February 4, 2004
Staffing Improved at Nearly 70% of California Hospitals
Safe RN Staffing Law 'Off to a Good Start,' Says CNA
Just one month after its effective date, California patients are already benefiting from the state's landmark law requiring safe registered nurse staffing ratios in California hospitals, the California Nurses Association said today.
Staffing conditions are improved at 68% of the hospitals surveyed by CNA, and 59% were generally in compliance with the requirements of the law. The CNA survey covered 111 hospitals, nearly 30% of the general acute care hospitals in California from mid to late January. The results were based on interviews with RNs in the hospitals.
"Our survey demonstrates that the Safe Staffing Law is off to a good start," said CNA President Deborah Burger, RN. "A sizeable majority of hospitals we looked at are making a good faith effort to abide by the law, and most have already seen results with improved conditions. That should be welcome news to all Californians and their families who are in need of hospital care."
"If we continue this trend," said Burger, "the law will undoubtedly save the lives and promote the safety and therapeutic healing of thousands of Californians."
Remarkable progress as industry attempts to undermine law continue
"While some significant problems remain, the progress made to date is very encouraging, and a hopeful sign of the intended promise of the law," Burger said, the results of the survey are especially remarkable given the ferocious industry opposition to the law - and active efforts to undermine it - by the lobbying arm of the hospital industry.
Hospital industry opponents have challenged the law in court, are seeking to persuade state officials to roll back patient protections established by the law, and have encouraged hospitals to find ways to evade the full intent of the law.
Two continuing issues, the CNA survey found, are the inappropriate use of Licensed Vocational Nurses and the efforts of some hospitals to reduce support staff which increases the work load of RNs and decreases the time they have to spend with patients.
Some hospitals have assigned patients directly to LVNs (which increases the patient care responsibilities of RN who are legally responsible for LVNs' patients), and even permitted LVNs to assess patients, which violates California law. "LVNs have an important role to play in the delivery of care, but not as a substitute for RNs," said Burger. Among the most consistent violations with LVN use is in Maternal Child/Postpartum care.
Specific, numeric RN-to-patient ratios, established by state health officials, became effective on January 1, 2004, some four years after the CNA-sponsored law was enacted. Some large hospital systems, including the University of California Medical Centers, and Kaiser Permanente have made good use of the intervening time in both hiring additional RNs and meeting the ratios in most clinical areas, the survey found.
CNA providing a more effective voice in ratio compliance
Hospitals represented by CNA had better record with 76% showing improved staffing and 63% in general compliance. "At these hospitals, RNs have a more effective voice, with the support of CNA, to take collective actions to advocate for enhanced patient safety," Burger said.
The CNA survey also found some hospitals that continue to lag far behind.
Antelope Valley Hospital in Lancaster, for example, is substantially out of compliance in its general Medical and Post-Surgical units and Telemetry (where patients are on monitors). San Leandro Hospital has not been meeting the ratios in its telemetry units and support staff has been cut. Several Sutter Health hospitals have also had problems with compliance in inappropriate roles for LVNs and other staff cuts.
For hospitals out of compliance, CNA RNs have met with hospital officials to press for changes, disseminated forms for RNs to report problems, and, in a few instances, held public protests. CNA will continue to monitor ratio compliance and pursue improvements, and seek to work with hospitals to assure safe staffing.
While state sanctions for violations are relatively weak, CNA noted that hospitals that willfully and egregiously endanger patients by failing to meet the safety standards established by state health officials are now more vulnerable for civil suits.
The survey results announced today are the first in what will be regular updates on the progress of the law, said CNA.