Regulating Health Care
Patient-ratio law ends 'nursing shortage'
Rose Ann DeMoro
Thursday, March 18, 2004
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Imagine a hospital without registered nurses. Picture yourself in a hospital bed, in pain, recovering from a stroke or a serious accident, seeing an RN only once in eight or 12 hours, sharing her with 12 or 18 or 20 other patients.
Envision your husband, mother or infant deprived of the proper care from an RN who does not have time to carefully observe the subtle changes in condition that can lead to instant death or permanent loss of function.
Sound far-fetched? Not long ago that was the common order in many hospitals, especially with the rise of corporate medicine and managed care that put profits, market share and severe restrictions on services ahead of therapeutic healing and recovery, and that pushed thousands of nurses away from the bedside. That's the world some in the multibillion-dollar hospital industry want back.
In 1999, California took a step back from the precipice of deteriorating conditions, enacting a long-overdue commonsense law that mandates a minimum level of on-duty nurses for safe care and requires staffing beyond that minimum if patients need more intensive care.
Hospitals had four years to implement the law, and many did. But executives in the California Healthcare Association, the hospital industry's lobbying arm, are continuing their campaign to reverse the new patient protections. These are the same industry lobbyists who fought virtually every bill to improve the quality of care from crackdowns on HMO abuses to nursing- home reforms, and they have opposed efforts to expand health-care access.
Their efforts come despite convincing evidence that decreasing nursing staffs can endanger patients' lives. The Journal of the American Medical Association, for example, has reported that each additional patient assigned to an RN increases the likelihood of a related death within 30 days by 7 percent.
These hospital officials are bombarding Gov. Arnold Schwarzenegger, the Legislature, the media and the courts with lawsuits, new bills and a misleading PR drive in an attack on the staffing law.
In this cynical, deceptive campaign, hospital administrators appeal to the public to accept a substandard level of hospital care -- thus producing bigger profit margins and higher executive compensation.
What the officials don't mention is a decade-long industry push to consolidate hospitals, close emergency rooms, place less-skilled caregivers at the bedside and lay off thousands of RNs -- creating a self-inflicted nursing shortage. Ironically, they now claim this manufactured "nursing shortage" has prevented hospitals from hiring RNs.
But the law has sparked a stunning reversal. Since it was signed, the state's RN workforce has grown by more than 10,000 a year. Today, California has 30,000 more RNs than was anticipated -- six times more than the number of additional RNs the state health department said were needed to accommodate the safe staffing law.
RNs are the guardians of patient safety. Many in our hospitals today are the valiant caregivers who stayed at the bedside through all the cutbacks and the shredding of the patient safety net, who often jeopardized their own health and their licensure to protect their patients in unsafe conditions created by an uncaring industry. Many fought for years to achieve passage of the safe-staffing law and remained in the profession with the hope and anticipation of what the law would bring.
The law has already made a difference. Since implementation in January, staffing has improved at nearly 70 percent of California hospitals surveyed by the California Nurses Association. That's the progress the hospital executives want to curtail, threatening to create a new exodus of RNs and endangering the lives of thousands.
While the hospital industry tries to manipulate the public, it has seriously underestimated the resolve of the RNs and the patients to protect the gains this law has already produced. On both the national and international stage, RNs are mobilizing to enact similar safe-staffing legislation, bringing hope back to their profession and health to their patients.
In the process, nurses hope to recalibrate the hospital's moral compass, which has allowed them to drift so far from their historic self-avowed mission: a single standard of care for all.
Rose Ann DeMoro is executive director of the 56,000-member California Nurses Association, which sponsored the safe-staffing law.