Schwarzenegger Says Nurses are "Set Dressing" - page 18

And the hits just keep on coming ... :uhoh21: According to the Sacramento Bee, Gov. Schwarzenegger had this to say about protesting nurses in California: "They are becoming now more and more... Read More

  1. by   Sheri257
    This, once again, seems to add credibility to the sexism charges ...

    Arnold backs off for the male dominated police and firemen unions ...

    But doesn't do the same for teachers and nurses.

    At least CNA won the appeal on the ratio law ...

    http://www.calnurse.org/?Action=Content&id=796

  2. by   mattsmom81
    Quote from MissPiggy
    Don't blame you... one of my fondest wishes was to start a nurses' union here before I got out, but I guess they'd rather stew in their own juices, so let them have their fun.
    Sorry if I sound bitter, but I have been a nurse here for the last 20 years and have seen enough! Am hoping to get out in Dec. when I am due to graduate with a Masters' in Clinical Psych and find a full-time internship in counseling. I now see why nurses are treated like you-know-what here - they are willing to take it! :spin:
    Sadly, I concur and wish you happiness in your new career. Nurses like you and I are rare in the south (and just become scapegoats in Texas)I've decided. I barely managed to stay afloat in Texas as a nurse...always dodging that 'bad attitude' label, just because I speak up and don't make a good doormat.

    Those who are lucky to work for good managers in good facilities, be thankful. Try not to leave. You may be surprised to find how bad things elsewhere.
  3. by   Lenny
    Quote from lizz
    And the hits just keep on coming ... :uhoh21:

    According to the Sacramento Bee, Gov. Schwarzenegger had this to say about protesting nurses in California:

    "They are becoming now more and more part of the set dressing," he said in an interview this week. "It's kind of like the extras when you do a movie and you need extras in the background. That's what they've become. That's fine with me."

    http://www.sacbee.com/content/politi...13318409c.html

    Here's the entire article:

    Members of the California Nurses Association stood up as Schwarzenegger was speaking at the Sheraton Grand on Thursday and unfurled a banner reading, "Stop the Power Grab."

    A week earlier, they protested as the Republican governor and a group of Hollywood stars arrived for a Sacramento movie premiere. The California Highway Patrol pulled one nurse out of the theater audience for questioning after spotting her hospital uniform.

    The CNA plans to fly an anti-Schwar-zenegger banner over the Oscar ceremonies in Hollywood on Sunday night.

    Officials of the state's largest nurses union say their concern is patient safety: They want the governor to stop blocking new regulations that would boost the number of nurses hospitals are required to have on duty.

    Largely due to the sponsorship of the CNA, California last year became the first state in the nation to institute mandatory nurse-patient ratios for hospitals. Until Schwarzenegger stepped in, the allowable ratio of patients to nurses was scheduled to decrease in January. The plan would have increased the mandatory number of nurses since each nurse would be handling fewer patients.

    But critics of the registered nurses union - namely, hospitals - say the group's aggressive tactics are more suited to the Teamsters than to caregivers. And they charge that the CNA is using the publicity as part of a national organizing drive.

    "What's important is that people understand their agenda," said Jan Emerson, a spokeswoman for the California Hospital Association. "Their vitriolic campaigning citing what are honestly minor changes to the ratios is not about their so-called concern about patients. It is about their efforts to make themselves a national labor union."

    Schwarzenegger himself is dismissive of the protesters who are becoming a regular part of his political road show.

    "They are becoming now more and more part of the set dressing," he said in an interview this week. "It's kind of like the extras when you do a movie and you need extras in the background. That's what they've become. That's fine with me."

    Officials at the CNA see the complaints about their tactics as pure sexism.

    "If you know anything about nurses at the bedside, they are extremely vocal in making sure they get the staffing they need," said Deborah Burger, a nurse who is president of the CNA. "They have to go up against sometimes very hostile hospital administrators and doctors. It only seems hostile or assertive because I think there's a bit of a gender bias. ... It's really trying to say women are not acting as they are supposed to."

    She added: "We couldn't be doing this aggressive campaign if we didn't have 100 percent support from our nurses."

    The CNA has 60,000 members and represents registered nurses at 171 health facilities throughout the state. Bay Area nurses founded the organization as a professional association affiliated with the national American Nurses Association about 100 years ago. It became a union in the 1940s.

