New Staffing ratios

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Hi, I work in Southern Calif in a community hospital of about 265-300 beds. My question is: How will the Gray Davis situation affect us in regards to the staffing ratios that are to take effect in January 2004? Do you think this will really happen, or will the hospitals delay due to "politics"?

Thanks. I really hope the ratios come and the hospitals are forced to staff adequately. I currently am in a critical care unit which provides great staffing, but as a nurse and a human being who could be hopitalized, I want to see safety on the floors!:)

originally posted by rebelwaclause

a knowledgable lvn is an asset to the team, not a hinderance.

oh...and regarding "if you report to the rn your legal obligation is discharged."...i know you are kidding...right? my license can be snatched and probably even more so. i have heard of rn's saying they where not informed of a patients condition, and the lvn getting flogged for it. or its the lvn's fault for not fillowing up with the rn on any given patient care issue. this is when teamwork, trust and personal dedication to being up on changes and advances in nursing and your own scope comes to light. i've worked with excellent rn's and others who i wouldn't let touch me on the side of the road. same with lvn's. i've witnessed lvn's in the hospital setting get it bad for things that was clearly an rn's responsiblity, but the rn wiggled out of it, and managment pursued the lvn instead. i guess rn's are harder to come by.

...sorry.....i know that's a whole "nutha" arguement ;)

thanks again!

regarding your legal responsibility being to inform the rn of a change in a patients condition that as you know is true.

the problem is that some rns will say they were not informed. management will discipline the "trouble maker' who is usually the nurse speaking out for the patients.

we once had an lvn terminated when a patient in dts who continually pulled of his monitor leads went into a lethal arrythmia on our tele unit. she was "covering" the break of the monitor tech.

(who was providing the nursing care to her patients?).

she said she had notified the entire nursing staff over the intercom as well as reporting it to the charge nurse. after working together for 12 years i can say i believe with all my heart she did!

she was the scapegoat with the upset family and physician. a code was called and the patient survived, as onery as ever.

the problem is proving the rn responsible for the patient was informed.

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....Ahhh Ha!...you DO understand!

Thanks for listening. You're alright with me!

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Yes.

Even worse i admit that as charge i have assigned the best LVN to work with the irresponsible RNs knowing the LVN will follow up on what the RN should be paying attention to.

I do explain to the LVN and apologise. Manager is told too.

Not fair at all to be punished for being a good nurse.

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:eek:

*GASP*

Ahhh-HAAAAAA! Its true! A plight against the LVN!

Hahahaha....Thanks for vindication, Space!

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I guess I am trying to say that either way you have it~with or without ratios our patient's safety is at risk!!! Ca is now trying to push LVNs and other students through RN programs at a fast rate. That I believe will decrease patient safety. I understand that fewer patients is safer, but where are the nurses coming from to take care of the fewer patients??? That's right the "fast track" RN programs!!!!! Maybe you understand me and if not that is ok.

You make some good points.

Recently we had a new grad BSN who had never bathed a patient!

She is smart and caring so I think will either become a fine nurse or leave the bedside.

I see you are quite young so WELCOME!

You clearly have the heart for nursing. I dearly hope you and other nurses of this millenium stay with high standards and make nursing the proud profession our work and skills deserve.

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Specializes in Nursing administration/ICU/PACU.

Hi! Can you please tell me, how has the manadatory staffing ratios affected hospitals in CA? The NJ State Hospital Asociation is claiming that several California hospitals have closed, because they could not staff the hospital and the daily fines were too overwhelimg. As a result, patients are riding around for hours in ambulances, because there is no hospital that can accept the patient due to staffing. I find this a little hard to believe, and I can't find any literature to back up this claim. NJHA claims mandatory staffing in NJ would be a "disaster, just like it is in California." Do you have any info. for me?

Thanks!

Kathy

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Well for years ERs have been "closed to ambulance admits" during high census.

When all in a geographic area are at peak they all must be opened. The State Department of Health Services then troubleshoots where each ambulance will go.

Of course patients who get to the ER without using the EMS must be triaged and treated or sent elsewhere if stable.

Flu season it is common for all hospitals to be under ER closure. It happened about every other year in the last decade for weeks at a time. Hospitals try to avoid it for more than a few hours because they must posrpone elective surgeries, utilize any competent management staff as direct care providers, and sometimes other restrictions.

One hospital closed its acute hospital while maintaining long term care. Santa Teresita hospital had been in financial trouble for a long time.

A relative of a friend actually reported that hospital to the state almost five years ago because there was NO RN on duty from 11:00 pm to 7:00 am. He needed IV antibiotica Q6H but got them Q8 because of that. Also many dressing changes were not done until they hired a private duty LVN for the daytime and an RN at night.

