Hospital industry seminars advise administrators how to evade RN ratios

Geeg · Dec 5, 2003

All the administrators say there aren't enough RN's in Cali to fulfill the ratios. NEWS FLASH: If you spend the $$$ they will come!! Put some cash out there and RN's from all over the country will be here in a flash.

pickledpepperRN · Dec 5, 2003

Originally posted by Gomer
Hey Spacenurse...

If you haven't already read it, check out page 5 in the Dec 1st edition of "Nurseweek".

Thank you, I have it. The title is, "Nurse staffing ratio law in limbo"

There are links to the announcement in the "Ratios too?" thread on this forum.

If you look up the Governors page at http://www.ca.gov

the reasons are stated as a series of "Wheareas"

This LAW not new regulation had the public hearings and all the reasons given not to implement the law.

I praise the hospitals including the University of California system and Catholic Healthcare West (CHW) that are already staffing by the ratios or in some cases nearly there.

Some such as Tenet have not been complying with the laws and regulations for many years. I will not work in such unsafe conditions.

If I lose my license because the hospital refused to provide staff and equipment I will never care for patients again.

My license would be worth a "do not send" although do to no credit of my own I have not (yet) been made a DNS.

http://www.calnurse.org/cna/watch/tenet/

http://www.calnurse.org/cna/news/columbia.htm

live4today, RN · Dec 5, 2003

I've gotten TONS of calls from nurse recruiters and travel nursing agencies to accept work in California. The pay they have been offering sucks big time, so I have yet to entertain the thought of going to CA again. Offer me something worth my time, or stop calling/emailing me.

pickledpepperRN · Dec 6, 2003

cheerfuldoer:

I consider the fact that our hospitals are not offering enough to attract you a loss for CA and a gain for the patients in "the zone".

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Here is an article from San Mateo County:

http://www.sanmateocountytimes.com/Stories/0,1413,87~11268~1810958,00.html

Article Last Updated: Friday, December 05, 2003 - 2:58:17 AM PST

County hospitals recruit nurses

By Emily Fancher, STAFF WRITER

San Mateo County hospitals have scrambled to find hundreds of new nurses this year to comply with state regulations taking effect Jan. 1.

Though they've used aggressive training and recruiting methods, no one knows if hospitals will succeed in meeting increased nurse-to-patient ratios in everything from critical care to psychiatric units, and what the effect on health care will be. The regulations are part of a 1999 state law, to be enforced starting New Year's Day by the state Department of Health Services.

Advocates say the ratios will improve patient safety and lower costs by reducing burnout and emergency care.

But critics -- mostly hospitals themselves -- say the increased cost will mean fewer beds and longer waits, especially because the new law takes effect at the height of an already bad flu season.

"The way the regulations are developed make it virtually impossible to be in compliance," said said Jan Emerson, spokeswoman for the California Healthcare Association, which represents hospitals.

She said these ratios must be met every second of every day in every unit, leaving little room for flexibility.

Will they be ready?

Barbara Harrelson, a spokeswoman for the Hospital Council, which represents hospitals in San Mateo and Santa Clara County, said the County's hospitals have done most of the hiring necessary.

"But it's an extreme challenge," she said. "It's a No. 1 priority for hospitals to be in compliance."

For example, Kaiser Permanente in Redwood City will be close to meeting their goal of hiring another 140 new nurses, said Work Force Planning Director Diane Gamberg. She said

Kaiser offers forgivable loans and scholarships to snag nursing graduates.

Other hospitals, such as Mills-Peninsula, will rely on contract rather than staff nurses.

"We're going to try to be ready," said Brenda DeRamus, nurse recruiter for for Mills-Peninsula Medical Center.

She said she has worked with the nursing programs at San Mateo County Community College District to fund faculty positions to increase the number of graduates.

Recruiting from abroad

As always, many of the nurses in the County are recruited from abroad, especially the Philippines.

Bruce Weisberg, operations director for Nurse Providers Plus in Daly City, a kind of temp agency for nurses, said about 80 percent of the nurses recruited by his agency are Filipino. He added that since Sept. 11, there's been a reduction of nurses from overseas.

He said there's lobbying at the state level to ease immigration restrictions, but it's still tough.

"It's a little discouraging is what it is," he said. "Nurses you're expecting to be here aren't here."

Linda Kresge, chief nurse executive at Sequoia Hospital, went to Korea two years ago to recruit nurses in anticipation of needing 40 new nurses to meet the regulations. She said Sept. 11 slowed down the process.

Lourdes Tancinco, an immigration lawyer who helps about a 100 Filipino nurses come to the Bay Area every year, said that the attempt to get more nurses here for the Jan. 1 deadline has not been entirely successful.