    The group also lobbies on health care issues and donates to political campaigns. Officially nonpartisan, the CNA tends to give to Democrats who support its views. The group opposed the recall election and declined to endorse a candidate in the race for a new governor.

    Ten years ago, the CNA broke away from the more conservative American Nurses Association at a time when the advent of managed care in California stirred political activism among nurses. The CNA's membership has almost tripled since then, its leaders say.

    According to the Center for California Health Workforce Studies at the University of California, San Francisco, about one in five nurses nationwide is a member of a union, but the rate in California is double that.

    The CNA gained national fame among nurses in 1999 when Gov. Gray Davis signed the nation's first law mandating staffing ratios at hospitals.

    Partly because of the ratio law, Modern Healthcare magazine last year named CNA Director Rose Ann DeMoro the 35th most powerful person in health care in the nation, above such people as the dean of the Yale medical school and executives at Kaiser Permanente.

    The group has been organizing nationally, sparking sometimes bitter fights in California, Hawaii and Illinois as they attempt to persuade nurses that the CNA can help them more than other unions.

    "The California Nurses Association has been nationally recognized as one of the most aggressive nursing unions in the United States," said Joanne Spetz, associate director of the Center for California Health Workforce Studies. "That's been controversial within the profession. There are a lot of nurses who think collective bargaining is contrary to the notion of being a profession."

    Emerson of the California Hospital Association, for one, is not a fan of the CNA's tactics. She recalls a 2001 protest that the CNA held at the hospital group's Sacramento offices.

    "They came into our office building, stormed the elevators, jammed our lobby and stood on our furniture," Emerson said. "They yelled all kinds of very angry charges, including, 'CHA kills people.' They marched around our reception desk for about 15 minutes. They broke through some locked doors and harassed support staff and then demanded to use our bathrooms. They told one of our lobbyists if they didn't let them use our bathrooms, they would urinate on our carpets."

    CNA officials describe the protest differently. They said it was fully within the bounds of acceptable conduct. The suggestion that they threatened to defile the CHA's carpets is "a baldfaced lie," said the CNA's DeMoro, a professional labor organizer whom the nurses hired away from a job organizing film industry producers for the Teamsters union 20 years ago.

    "What Schwarzenegger has done is made this a very partisan fight because now he's getting the Republicans to attack us," DeMoro said. "The reality is nurses are not partisan."

    Schwarzenegger amped up the nurses' ire at a Long Beach speech in December when he responded to their noisy protest by saying, "Pay no attention to those voices over there. They are the special interests, and you know what I mean. The special interests don't like me in Sacramento because I am always kicking their butts."

    More recently, the CNA says the Schwarzenegger administration has overreacted to some of its protests, citing the incident when a nurse, Kelly DiGiacomo, was questioned and detained during the movie premiere.

    Kelly Huston, a spokesman for the California Highway Patrol, said that the officers were performing routine security matters.

    The governor says he has nothing against nurses.

    "They have taken care of me really well each time I was in the hospital, if it was in the heart surgery or the hip surgery or whatever it was," he said.

    He added: "Each of those nurses that are protesting are at the same time saving lives. And they are just being dragged in by the union. Eventually, they will get it that the unions are taking (money) from their paychecks and they have no control over it."

    He doesn't plan to change his mind.

    The nurses "can do whatever they need to do," he said. "I do what I need to do, and that's how we're going to go down the line."

    The nurses don't plan to change, either.

    "We don't have a choice but to fight the fight," DeMoro said. "If we don't fight, who will help the public?"
    That's what you get when you elect an Austrian actor for Governor...........and to think that some inbreds actually wanted to change the Constitution to allow this moron to be allowed to run for President. Tell him the oval office is all full up; go sell crazy somewhere else.
  4. by   SmilingBluEyes
    The elected an Austrian actor for governor. What "Austrian" has to do with it, I am unsure. How did you feel when we elected an American Actor as President? Just curious.
  5. by   HisAlone
    I live out here in California. Of the three major hospitals in my county (Ventura) two are union and one is non-union. The non-union hospital pays on average $3-5 more an hour and significantly better employee benefits. They have recently implemented discharge lounges to get patients off the unit to further reduce nurse workload - something neither of the two union shops are considering.