The newspaper said there were problems with not having a doctor on call, babies delivered with no doctor present was routine.

There was a layoff and the nurses went to area hospitals.

My hospital planned ahead to meet the ratios with RNs. We have less assistants on floors where nurses are not stronly united. The wonderful LVNs float more to the units with high acuity.

The biggest problem is getting increased staff for higher acuity.

Nevertheless where a year ago med/surg nurses were assigned 8 to 10 patients routinely, even more on occasion no one has more than 6 now. There is usually a free charge or manager to take responsibility for patients so nurses can take their breaks.

Staffing is much improved, but not yet ideal.

Tenet is selling many hospitals. There is a committment to keep them open as hospitals. The ratios are NOT why Tenet is in trouble. There is a thread about their business dealings here on ALLNURSES.

Here are some articles about the ratios.

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http://www.bizjournals.com/sacramento/stories/2004/05/10/story1.html?t=printable

From the May 7, 2004 print edition

New nurse law fails to cause emergency

Kathy Robertson

Staff Writer

After dire warnings that new nurse-staffing rules could hamstring hospitals, state regulators received a total of 49 complaints that California hospitals had failed to meet nurse-to-patient staffing ratios in the first three months of the year. Citations were filed against two hospitals, neither one in the Sacramento area.

There were 60 requests for a waivers to deal with unexpected high numbers of patients or create new triage systems. Twenty-nine were denied, 23 waivers were approved and eight hospitals were told the request wasn't necessary.

Chaos does not reign, as some predicted. Ambulances aren't circling Sacramento, looking for a place with enough nurses to land. No hospital units have closed as a result of the law.

One hospital in Southern California did shut down as a result of financial problems and an inability to meet California's landmark staffing law, which took effect Jan. 1.

The rest of the 450-odd hospitals in the state scrambled to comply with the new rules. Most have not succeeded every minute of every day, but the California Nurses Association, the aggressive union behind the ratio law, seems generally pleased with the results.

"If you look at the enforcement numbers, it was a pretty simple and easy transition into the ratio law," said spokeswoman Jill Furillo. "Considering the way hospitals said it would be so disruptive and impossible to comply, we are pretty surprised."

"We're doing fairly well. I don't know about other institutions, but have no sense they are failing miserably," said Carol Robinson, associate director of patient-care services at the UC Davis Medical Center, the busiest hospital in the region. "At a given moment in time, we may be out of compliance, but it's such a fluid, moving situation. Staffing is actually better."

Hospitals' lawsuit is still pending: The landmark law requires a minimum nurse-to-patient ratio at all times for most hospital units. They range from 1 nurse per patient in trauma units to 1 nurse to 6 patients in a medical/surgery unit. Some ratios get tougher between now and full implementation of the law in 2008.

"Overall? We're not hearing anything dire," said Gina Henning, the staff specialist at the state Department of Health Services in charge of the ratio rules. The complaints the state has received don't allege that patients were harmed, she said.

A few months out, two sticky issues linger.

The trade group that represents California hospitals sued Dec. 30 to stop the state from enforcing the part of the new law that requires compliance during breaks and meals. The California Healthcare Association says it is impossible for hospitals to comply with the ratios "at all times." A hearing on the lawsuit will be held in Sacramento County Superior Court May 14.

There is also disagreement over the extent to which hospitals can use less-skilled licensed vocational nurses to meet the ratio law. The regulations say "licensed nurses," but the union that represents registered nurses says many patients are too sick to be looked after by LVNs on their own.

Despite the relatively few complaints, hospitals fear consequences. "Even though DHS is not actively enforcing 'at all times' -- that's why the numbers are so low -- that doesn't absolve hospitals," said Jan Emerson, spokeswoman for the healthcare association.

Medicare and Medi-Cal, government programs for the elderly and poor, can come in and audit hospitals retroactively, Emerson said. Part of the audit requirement is to show compliance with all laws. If a hospital doesn't obey the law, the government programs can deny payment retroactively.

In addition, trial attorneys can claim a problem with patient care and subpoena the staffing ratios as part of the hospital record, Emerson said. If hospitals don't meet the ''at all times" rule and something bad happens to a patient, lawyers can make a case for negligence -- and the $250,000 cap on medical malpractice awards wouldn't apply.

Other states are watching California carefully. Ratio bills are on the move in Pennsylvania and New York. Nevada rejected ratios. A vague bill was introduced and dumped in Missouri. A bill before Congress would create a task force to study nurses' work environment and patient safety.