"They haven't always recognized our need to expedite the applications," she said of immigration agencies.

Tancinco said many of her clients were doctors in the Philippines who come here for nursing opportunities, creating a "concern over the exodus of registered nurses because there may come a time when there's a shortage in the Philippines."

She said another problem with recruiting from overseas is "runaway nurses" who sign a year-long contract with a sponsoring hospital and then move elsewhere for a higher salary. With overtime, nurses can earn as much as

$100,000 a year.

Jill Furillo, director of national affairs for the California Nurses Association, said that San Mateo County has increased salaries and benefits to attract nurses. She added that hospitals have known the exact ratios for two years -- plenty of time to fill staffing.

If hospitals don't meet ratios, the Department of Health Services can visit, issue a citation and require the hospital to outline a plan of correction.

Staff writer Emily Fancher covers Daly City, South San Francisco, Colma and Brisbane. She can be reached 348-4340 and [email protected] .

pickledpepperRN · Dec 6, 2003

From the Governor:

http://www.governor.ca.gov/state/govsite/gov_htmlprint.jsp?BV_SessionID=@@@@0106029546.1070692922@@@@&BV_EngineID=hadcjcihdgelbemgcfkmchchi.0&sFilePath=%2fgovsite%2fexecutive_orders%2f20031117_S-2-03.html&sTitle=Executive+Order+S-2-03&sCatTitle=Exec+Order&sSubCat=null&iOID=53447

EXECUTIVE ORDER S-2-03

by the

Governor of the State of California

WHEREAS, State Government should be dedicated to provide certainty for the regulated communities as well as meaningful and fair public participation in government decisions which impact the cost of doing business in California;

WHEREAS, the express language of the California Administrative Procedure Act declares that "There has been an unprecedented growth in the number of administrative regulations in recent years;"

WHEREAS, the increased costs associated with California's regulatory environment have diminished competition in the national and global marketplaces for the State's goods and services;

WHEREAS, the California Administrative Procedure Act requires that state Agencies proposing to adopt, amend, or repeal any administrative regulation must assess the potential for economic impact on California business enterprises and individuals;

WHEREAS, the California Administrative Procedure Act requires that all adopted regulations be easily understandable, the least burdensome and effective alternative, be consistent with underlying legislative authority and minimize the economic impact to the regulated communities;

WHEREAS, the California Administrative Procedure Act also provides that Agency policy enforced as if it were a regulation, but which has not been adopted, amended or repealed subject to public notice and comment, is contrary to law and public policy because it subverts open government; and

WHEREAS, with the onerous impact of over-regulation on the daily lives of Californians, it is time to reassess the system of State Government that is perceived to work against businesses and inhibit growth and economic prosperity.

NOW, THEREFORE, I, ARNOLD SCHWARZENEGGER, Governor of the State of California, by virtue of the power and authority vested in me by the Constitution and statutes of the State of California, do hereby issue this order to become effective immediately:

1. Each Agency, department, board, commission and office of the executive branch (hereinafter referred to as "Agency" or "Agencies") shall:

a) Subject to any exceptions the Director of the Department Finance allows for emergency or other situations relating to health and safety, request, pursuant to the California Administrative Procedure Act, the immediate return of any proposed regulation, including emergency regulations, for final adoption, amendment, or repeal or other processing by the Office of Administrative Law (OAL) for further review for a period not to exceed 180 days;

b) Subject to the exceptions described in paragraph 1 a) above, cease processing, pursuant to the California Administrative Procedure Act, any proposed regulatory action, including emergency regulations, for further review for a period not to exceed 180 days;

c) Pursuant to law and the extent necessary to comply with this Executive Order, suspend or postpone the effective date of any adopted, amended or repealed regulations published in the California Regulatory Notice Register but not yet effective;

d) Reassess the regulatory impact on business of any proposed regulation for adoption, amendment or repeal described in paragraphs 1 a)-c), above, pursuant to California Government Code section 11346.3 and submit a preliminary report to the Legal Affairs Secretary within 90 days of the date of this Executive Order; and

e) Submit a report of all regulations adopted, amended or repealed by each Agency since January 6, 1999 to the Legal Affairs Secretary within 90 days of the date of this Executive Order which specifically addresses the following:

1) The impact of the adopted, amended or repealed regulations on California businesses as required by California Government Code section 11346.3;

2) The authority for the adopted, amended, or repealed regulations pursuant to California Government Code sections 11342.1 and 11342.2; and

3) Conformity of the adopted, amended, or repealed regulations with the criteria set forth in California Government Code section 11349.1, of necessity, authority, clarity, consistency, reference and non-duplication.