    The nurse to patient ratios were already reduced before the Gov came into office - which is a lot better than many states. A number of hospitals and trauma units out here were forced to close their doors as a direct result of HOW those reductions were implemented - one swell foop with no time to implement any changes to budgetary or staffing plans. What essentially happened was that the hospitals fired most of the CNAs to prop up the budgets that were in already place in order to hire on extra nurses. So the nursing workload actually INCREASED because they had to pickup extra duties that were originally being done by the CNAs. Entire wings had to be shut down because there weren't enough staff to comply with the new ratios. Empty beds = no money = doors closed = employees AND patients looking for other positions. The Gov stepped in at the request of the AHA to stop further reduction in order to give the hospitals a chance to regroup.

    Now I like lower ratios as much as anyone and am fully on board with the patient safety issues. But there is a smart way to skin a cat and a reckless way to do it. I have no problem looking at the BIG picture. I took a big step back when this thing went down and took a good hard look at what was going on. I spent 30 years in the business world before I changed careers and went into nursing. I marketed computer based applications to hospitals and had some insight into their budgetary cycles and their financial and cash-flow challenges. I do not look at hospitals as evil blood-sucking beancounters. I see hospitals for what they are: businesses that have a bottom line that keep their doors open to patients and their employees employeed.

    Out here in California, especially Southern CA, we have a HUGE number of patients who do not pay their bills. God bless and protect each and every one of them, but we have a lot of illegals coming across the border and straight into our hospitals without a thin dime to pay for the services that they receive. The hospitals have to eat most of this. We also have a huge homeless population, many of which are psych patients that are overunning our EDs to the point where we can't hardly get to the traumas coming in. We can't discharge anyone onto the street, so we have patients in the ED who have been in there for upwards to 6 weeks or more because we have nowhere else to send them. For some of the homeless, the hospitals have to pay for a taxi to take them to a hotel for which they also pay. MediCal screws hospitals on a daily basis.

    The issues out here are a lot bigger and a lot more complex than some are willing to admit. Instead of getting emotional and reactionary about it I think we all need to take a deep breath and look at all sides of this thing objectively. I do not for a moment believe that the evil hospitals are purposefully looking to overload nurses just so that they can pocket the cash and send all their leisure-suit wearing executives to Hawaii for expensive vacations. They have problems that need to be addressed, just as we do. A reasonable middle ground has got to be found that provides effective solutions to the multiple problems that we are facing. Like it or not the AHA and the ANA and the CNA need to work together with Sacramento to prevent cutting our arms off in order to save our fingers.

    The Gov is doing a LOT of unpopular things out here - true. I didn't vote for the man but I wanted his predecessor OUT. This state was darn near bankrupt when Arnold got in and there are actually quite a few of us out here that understand that we have to suck in our guts and brace ourselves for a lot of major cuts in order to bail the state out. We are taxed out here within an inch of our lives already - I can't afford to give up any more of my paycheck if I'm going to make my next mortgage payment. So we have to make cuts. We don't have to like it, but we have to tolerate it, at least until this state gets back up on its feet. We had to look reality square in the face, make sacrifices in alot of areas, practice a bit of patience, and set our eyes on a future that will hopefully be better one day. In the meantime all the bad-mouthing rhetoric on EITHER side of this issue isn't going to improve our lot one iota.
    Last edit by HisAlone on Apr 12, '05
  6. by   UM Review RN
    Quote from HisAlone
    The issues out here are a lot bigger and a lot more complex than some are willing to admit. Instead of getting emotional and reactionary about it I think we all need to take a deep breath and look at all sides of this thing objectively.
    Indeed they are! Had you been a nurse since even the '90s, you'd know that nurses have been taking the hospital budget hit so consistently that their salaries have essentially remained flat, yet their patient load keeps increasing in acuity and in number.

    I suggest you read "Code Green" for a better history of the problem. Nurses were up in arms then and, due to little or no real improvement to the problem of staffing and adequate patient/nurse ratios today, have every right to be finally "madder than hell and we aren't going to take it any more."

