily email---most up-to- date info I post here comes from link at that site. They cull all major papers for health stories....as addictive as allnurses.
  13. by   NRSKarenRN
    Feisty:
    Any update re staffing ratios legislation yet?
  14. by   massEDgirl
    I am all for nurse patient ratios...and I thinks it is great how far CA has come...Here in MA we look closely at the goings on in the CNA.

    I have been an ED nurse now for 8 years...I just don't quite understand their ratio for the ED.....1:3??...1:6??.....How can you set ratio's in the ED??......Beleive me!!!...Not that I would not want them!!


    On a floor or ICU there are only so many beds per floor.....So you can kinda figure out how many nurses you would need if all beds were full....and figure out ratios from there.

    Now the ED......how do you figure this out??

    I work in a busy level II trauma center.....18 regular beds.....(2 of which are trauma rooms....4 of which could be used as trauma if need be).....In the regular section we have the room for another 12-14 hallway spots ...(which we use on a daily basis).....We have an 8 bed observation area which is supposed to be used for patients being HELD in the ED due to no beds on the floor.....(we HAVE used this are for regular ED patients......and we have a 5 bed prompt care area. Also our triage area has 2 beds if you need to lie someone down right away.

    Now count the HUGE waiting area with countless chairs that have TONS of triaged patients in them waiting to come in to be seen...(which by the way you are VERY much responsible for)

    How can you figure ratios out from this?? There is no controling the amount of patients in the ED...like you can control the amount of patients on the floor. ...You might be able to go on diversion to ambulance traffic ( a trauma center does not always have that luxury)....but the doors to the triage remain open 24/7...there is NO stopping the patient flow that walks in...20....50....100 patients a shift.

    Wildtime....looking at the potential number of patients my ED could be looking at , at any one given time.......do you still feel a 6 pt to 1 nurse ratio in the ED is unsafe......He!!...there are some nights I would be happy to have a 10 patient to 1 nurse ratio!!

    I think this legistration will eventually be great for the floor nurses....but in all reality I can't see them making it work for us ED nurses.

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