Enforcement so far: A total of 49 complaints were filed with state regulators from Jan. 1 to March 31. The state investigated and filed two citations, one against Riverside County Regional Medical Center in Moreno Valley and the other against Kindred Hospital in San Leandro.

"All the healthcare facilities know the regulations, so we are not out there watching to make sure (compliance) takes place," said Norma Arceo, a spokeswoman for the state Department of Health Services. But regulators do respond to complaints.

Staff assignment sheets at Riverside County Regional Medical Center, summarized by the state, show there was 1 registered nurse and 1 certified nursing assistant to look after 9 patients in the medical/surgery unit on Jan. 14. Two registered nurses had eight patients each. The required ratio is 1 licensed nurse to 6 patients.

The chief nursing officer acknowledged the problem and the state signed off on a fix-it plan that includes daily monitoring, daily meetings to project staffing needs, and attempts to increase the pool of available nurses.

Records from Kindred Hospital in San Leandro show the facility failed to meet ratio rules in the medical/surgery unit for six out of 10 shifts from Jan. 3 through Jan. 5. In one instance, 3 registered nurses cared for 23 patients when they should have been responsible for no more than 18.

The hospital correction plan says that when sick calls compromise the work schedule, "all efforts" will be made to bring in supplemental staff or reassign managers to direct patient care on a temporary basis.

Wiggle room: The new law allows hospitals to request program flexibility in special circumstances, and rural hospitals with scarce staff resources can ask for a waiver if they can't satisfy the rules.

The state received 60 requests in the first quarter, including two from Sacramento-area hospitals. Twenty-three waivers were approved, 29 denied, and state regulators determined eight weren't needed.

"There are over 450 licensed hospitals in the state," state regulator Henning said. "Less than 10 percent have asked for flexibility. That means 90 percent think they don't have a problem."

Sutter Roseville Medical Center asked for and got a waiver that allows the hospital to continue a new triage procedure using a doctor up front, instead of a nurse, to move patients through the emergency department more quickly.

Marshall Medical Center in Placerville asked that six hospital units -- ranging from the emergency department to the medical/surgery unit -- be relieved from a requirement to meet the staffing ratios when nurses take breaks or lunch.

The hospital also wanted to count a radio responder nurse toward the ratios, and count the triage nurse when there are lots of patients.

The state said no to both.

Overall, the ratio law still draws criticism from a hospital industry that claims the rules are impossible to meet due to frequent changes in census and a severe shortage of nurses.

The California Healthcare Association sponsored legislation that would delay further toughening of the ratio for medical/ surgery units in 2005 to 1 nurse for 5 patients. It is 1:6 now.

Assembly Bill 2963 by Republican Assemblyman Rod Pacheco from City of Industry failed to get out of its first policy committee April 20.

The trade group hopes the court system will step in on another issue.

'At all times': The ratios rule around the clock, with no exceptions. Meal and break times for nurses are a particular problem, hospitals say.

In the past, hospitals have juggled workers on a shift to make sure patients were covered during breaks. Now they have to hire extra nurses to pick up the slack. This rule alone will cost Catholic Healthcare West, parent of local Mercy hospitals, an estimated $40 million to $50 million a year.

The hospital group's lawsuit asks the court to prohibit an "at all times" interpretation of the law and rule that it's OK for hospitals to let on-duty nurses go on breaks without jeopardizing compliance.

Instead, hospitals want the rules to be interpreted to mean "regular assigned staff the beginning and end of each shift."

"Nine out of 10 hospitals are out of compliance with the 'at all times' requirement," said hospital association spokeswoman Emerson. The trade group has lobbied the Schwarzenegger administration to consider changes to the ratio regulations, so far without success.

Nurses are expected to be out in force in Sacramento May 14, the date for the first court hearing on the lawsuit. A rally will begin at the Capitol at 10 a.m., followed by a march to the courthouse.

"If you look at the way hospitals are organized -- mostly 12-hour shifts -- breaks for an hour could mean four to six hours a day when ratios are not met," said Furillo of the nursing union. "Disease processes do not recognize meals and breaks. Patients can crash during them."

Licensed or registered? There's still controversy over what kind of nurses can be counted toward compliance with the new ratio law. The regulations require a "licensed nurse," and hospitals read that as both LVNs and RNs.

"Both the statute and the regulations refer to 'licensed,' " said Henning of Health Services. "That's minimal line nurses, not RNs."

The kinds of tasks LVNs can do are more limited under state law than those performed by RNs -- and RNs want to protect their turf. RNs can assess patients. LVNs can't. If an LVN covers for a RN and a patient gets worse, the less-skilled nurse may not be in a position to make a good judgment call, Furillo said.