    Hospitals had plenty of time to implement improvements. It shouldn't have taken a law to get these changes in place.
  7. by   Sheri257
    Quote from HisAlone
    The nurse to patient ratios were already reduced before the Gov came into office - which is a lot better than many states. A number of hospitals and trauma units out here were forced to close their doors as a direct result of HOW those reductions were implemented - one swell foop with no time to implement any changes to budgetary or staffing plans. What essentially happened was that the hospitals fired most of the CNAs to prop up the budgets that were in already place in order to hire on extra nurses. So the nursing workload actually INCREASED because they had to pickup extra duties that were originally being done by the CNAs. Entire wings had to be shut down because there weren't enough staff to comply with the new ratios. Empty beds = no money = doors closed = employees AND patients looking for other positions. The Gov stepped in at the request of the AHA to stop further reduction in order to give the hospitals a chance to regroup.
    I agree with a lot of what you're saying, but there's a couple of things you might be missing here.

    For one thing, the hospitals had five years to plan for the ratios. There was plenty of time to plan. That's why Kaiser was meeting the ratios two years ahead of schedule. That's also why Kaiser broke with the AHA in supporting the ratio law.

    While the AHA likes to cite the ratio law as part of the reason for the shut downs, they also admit that illegals are the bigger problem. As you pointed out, illegals are a huge problem but, I don't think suspending ratios is the answer. 30,000 California RN's have come back to work since the ratios took effect. They could easily leave (again) if patient loads get too high.

    As far as CNA's getting fired ... that's true in some cases. Although most hospitals in my area still have CNA's. Nevertheless, most RN's I know don't have a problem with it. Their license is on the line and, given a choice, they'd rather have no CNA and five-six patients than 12 patients with CNA's.

    The real problem that has to be addressed, IMHO, is illegals, not the ratio law.

    Last edit by Sheri257 on Apr 12, '05
  8. by   HisAlone
    I have read Code Green and am well aware of the history. That does not change the fact that there are realities that have to be dealt with. These problems don't start with nursing and end with hospital administrators. The reason I left a $100K/yr job as an engineer in the telecommunications industry to start a $8/hr job as a CNA while I put myself through nursing school was because of the exact kind of thing. Nursing isn't unique to the world of corporate mergers, layoffs, overwork and underpay, and the disintegration of employee-employer loyalty and respect. And safety factors also permeate a large number of other industries. I figured as long as I was getting screwed I may as well do something that meant something in this world. For me that was nursing.

    I figure that I can do one of two things. Either I can caterwaul about my problems or I can do something constructive in my own personal sphere of influence to bring solutions to the problems. Some of the things that I have seen thoughtful co-workers suggest in staff meetings have had a tremendously positive impact in our workplace. Constructive input and positive participation in nursing organizations will always remain crucial to the industry as a whole.

    I have never suggested that nurses shouldn't band together and work to change things. What I take exception to is the vitriol, the name calling, the fingerpointing, and the unprofessional conduct that I have seen so much of - all done in the name of "progress". Progress is achieved not through screaming voices but through intelligent debate by people who are willing to look at all sides of an issue and recommend reasonable approaches that contribute to progress.

    Those who were most instrumental in seeing the changes out here regarding ratios were the ones that presented the facts in Sacramento in firm but professional presentations to the lawmakers. Countless named and unnamed people have diligently worked behind the scenes to garner respect, raise understanding, and gain support. The reactionary fringe have been an embarrassment to our ranks. Anger tends to turn one's brain to fecal matter. I sincerely hope that no one thinks that some of the disgraceful conduct of the more colorful proponents that have been observed out here is garnering support from the public. If we want to be treated as professionals we must, at all costs, remain professional. Let's vent behind closed doors then present a united front of professionalism to press our case to the public. Otherwise we will win a few battles only to lose the war. I'd like to think that, with strong leadership and unity, we can achieve positive outcomes while maintaining the nobility of the profession in the public sphere.
    Last edit by HisAlone on Apr 12, '05
  9. by   UM Review RN
    Quote from HisAlone
    I have read Code Green and am well aware of the history. That does not change the fact that there are realities that have to be dealt with. These problems don't start with nursing and end with hospital administrators. The reason I left a $100K/yr job as an engineer in the telecommunications industry to start a $8/hr job as a CNA while I put myself through nursing school was because of the exact kind of thing. Nursing isn't unique to the world of corporate mergers, layoffs, overwork and underpay, and the disintegration of employee-employer loyalty and respect. And safety factors also permeate a large number of other industries. I figured as long as I was getting screwed I may as well do something that meant something in this world. For me that was nursing.