2. Within 30 days of the date of this Executive Order, each Agency shall assess and identify any present issuance, utilization, enforcement or attempt at enforcement of any guideline, criterion, bulletin, manual, instruction, order, or standard of general application which has not been adopted as a regulation in potential violation of California Government Code section 11340.5(a) and submit its findings to OAL pursuant to California Government Code section 11340.5(b) and the Legal Affairs Secretary;

3.Upon submitting the findings of paragraph 2, above, to OAL and the Legal Affairs Secretary, any Agency utilizing such guideline, criterion, bulletin, manual, instruction, order or standard of general application in the normal course of business until OAL makes its determination to the Governor pursuant to California Government Code section 11340.5© shall do so on an opinion-only basis which will not carry the force of law;

4. Within five working days of the date of this Executive Order, the Director of OAL shall submit to the Legal Affairs Secretary a list of all regulations pending 30 day review under California Government Code section 11349.3, as well as any emergency regulations filed within the last 60 days with OAL pursuant to California Government Code sections 11346.1 and 11349.6;

5. The Director of the Office of Administrative Law shall, as soon as is practicable, appoint an advisory body consisting of no more than five (5) persons knowledgeable in regulatory matters to advise the Office of the Governor on how the regulatory process can be improved in California. The term of the advisory body shall expire on or before July 30, 2003; and

6. Agency Secretaries and other Cabinet level positions will be responsible for ensuring compliance with the provisions of this Executive Order. For those departments that do not have Cabinet level representation, the Department of Finance will be responsible for ensuring compliance with the provisions of this Executive Order; and

7. The regulatory relief described herein shall be accomplished through existing resources.

I FURTHER DIRECT that as soon as hereafter possible, this order shall be filed with the Office of the Secretary of State and that widespread publicity and notice be given to this order.

IN WITNESS WHEREOF I have hereunto set my hand and caused the Great Seal of the State of California to be affixed this the seventeenth day of November 2003. /s/ Arnold Schwarzenegger Governor of California

pickledpepperRN · Dec 6, 2003

http://www.calnurses.org/

California's multi-billion dollar hospital industry has stepped up its 11th hour campaign to derail final implementation of the new RN staffing ratios - and have asked new

Governor Arnold Schwarzenegger for help.

January 1 is the operative date of the

ratios when all hospitals are required to

be in compliance. But hospital executives

who have long opposed the law continue

to work to undermine it.

What the hospitals want from Governor Schwarzenegger:

Delays in full implementation and a waiver of any sanctions for any hospitals that say they are unable to hire sufficient RNs.

Higher, unsafe ratios in Emergency Departments and psychiatric care.

Reduced standards on night and evening shifts, and during breaks.

These changes would endanger thousands of Californians.

As the Journal of the American Medical Association reported last year, for each additional patient assigned to an RN the likelihood of death within 30 days

increased by 7 percent.

California hospitals have had over four

years to prepare since the law was signed, and two full years since the proposed ratios were announced, to hire the additional RNs they need to assure patient safety.

But still claiming it can't "find" the nurses, the hospital industry has:

Held seminars across the state advising local hospital officials of methods to evade compliance, including announcing closures as a means of applying political pressure for changes in the law.

Lobbied California counties to pass resolutions calling for delays.

Contacted media throughout California requesting stories about the hospitals' "plight".

Hundreds of RNs have responded to CNA alerts the past two weeks urging action to oppose delays or revisions in the law.

It is vital that the campaign continue.

In the coming days, your voice may be crucial to assuring the ratios are properly implemented and enforced.

The hospitals hope the governor will act on their pleas for immediate delays and waivers and then revisions in the law.

Contact Governor Schwarzenegger's office today.

Call the Governor's comment line 916-445-2841, press 1 to leave a message.

Send an e-mail to the Governor at: [email protected]

Please copy your email to CNA: [email protected]

Tell him you oppose any efforts to block or interfere with implementation

of the Safe Staffing Law.

Urge him to support implementation and full enforcement of the law to protect public safety and save the lives of thousands of California patients.

Send a letter to the editor

Additionally, CNA is urging RNs to send letters to your local newspapers expressing your support for the law, and what is at stake for patients if the law is not implemented and properly enforced.

Californians strongly support the Safe Staffing Law, and need to be alerted about the present threat.

Click here for some tips on sending letters, and some select e-mail addresses of California Newspapers

PMHNP10 · Dec 6, 2003

This issue is of interest to me because no later than the first part of Feb I am most likely going to be taking a travel assignment in CA, and I'm bringing my GN girlfriend with me.

nrsfriend says:

I hope that the hospital nurses out there use their fine minds and do not fall prey to the propagandizing approach of CNA , or CHA for that matter.