Scope-of-practice issues are up to the state agencies that regulate them, not the Department of Health Services. The two boards that oversee RNs and LVNs are putting together language to clarify the situation, Henning said. "We are working with other parties on this issue of LVNs," said Louise Bailey from the Bureau of Registered Nurses. She declined to say more.

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http://www.calnurse.org/112103alert/debraletter42704.html

This Editorial from Debra Burger, RN, CNA President, was published in the The Daily News of Los Angeles on April 27, 2004

HEADLINE: DON'T STOP PROGRESS RIGHT IN ITS TRACKS;

NURSE-TO-PATIENT RATIOS HELPING CALIFORNIANS WHO ARE HURT, SICK

BYLINE: Deborah Burger

WILL safer patient care put San Fernando Valley hospitals out of business?

Their goal is to erode public support for improved nursing care, and thus bestow political cover to roll back the patient protections that are already making our hospitals safer and increasing the number of registered nurses in California.

A recent dire report by the Economic Alliance of San Fernando Valley, written by hospital CEOs, is part of the hue and cry. It's missing several salient facts:

--California hospitals reported $3.9 billion in profits in 2002 to the Office of Statewide Health Planning and Development. The largest hospitals were especially well off, listing average profits of about $48 million each. Hospital profits nationally totaled $240 billion from 1986 through 2000.

--Hospitals play a central role in skyrocketing health care costs, the effects of which include the recent grocery strike and the workers' compensation debate. California hospitals marked up their prices by 300 percent over costs in 2000-01, according to a study by the Institute of Health and Socio-Economic Policy last year.

--The nation's 20 biggest pharmaceutical corporations racked up $60.7 billion in profits in 2002. Ten health-care industry chief executives held nearly $8 billion in stock wealth in 2002. Over $732 billion was consumed by hospital, pharmaceutical, Health Maintenance Organizations and medical device corporate mergers from 1993 to May 2003 in an industrywide scramble to muscle up on market share.

Don't stay up nights worrying about the financial health of these moguls. What should concern people instead are the gaping holes in the patient safety net.

A March 2004 Commonwealth Fund survey found 45 million Americans were without health coverage in 2003. Nearly half the insured cited increases in their premiums and their share of medical bills, or cuts or new limits in benefits. Further, 41 percent of adults, age 19 to 64, had trouble paying medical debt; of those, 27 percent were unable to pay for food, heat or rent due to medical bills and 44 percent had to use all or most of their savings.

Quality of care varies widely with those relegated to public hospitals and clinics forced to endure longer waits and fewer resources while others can count on boutique care in specialized facilities for the wealthy.

Too many hospitals put a premium on revenue enhancement while skimping on care standards. Poorer hospital nurse staffing is directly linked to higher rates of urinary tract infections, post-operative infections, pneumonia, pressure ulcers and increased lengths of stay, the Agency for Healthcare Research and Quality affirms. Even the private, hospital-funded agency that accredits hospitals, reports that inadequate staffing precipitated one-fourth of preventable patient deaths, injuries or permanent loss of function the past five years.

The response by too many corporate interests to this grim data is to fight any meaningful reforms to expand access to care and assure one standard of care for all, and to wage a campaign to reverse California's landmark safe staffing law.

In addition to a media push, the California Healthcare Association, the hospital industry's lobbying arm, has filed a lawsuit to throw out the requirement that patients should be entitled to safe nursing care "at all times" - meaning the ratios would apply only at the beginning of a shift. The logic seems to be that it's acceptable to put your loved one who has suffered a heart attack or been in a serious accident at risk of unsafe care most of the time they're in the hospital.

The staffing law has already improved staffing in 70 percent of hospitals surveyed by the California Nurses Association. And it's fueling an infusion of new nurses into the state. In the four years since the law was signed, the number of RNs licensed to practice in California has grown by 10,000 annually. The number of nursing students and nurses from other countries taking RN exams to work in California has doubled, and the state agency that licenses RNs has a waiting list of 4,200 additional nurses seeking employment here.

Those who profit off pain and suffering would do lasting damage to all Californians who will one day be hospital patients if they derail this progress now. We should be deploying ways to ensure the success of this law, and promoting new mechanisms to provide quality health care for all.

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http://www.calnurse.org/cna/press/010604.html

January 5, 2004

UPDATE Monday PM - Day 5-staffing ratio law update

Sutter Solano RNs Improve Nurse Staffing As New Law Goes into Effect

Sutter Solano Medical Center (SSMC) Registered Nurses, represented by the California Nurses Association (CNA) reported this after noon that the hospital had made significant progress toward meeting the standard set by California's new nurse-to-patient staffing law.