    I figure that I can do one of two things. Either I can caterwaul about my problems or I can do something constructive in my own personal sphere of influence to bring solutions to the problems. Some of the things that I have seen thoughtful co-workers suggest in staff meetings have had a tremendously positive impact in our workplace. Constructive input and positive participation in nursing organizations will always remain crucial to the industry as a whole.

    I have never suggested that nurses shouldn't band together and work to change things. What I take exception to is the vitriol, the name calling, the fingerpointing, and the unprofessional conduct that I have seen so much of - all done in the name of "progress". Progress is achieved not through screaming voices but through intelligent debate by people who are willing to look at all sides of an issue and recommend reasonable approaches that contribute to progress.

    Those who were most instrumental in seeing the changes out here regarding ratios were the ones that presented the facts in Sacramento in firm but professional presentations to the lawmakers. Countless named and unnamed people have diligently worked behind the scenes to garner respect, raise understanding, and gain support. The reactionary fringe have been an embarrassment to our ranks. Anger tends to turn one's brain to fecal matter. I sincerely hope that no one thinks that some of the disgraceful conduct of the more colorful proponents that have been observed out here is garnering support from the public. If we want to be treated as professionals we must, at all costs, remain professional. Let's vent behind closed doors then present a united front of professionalism to press our case to the public. Otherwise we will win a few battles only to lose the war. I'd like to think that, with strong leadership and unity, we can achieve positive outcomes while maintaining the nobility of the profession in the public sphere.

    So you're on whose side?

    The one that doesn't fingerpoint and call names and behave badly in public?

    Which would that be?
  10. by   HisAlone
    lizz,

    Thank you for your polite and thoughtful response - I appreciate it.

    ...the hospitals had five years to plan for the ratios. There was plenty of time to plan. That's why Kaiser was meeting the ratios two years ahead of schedule. That's also why Kaiser broke with the AHA in supporting the ratio law.

    Five years was plenty of time for powerhouses like Kaiser, but not for many of the smaller institutions.

    While the AHA likes to cite the ratio law as part of the reason for the shut downs, they also admit that illegals are the bigger problem. As you pointed out, illegals are a huge problem but, I don't think suspending ratios is the answer.

    Illegals contribute severely to the overall financial picture of these hospitals, which includes the budgets in place for payroll. No one ever suggested that the ratios be rolled back; the recommendation was to delay going from 6:1 to 5:1 on medsurg floors only. I imagine a lot of nurses elsewhere in the country would squeal with joy at a 6:1 ratio. Units such as ED, ICU, Tele, Peds, etc. still have their lower ratios as per acuity. Our hospital also added a DOU with low ratios to step patients down from ICU to Tele before transferring patients out to the medsurg floor to ensure that they are more stable.

    As far as CNA's getting fired ... that's true in some cases. Although most hospitals in my area still have CNA's. Nevertheless, most RN's I know don't have a problem with it. Their license is on the line and, given a choice, they'd rather have no CNA and five-six patients than 12 patients with CNA's.

    We still have CNAs - about half as many as before. The nurses have to take up the slack in areas that don't require their higher training i.e. bedbaths, filling water pitchers, etc. More likely these things just don't get done (squeaky wheel mode ). Linen changes are being farmed out to housekeeping.

    The real problem that has to be addressed, IMHO, is illegals, not the ratio law.

    Illegals and the psych homeless population both need to be addressed. The ratio law was never in permanent jeopardy.
    Last edit by HisAlone on Apr 12, '05
  11. by   Sheri257
    Quote from HisAlone
    No one ever suggested that the ratios be rolled back; the recommendation was to delay going from 6:1 to 5:1 on medsurg floors only. I imagine a lot of nurses elsewhere in the country would squeal with joy at a 6:1 ratio.

    The ratio law was never in permanent jeopardy.
    Actually, I beg to differ. IMHO, this was a game Arnold was playing to test whether he could roll back the ratios all together.

    First they claimed they were only going to suspend the 6 to 5 reduction for a couple of years so the hospitals could get their act together. Then, after the emergency reg was thrown out by the courts, the Health Department said they are now drafting a permanent regulation to do the same thing.

