Copyright 2002 Knight Ridder/Tribune Business News
Copyright 2002 San Jose Mercury News
San Jose Mercury News...11/20/2002
By Barbara Feder Ostrov
Vangy Leyba, a registered nurse at St. Francis Hospital in San Francisco, knows in her bones that more nurses on the hospital floor mean better care for her patients.
"They keep loading us up with patients and there's not enough help," said Leyba, who nurses cancer patients. "The patients don't get the care they deserve. What am I supposed to do, divide myself six ways?"
Leyba was among an estimated three hundred nurses from around the Bay Area who flocked to a spirited public hearing Tuesday on mandatory new nurse staffing standards for California's hospitals.
The standards, first approved by Gov. Gray Davis in 1999 but not unveiled in detail until early this year, would require hospitals to provide a minimum number of nurses for inpatients.
The first of their kind in the country, the standards call for one nurse for every six patients in medical-surgical wards, increasing to one nurse for every five patients within 12 to 18 months. One nurse would be needed for every two patients in intensive care, labor and delivery, and burn units.
But those ratios are not finalized yet. Tuesday's hearing in San Francisco, one of three statewide, was held to obtain public comment on the ideal number of patients per nurse in various hospital units.
Neither unionized nurses nor hospital representatives, who have proposed their own staffing standards, are happy with the middle ground charted by state health officials.
Hospital officials have proposed a minimum of one nurse to 10 patients in the medical-surgical unit, which hosts the bulk of a hospital's patients. They argued that a statewide nursing shortage and high labor costs will make it almost impossible for California's hospitals to meet the ratios by 2004. On Tuesday, they exhorted state officials to push back the deadline until 2006.
"We just don't have the nurses in the state," said Jan Emerson, spokeswoman for the California Healthcare Association, a hospital industry group.
Joan Smith, a registered nurse who directs patient care services for Valley Medical Center, Santa Clara County's public hospital, warned that the ratios, as proposed, would put Valley Med "on a collision course" with a strained emergency health care system that could harm public health.
However, managed care giant Kaiser Permanente last year committed to a company-wide standard of one nurse to four patients in medical-surgical units. On Tuesday, spokesman Terry Lightfoot said Kaiser had hired 1,600 registered nurses since January to help meet that goal.
Two of California's leading nursing unions, the Service Employees International Union Nurse Alliance and the California Nurses Association, both issued proposals that provide far more nurses at the bedside than the hospital industry's.
The two unions are battling for dominance in California's healthcare market and differ on a number of key issues: the SEIU has previously proposed a ratio of one nurse to four patients on the same unit, while the California Nurses Association's proposal sought one nurse for every three patients. SEIU also advocates that lesser-trained licensed vocational nurses should be counted in the ratios, while the California Nurses Association argues for registered nurse-only ratios.
Because vocational nurses must be overseen by registered nurses, the registered nurses' workload will not decrease if they are still monitoring vocational nurses' patients, said California Nurses Association president Rose Ann DeMoro.
Hospitals typically staff their wards depending on the number of patients and the complexity of their illnesses. They report average ratios of one nurse to six patients, but nurses argue that is an ideal often compromised by short staffing and mandatory overtime. Nurses say they have taken care of as many as 12 acutely ill patients during a shift.
Many say they are so overworked that they worry about making mistakes that could cost patients their lives.
"No matter how organized and efficient we are, nothing can take the place of having enough nurses to do the work," said Terry Dye, a registered nurse at Sutter hospital in Santa Rosa.
The state Department of Health Services is taking public comment until Dec. 6. The final mandatory staffing levels are expected to take effect in Jan. 2004.