The improvement in the hospital's staffing ratio came after the RNs said they were willing to provide patient care in strict adherence to the new mandated ratio regulations which went into effect January 1.

The nurses began their action on the law starting with the morning shift Monday insisting on adequate staffing and against any improper assignment of nursing tasks to Licensed Vocation Nurses (LVNs).

As the day began, off-duty RNs made themselves available to work in the SSMC medical surgical units beginning this morning to ensure adequate staffing to meet the requirements of the new law.

For the morning shift an agreement was reached for a ratio of one RN to six patients which conforms with the state regulations. There were 25 patients and only three RNs on the medical surgical units when the evening shift began, which would have required each RN to have eight patients-a clear violation of the 1:6 rule. The Hospital again called in additional nurses resulting in a 1:5 ratio with the additional help of one LVN.

"As was demonstrated at Sutter today, there are RNs ready and willing to work in hospitals to meet the requirements of the new regulations," said CNA President Deborah Burger, RN. "Administrators from other hospitals in the state would be wise to learn from this example."

The one outstanding issue is preserving the assistance of the LVNs historically assigned to each floor. After calling in additional RNs, the hospital sent LVNs assigned to the medical surgical floor home today.

"The intent of the law is to staff with the prescribed RN ratios for that unit and at the same time to maintain the ancillary caregivers that have always assisted the RNs," said Burger.

"For many weeks the Sutter Solano hospital management has been adamant that they could never meet the staffing ratios as required by the new law," said Myrna Aquino, RN, a 14 year veteran at the facility and member of the nurse Professional Performance Committee. "We are thrilled that the nurses remained united until Sutter had no choice but to staff according to the ratios."

The California Nurses Association (CNA) is the largest and fastest growing all-RN professional organization in the country representing 55,000 Registered Nurses in 150 facilities throughout the state. CNA sponsored the Safe Staffing Bill that was signed into law in October, 1999.

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February 4, 2004

Contact: Charles Idelson, 510-273-2246, or 415-559-8991 (cell) or Jill Furillo, 916-417-6203

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.

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http://www.thepresstribune.com/main.asp?SectionID=1&SubSectionID=12&ArticleID=3912

Friday, January 09, 2004

Roseville's two hospitals fully staffed

By Sarah Langford

Due to careful planning and foresight, Roseville's two hospitals entered the New Year in full compliance with a challenging new law that lowers the nurse-to-patient ratio in hospitals across California.

Both Sutter Health and Kaiser Permanente were fully prepared when the law requiring there be one nurse to every six patients in the general medical-surgical unit of hospitals became effective Jan. 1.

AB 394 is the first law in the nation to require specific nurse-to-patient ratios for every unit of a hospital, and was signed by former governor Gray Davis in 1999.

Barbara Nelson, chief of nursing at Sutter Roseville, said the hospital has been working hard for the last several years on retaining and recruiting new nurses.

"While most things are running quite smoothly, I would say the most challenging part of the new law is the 'at all times' requirement," Nelson said. "The ratios must be in place around the clock, and as a result there has been less flexibility in breaks and lunches."

According to Sandy Sharon, nursing executive at the Roseville hospital, the law taking effect in the midst of the flu season has added to the challenge of meeting it.

"A number of our own staff has been out with the flu," Sharon said. "We've had managers providing lunch and break relief when we are short-staffed."

Kaiser currently employs 445 registered nurses and licensed vocational nurses at its Roseville hospital. There are 550 at Sutter.

Cinde Breedlove, a spokesperson for Kaiser in greater Sacramento, said there is no current plan to admit fewer patients to comply with the law. In fact, Kaiser recently added 50 beds to the Roseville hospital and is planning a 179-bed, state-of-the-art Women and Children's Center to open in 2007.

The law, sponsored by the California Nurses Association, corresponds with a several-year nursing shortage in California. The state ranks 49th nationally in number of RNs per capita, according to the California Healthcare Association.

Nelson said increased career opportunities for women in the workforce has contributed to the shortage in nurses.

Sharon believes factors such as an aging population, technology that increases the life-span of patients and a generation of nurses moving into retirement are additional factors.

"We are calling 2004 the 'Year of the Nurses,' " Sharon said. "Nurses are central to patient safety. They are the person at the patient's bedside 24-7 administering medications and providing continual care. Nurses will get a lot of attention this year and for a good reason."

Though the effect of the new law won't be clear for several years, Nelson anticipates positive results.

"Increased patient care and more jobs for nurses? Of course those are always good things," Nelson said.

Sarah Langford can be reached at [email protected]

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