    A permanent regulation .... this after numerous claims by Schwarzenegger that he was only going to suspend the 5:1 ratio for a couple of years.

    I hope they won't attempt to roll back the ratios all together, mostly because of all of the bad press and court rulings they've gotten. But I'm convinced that the ultimate agenda is to roll back the ratios, if they think they can get away with it.

    Call me crazy ... but I just don't trust politicians. They've already lied about their agenda on this issue.

    That's how the game is played. Whittle down the ratio requirements with a reg here and a reg there. Before you know it, there won't be any ratios left.

    That's what this is all about, IMHO.

    Last edit by Sheri257 on Apr 12, '05
  12. by   mjem
    Arnold's wife Maria was recently on Oprah and she stated "Well behaved women do not make history".
  13. by   begalli
    let's do take a look at the "big picture," as we do so well as nurses.

    i found this very interesting letter written by the cha to schwarzenegger in september of last year. it's a very long read, but well worth the time.


    in this letter the "cha, on behalf of all california hospitals, implores the administration and the legislature to immediately begin addressing the underlying factors -- unfunded mandates, skyrocketing costs, declining reimbursements and an unrelenting uninsured population -- that are leading to a meltdown of california's hospitals."

    read on.....

    -------------------------------------------------------------------

    september 1, 2004

    the honorable arnold schwarzenegger
    governor of california
    statecapitolbuilding
    sacramento, ca95814

    dear governor schwarzenegger,

    i wish to express the appreciation of the california healthcare association (cha) for your continued attention to the many challenges facing our state's health care system. we've enjoyed the opportunity to discuss with you and your staff the complex issues facing california's hospitals, and we look forward to continuing our efforts in sacramento.

    hospitals exist, first and foremost, to care for patients in times of need. but the ability of hospitals to fulfill their mission is increasingly at risk, and access to care for many californians is being jeopardized every day.

    california hospitals are in a wasteland of unfunded mandates, a meltdown of emergency services, state regulations that are creating unintended consequences and a multi-faceted financial crisis. the confluence of adverse forces on hospitals is reaching unprecedented proportions.

    there have been six hospital closures in los angelescounty since january. an additional seven hospitals in l.a.county have either scaled back or eliminated mental health care units. all told, more than 70 california hospitals have closed in the past decade.

    we regret to inform you that, before the end of this year, more hospital closures, downsizings and cutbacks will be announced.

    california's hospitals are major contributors to the health of every community across this vast state. california's hospitals are on the front lines, providing quality health care 24 hours a day, seven days a week to all patients regardless of their ability to pay. hospitals provide life-saving emergency and trauma care, offer many specialized technologies and services and perform medical miracles every day.

    but many of california's hospitals themselves are on life support. while the costs of providing care continue to accelerate, payments from both governmental and private payers continue to squeeze hospitals. evidence of the financial pressures facing california hospitals is verified by the regular downgrading of hospital bond ratings, hospital closures, and cutbacks in emergency departments and other services. more than half of california's hospitals are currently operating in the red.

    the current condition of hospitals in california is not the sole result of actions (or inactions) by the legislative or executive branches of government. nonetheless, certain decisions, however well intended, have substantially contributed to the financial distress of hospitals and will lead to the closure and cutbacks of others. these unintended consequences are reducing patients' access to care and will make things worse in the next few months.

    the single biggest pressure point on hospitals is the unrelenting number of uninsured patients. one out of every five californians is uninsured. uninsured patients, unable to obtain preventive health care services, are jamming hospital emergency departments (eds), sicker and more costly to treat. in 2003, california hospitals provided $5.1 billion in uncompensated care -- much of which was incurred in treating the uninsured. making matters worse, decisions to limit the ability of private hospitals to transfer uninsured patients to public facilities have resulted in greater losses to private hospitals.

    compounding the problems in hospital eds -- and in all other hospital units -- is california's experiment with nurse-to-patient staffing ratios that became effective on january 1, 2004. based on six months of survey data gathered by cha, 85 percent of california hospitals are unable to comply with the rigid ratios adopted by the department of health services (dhs).

