Kaiser Backs Union Plan to Boost Nurse Staffing Levels
Health: HMO says move could cost $200 million a year. Critics charge that the firm is trying to head off new state standards
By CHARLES ORNSTEIN
Kaiser Permanente is throwing its support behind a union proposal to boost nurse staffing levels, a move that could cost its 28 California hospitals $120 million to $200 million annually, Kaiser officials said Thursday.
But the announcement from the state's largest HMO came under immediate attack from union officials and consumer watchdog groups as more of a public relations effort than a worthy proposal.
The HMO's position is an apparent departure from its earlier stance on hospital staffing and is at odds with the stance of California's hospital industry as a whole. Most hospitals favor more moderate or flexible staffing levels. The proposal stands out for another reason: In a state that recently has been torn by strife between nurses and hospital management, Kaiser has adopted a proposal drafted by two labor unions--the Service Employees International Union and the United Nurses Assns. of California.
A top Kaiser executive said Thursday that the higher ratios are in the company's best interest. Because of a 1997 agreement with the Service Employees International Union, Kaiser management agreed to consult with labor leaders on big decisions. Just Wednesday, Kaiser announced a 14% pay raise for its nurses in Northern California, an effort to remain competitive with other hospitals.
"We are kind of taking a giant leap of faith here with our labor partners to say, 'This is what really needs to happen to improve quality of care in California hospitals,' " said Mary Ann Thode, senior vice president and chief operating officer of Kaiser Permanente.
But a rival union and consumer activists fear that Kaiser is trying to forestall enforcement of the state's nurse staffing rules, which are set to take effect Jan 1.
Kaiser acknowledged that it could take two to five years to meet its staffing goals.
The Kaiser proposal calls for a minimum of one nurse for every four patients in general medical and surgical wards, versus the hospital industry's suggestion of one nurse per 10 patients. The unions want a nurse for every three pediatric patients; the hospitals say one nurse can handle six.
Officials at the California Department of Health Services are in the process of implementing a 1999 state law that will set minimum nurse-staffing levels in various hospital departments. Hospitals that violate the regulations can be cited, given time to correct the problem, and, ultimately, be shut down.
Efforts to improve the nurse-to-patient ratio come amid the worst nursing shortage in decades. Hospitals routinely have 15% to 20% of their nursing positions vacant, despite offering signing bonuses and other incentives.
Kaiser's endorsement of the new nurse-patient ratios appear to conflict with its previous positions on the issue. In 1999, when the issue came before the Legislature, Kaiser strongly opposed the bill. In a four-page policy memo, a Kaiser official wrote, "There is no research conducted on the effect of ratios on patient outcomes."
Furthermore, "California already is experiencing a nursing shortage with an even greater shortage ahead of us," the memo said.
Now, however, the company believes the Service Employees International Union standards are "reasonable and doable," said Kaiser spokesman Terry Lightfoot.
Kaiser officials say outside factors make it impossible to predict the cost of the new nursing ratios. While officials say the new costs could range from $120 million to $200 million per year, Kaiser expects to save some of the $100 million it spends on overtime, traveling nurses and local nursing registries.
Unions have long pushed for better staffing ratios in hospitals, and Kaiser's plan in one sense proves labor's increased power in California health care. But the plan pits two of the state's largest nurses unions against one another, siding with the Service Employees International Union over the California Nurses Assn., which represents about half of Kaiser's 18,000 registered nurses.
The California Nurses Assn. fears that, to save money, Kaiser will use licensed vocational nurses, who are less broadly skilled than registered nurses, for tasks that require a registered nurse's expertise. The Service Employees International Union represents a large number of licensed vocational nurses.
The California Nurses Assn. on Thursday called Kaiser's move a "death-bed conversion."
"The irony here is just tremendous," said Rose Ann DeMoro, the union's executive director. "Kaiser probably under staffs more significantly than any of the employers in Northern California. They have been trying to derail the safe-staffing bill for years."
They also complain that Kaiser is trying to delay the inevitable by implementing the ratios over a drawn-out period.
But the California Nurses Assn.'s rivals lauded Kaiser's move. "It's pretty impressive that Kaiser is taking this step forward and addressing this," said Kathy Sackman, a registered nurse who is president of United Nurses Assns. of California. "Nurses don't expect hospital employers, particularly the big ones, to make this sort of positive, forward-thinking move."
Added Rhonda Goode of the Service Employees International Union Nurse Alliance, "They really listened to the nurses who give the care."
Jan Emerson, a spokeswoman for the hospital trade group, the California Healthcare Assn., dismissed Kaiser's announcement as pure labor relations. "You should be basing staffing decisions on the needs of patients," she said.
Jamie Court, executive director of the Santa Monica-based Foundation for Taxpayer and Consumer Rights, echoed California Nurses Assn. complaints that Kaiser is trying to shift some tasks from registered nurses to less expensive staff members.
"This is not a safe-staffing ratio. It's a cheap-staffing ratio. And that was not the intent of the law."
Lightfoot, the Kaiser spokesman, said nurses cite working conditions as a major reason for leaving the profession. "We believe that by increasing nursing ratios, we will encourage more nurses to come into the profession."