Quite the curious statement. Well let's just do what is requested here. First thought is how is the CNA or CHA beneficiaries of the new staffing ratios. TX is nonunion, so I am unfamiliar with how unions work; therefore, I honestly don't know...maybe CNA does stand to benefit??? And if they do benefit, so what? Their is no possible way someone of sound mind can argue that the patients are NOT the primary benefactors of the ratios. And if anyone is about to argue that human beings are less important than the money, I question their self worth.

Hospitals in California are closing folks, for many reasons so what does that do for the state of California Health?

Well that is unfortunate that hospitals are closing, if indeed they are. And how many of them are closing because of these new ratios????

Is anyone concerned about where they will work if their hospital closes? NO!! That is because the nursing shortage is REAL and we can always find a job!

With all due respect, no it is not "REAL". About 1/3 of all nurses refuse to work in a hospital because of the current working conditions present in hospitals... staffing ratios, lack of auxillary staff, mandatory OT, etc, etc, etc.

The average age of the California nurse is 48 - so who will be taking care of us when we finally succumb to the ravages of old age?

Good question, indeed. Nursing schools across the country are graduating 20, 30, 60+ new nurses each semester, and there are about 1200 such schools. Using a low estimate, that comes out to 36000 nurses each semester (average of 30 students/school). Unless someone has numbers to reeducate me, logic tells me the 72000 new nurses a year supplements the nurses retiring each year. The argument against my logic is that these nurses won't stay in the field. So once again, we refer back to the working conditions. In the medical field this is positive feedback, or rather, a vicious circle.

There are not enough nurses in California to meet our needs now

This might be the most truthful comment from the post I'm commenting on.

and that is without mandated and ill thought out staffing ratios!

Now correct me if I'm wrong, but haven't hospitals known about these ratios for at least 4 years? Why were there no attempts made to become compliant with the impending laws 1, 2, 3 years ago? Rather the hospitals were spending money on fighting these laws. Is there really a strong argument that these stalling hospitals are are entering into the era of new ratios in good faith? Add into the mix the mere mention of the word Tenet and combine that with the fact that they are the frontrunners of the targets of the "propagandizing approach of CNA, or CHA for that matter" further casts a cloud of suspicion. And if that weren't enough, I have one simple question. Where were the staff nurses at in these meetings. If the purpose of them was to truly figure out how to (in good faith) implement the ratios and educate the public, seems you want your nurses included as the educators.

Obviously there are things I am unaware of and things I'm missing, but I thought Gov. Arnold suspended all new laws for 6 mos so he could review them??? Am I mistaken?

Hellllllo Nurse, BSN, RN · Dec 6, 2003

FANTASTIC post, psychrn03!

Thank you!

Home Health Columnist / Guide · Dec 6, 2003

Originally posted by Hellllllo Nurse
FANTASTIC post, psychrn03!

Thank you!

Second thumbs up in agreement.

sharann, BSN, RN · Dec 6, 2003

You know, I have never e-mailed or phoned or written to a politician ever before, but I have had enough. I e-mailed the governor yesturday a letter and cc'd it to CNA's link. I am not a CNA member, my hospital in non-union because the nurses are pathetically scared of losing their jobs. But I want those ratios in effect! I don't even work the floors. I am in PACU where we have ratios already because its a critical care area. The hospitals have to do whats right, but they wont unless they have to. The governor has his chance now to show what he is or is not made of...

bluesky, BSN, RN · Dec 6, 2003

Originally posted by Hellllllo Nurse
FANTASTIC post, psychrn03!

Thank you!

Absolutely! Thank you from me too :)

My dh and I (1 nurse, 1 nursing student) were thinking of moving to San Francisco pronto pronto after I graduate... maybe not!

pickledpepperRN · Dec 11, 2003

sharann:

I think all the letters, calls, and e- mails did good. Thank you!

We and or our loved ones may need a nurse. Is there another reason to be hospitalized?

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http://www.califnurses.org/

California Gov. Arnold Schwarzenegger has said he will not seek immediate delays in California's RN staffing ratio law. But the state's multi-billion dollar hospital industry

is continuing its campaign to upend the law

with further revisions to the ratios - and

have asked the Governor for help.

January 1, 2004 is the operative date of the ratios when all hospitals are required to be in compliance. The Governor's office confirmed to CNA December 9 that it agrees that the regulations are complete and that it will not act to intervene prior to January 1. CNA has held that there is no statutory basis for further delays in the law.

But the Governor's office said it considers

the ratios to be part of a series of laws and regulations enacted under former Gov. Gray Davis that are all subject to regulatory

review and changes in the coming months.