    the nurse-to-patient ratios were established by dhs during the davis administration. given california's dire nurse shortage, there are not enough nurses in this state to make these regulations work. in december 2003, before the ratio regulations became effective, dhs posted on its website actions that hospitals could take to comply with the regulations. among the suggestions made by dhs are: encourage physicians to discharge patients sooner, delay new admissions or cancel elective surgeries. is this really the best advice that dhs can offer hospitals?

    it is difficult to believe that the public could actually support some of these recommendations. to suggest that patients be discharged sooner or to recommend delaying admission to any patient in need of care shows disregard for the public's health and well-being.

    a more reasonable approach to meeting nurse-to-patient ratios would take into account the current supply of nurses and the day-to-day realities of caring for patients in a constantly changing environment. making matters worse, the 1:6 nurse-to-patient ratio in medical-surgical units is scheduled to drop to an even more unworkable ratio of 1:5 this coming january.

    we also need flexibility to adjust the ratios to meet actual patient needs, rather than comply with an artificial number that must be met every minute of every shift in every unit every day. to require hospitals to reassign patients to a substitute nurse whenever their assigned nurse takes a phone call or uses the restroom defies common sense.

    state financial assistance also is necessary for hospitals to meet the sweeping requirements of the hospital seismic safety mandate. the public policy objective of this law is laudable. california hospitals support the goal of improving the safety of all hospital buildings. the problem for most hospitals comes in funding these capital improvements.

    cha conservatively estimates that the hard construction cost for meeting the hospital seismic safety mandate will be at least $24 billion without financing charges. rand has placed the price tag as high as $41 billion without financing costs. the simple truth is that such a large amount of capital does not exist. many hospitals are not credit worthy and cannot qualify for a loan to make their retrofit or rebuilding projects feasible.

    the real irony is that unless access to capital is made available or the implementation deadlines are altered, the law intended to keep hospitals open following a major earthquake may instead force some hospitals to close before the next earthquake occurs.

    it's important to remember that constructing earthquake-safe buildings and hiring enough nurses are not the only keys to delivering high quality, 21st century hospital care. a vast array of new technologies are resulting in medical miracles every day. patients are living longer and healthier lives because of advancements in technology and modern drugs. but these advancements are expensive. for example, new drug-coated stents are improving the life expectancy of cardiac patients while reducing the need for open-heart surgeries by one-third. but this advanced technology costs 100 times more than traditional cardiac balloon catheterization.

    at a time when lives are being saved every day as a result of miraculous, but costly, new technologies, hospital reimbursements are increasingly inadequate. unless payments keep pace with costs, some hospitals will be unable to provide the necessary treatments because the technology is unaffordable. none of us wants that patient to be our friend or family member.

    cuts in the medicare program, stemming from the passage of the federal 1997 balanced budget act, have totaled more than $4.5 billion to california hospitals. additionally, medicare payment updates have been less than inflation for 13 of the last 15 years, resulting in a 21 percent payment gap.

    payments to hospitals by the medi-cal program are the lowest in the nation per enrollee. in 2000, california's medicaid spending per enrollee was $2,068 compared to new york, which topped the list at $7,609 per enrollee.

    as you know, most california hospitals lose money on every medi-cal patient they treat -- a situation that cannot continue if hospitals are going to keep their doors open. already this year, several california hospitals have announced that they are terminating their medi-cal contracts because of the financial losses caused by the underfunding of this program. these contract cancellations will mean reduced access to care for the state's most vulnerable patients. on the other hand, hospitals must make these difficult decisions in order to remain open for their communities.

    exacerbating our concerns about medi-cal is the administration's announced intention to restructure this program, and the impact medi-cal redesign may have on the state's safety net hospitals. we share the state's goal to create financial stability for the safety net hospitals, but stability can only be achieved if funding to the safety net is maintained at current levels and funding for future growth is built into the restructured system.

    many other outside forces are pressing down on hospitals -- including a growing desire for "transparency" in regards to hospital costs and quality of care; the manner in which hospitals bill and collect from low-income, uninsured patients; and expectations among some that hospitals be required to stay open regardless of whether they have the staff or resources to provide care. these external pressures further compromise the availability of hospital services.

    a full assessment of all the challenges currently facing california's hospitals makes clear that the meltdown we have been warning about for several years is at hand. to paraphrase an article from the august 29, 2004 edition of the los angeles times, los angelescounty has become "the chernobyl" of health care. this statement, unfortunately, describes the current state of health care throughout california.

    attached is a chart showing key health care indicators for california and the united states. this information should be helpful in putting the issues facing california's hospitals into context.

    cha's vision is an "optimally healthy society." our goal is for "every californian to have equitable access to affordable, high-quality, medically necessary health care." these ideals drive hospitals toward a higher purpose -- that of caring for all patients in need. cha is committed to doing everything possible to increase access to care for all californians. but the adverse forces converging upon hospitals are making the achievement of this goal increasingly problematic.

    in order to avoid additional closures and reductions in hospital services, the state must act on several key items:

    * a solution must be found to the underlying achilles' heel in health
    care -- the 6.5 million uninsured residents in california. all
    californians must be provided a basic level of health care coverage.
    without it, hospital eds will continue to be used as the source of
    primary health care services for the uninsured, with both hospitals
    and health care purchasers absorbing the costs.

    * medi-cal payments to hospitals and physicians must be raised to at
    least the national average. currently, california's medi-cal program
    is dead last among all states in payments to health care providers.

    * legislation is required to stop the meltdown in emergency services.
    hospital eds are under siege. additional funding for hospitals,
    emergency physicians and on-call physicians must be generated, or
    closures and cutbacks will place many californians in jeopardy because
    they will not have access to trauma and emergency care.

    * a legislative solution also must be found to the hospital seismic
    safety conundrum. this solution must include funding assistance to
    hospitals and a nexus between the allocation of funds and the
    january 1, 2008 deadline for compliance.

    * a serious attempt must be made to address california's dire nurse
    shortage. california ranks 49th in the nation in the number of nurses
    per capita. according to the california economic development
    department (edd), california will be short 30,000 nurses by 2006. by
    2010, edd estimates that the nursing shortage will grow to 97,500.
    the nursing shortage crisis is even more acute because of the rigid
    requirements of the nurse-to-patient ratio regulations. california
    hospitals are already doing more than their share -- contributing more
    than $50 million this past year to nursing schools around the state.

    * immediate action must be taken by the administration to make
    reasonable adjustments to the nurse-to-patient ratio regulations --
    particularly as they relate to temporary absences of nurses from
    non-intensive care hospital units, and the impending reduction of
    ratios from 1:6 to 1:5 in hospital medical-surgical units, slated to
    become effective on january 1, 2005.

    on behalf of all of california's hospitals, i pledge our assistance and our commitment to finding workable solutions that will preserve access to care for all californians. we look forward to working with you on the issues of critical importance to all californians.

    sincerely,
    c. duane dauner
    president

    http://www.calhealth.org/public/pres...r%209-1-04.pdf

    --------------------------------------------------------
    as this letter points out in the beginning, hospitals in california were closing long before ab 394 went into effect.

    this letter from the cha proves to me that hospitals do not view registered nurses as assets to their facilities and professional contributors to the healthcare system. bottom line is that we cost money. it's not at all about quality, safe patient care. as a matter of fact, the kind of patient care i'm talking about is not even mentioned once in this letter when the staffing ratios are addressed. they just refuse to admit it.

    so why has the cha come after us blaming nurses for the hospital closures when they themselves admit that the crisis is a multi-faceted problem? is it because they think we're pushovers or did they think it would be easy? why not go after some of the other, bigger problems and demand change? i know why, it's because they'd never win against the governmental bureaucracies.

    well they're not going to win with the nurses either.

    i really don't understand how any nurse can support the abolishment or rollback of our ratios or how they can support the cha or the governor when it comes to this issue.

    our patient's need us now. delaying the ratios is not the answer either. the condition of california hospitals will not be fixed overnight. delay now and the ratios will never go into full effect.

    as an interesting side note, cha is open to the idea of a single payor healthcare plan for all people of the state of ca as a resolution to the problems hospitals face.

    so, if anyone can tell me why nurses and patients should be the sacrificial lambs in the crisis that hospitals face when there are so many other problems, i'm all ears. might as well just turn patients away at the door then to continue to subject them to poor, and at times, substandard dangerous care provided by tired, overburdened angry nurses.

    registered nurses are not the problem!
    Last edit by begalli on Apr 13, '05

close