3/4/05: Judge backs California nurses over staffing - page 6

los angeles times, march 4, 2005 judge backs california nurses over staffing gov. arnold schwarzenegger had no authority to suspend a new law requiring more nurses at california hospitals and... Read More

  1. by   tiredfeetED
    5:1 ratio is great in the long run..
    but my hospital did not have enough staff for the change and we ened up with 7 holds from MS in the ED this week to due staffing...my hospital forgets EDs have ratio too!
  2. by   Thunderwolf
    Great article. Great news. Yahooo and congrats to the nurses in California. Maybe, California nurses will become the catalyst for the rest of the nation. And for Arnie, yeah buddy...you needed your butt kicked. What an arrogant, fascist a**. Anyway, just my 2 cents.
  3. by   pickledpepperRN
    tiredfeetED: The Hospital association, governor appointed DHS officials, and your hospital seem to have no respect for the law. This is directly from the Title 22 regulations licensing hospitals -
    " In a hospital providing basic emergency medical services or comprehensive emergency medical services, the licensed nurse-to-patient ratio in an emergency department shall be 1:4 or fewer at all times that patients are receiving treatment. There shall be no fewer than two licensed nurses physically present in the emergency department when a patient is present.

    At least one of the licensed nurses shall be a registered nurse assigned to triage patients. The registered nurse assigned to triage patients shall be immediately available at all times to triage patients when they arrive in the emergency department. When there are no patients needing triage, the registered nurse may assist by performing other nursing tasks. The registered nurse assigned to triage patients shall not be counted in the licensed nurse-to-patient ratio."


    From the March 25, 2005 print edition

    Nurse-rules fight may be mostly words
    Kathy Robertson Staff Writer

    California hospitals need 4,000 more hard-to-find nurses to meet the new nurse-to-patient ratios ordered by a Sacramento County Superior Court judge March 14, shrieks the hospital industry -- and that's on top of 14,000 vacancies statewide.

    Stop trying to subvert state law and just do it, the California Nurses Association screams back at hospitals and the governor, who has sided with the industry in trying to relax the first-in-the-nation staffing rules.

    But this noisy feud might be mostly a war of words. The temporary agencies that deliver nurses to hospitals when they're desperate for staff say they haven't seen a huge uptick in demand since the court put the stricter standard in place. It supports the claim by Sacramento hospitals that they're mostly meeting the rules.

    "We haven't seen a tremendous change, quite honestly," said Steve Swan, business development manager of Valley Healthcare Systems Inc., a nurse staffing firm in Citrus Heights. "A lot of hospitals had these people anyway."

    There hadn't been any reports of hospitals ignoring the stricter rules since March 14, either, until Wednesday, when one complaint was filed with the state. It wasn't clear if it involved a local hospital.

    It gets complicated
    The Schwarzenegger administration and the hospital industry aren't about to give up their fight, however.

    They've filed an appeal seeking to overturn the March 14 ruling that threw out emergency regulations adopted by the administration last fall to ease the rules. On March 17 they also asked for a stay to again halt the stricter ratios until the court fight plays out.

    Midweek, there was no word on the stay.

    "We asked for expedited review," said Jan Emerson, a spokeswoman for the California Hospital Association, "but even that could take several days."

    The hospital industry and the state Department of Health Services contend that the nurse staffing ratios -- which took effect at the start of 2004 and were supposed to get tougher starting Jan. 1, 2005 -- were harming hospitals, forcing reductions in available medical care, and exacerbating a serious shortage of nurses.

    Emergency rules filed by the administration in November blocked the new minimum ratio that was scheduled to take effect in January, which would have required hospitals to have one registered nurse working for every five patients. The move also loosened rules for emergency rooms and a requirement that nurse-to-patient ratios applied "at all times," even during employee breaks.

    The nurses' union went to court to get the emergency rules tossed. They prevailed March 14, when Sacramento County Superior Court Judge Judy Holzer Hersher signed a final ruling that said the governor overstepped his authority when he relaxed the ratios, and concluded that the determination of "emergency" was "arbitrary and capricious and entirely lacking in evidentiary support."

    "They claim the hospitals need eight bazillion more nurses," said union spokesman Chuck Idelson. "There's no evidence of that."

    The ratio law -- signed by former Gov. Gray Davis in 1999 -- followed a 10-year campaign by the California Nurses Association. The intent was to set minimum staffing levels in California hospitals to keep patients safe in the era of managed care. The law left specific numbers up to the state Department of Health Services, but they were issued by an agency that served Davis, not Schwarzenegger.

    The politics have changed dramatically since then.

    Meeting the ratios
    State officials sent a letter to all California hospitals March 17 telling them the original rules are now in effect, pending further court action.

    Local hospitals appear mostly in compliance. Some exceed the levels set by the rules.

    Kaiser Permanente decided to gear up to staff one nurse to every four patients in medical-surgery units awhile ago. It doesn't always happen, but Kaiser often exceeds the strict new ratio of 1 to 5, said Terri Owensby, assistant administrator for patient-care services at Kaiser's South Sacramento Medical Center.

    "And, for the most part, we are meeting the 'at all times' language," she added. "We have an assistant manager on duty 24/7, so if we get into trouble, there is another person around to help."

    When staffing gets tight and additional patients enter the hospital, Kaiser uses its own per-diem pool of nurses or brings in "travelers," or visiting nurses.

    There are six travelers on duty at South Sacramento, but they're generally there on 13-week stints and were placed before the recent court rulings, Owensby said.

    "We made a decision to move ahead before it was mandated," said Kaiser spokeswoman Kathleen McKenna. Kaiser hired 329 new registered nurses in the Sacramento Valley in 2004 and another 82 so far this year.

    Kaiser had 63 nurse vacancies last month; there were a total of 437 vacancies at hospitals across the region. That's down from almost 700 last year.

    "There's definitely a nursing shortage; we do have positions that are open, but we are working very hard to get them filled," said Carole Gan, a spokeswoman for the UC Davis Health System. The university medical center already meets or exceeds the mandated ratios, she said.

    UC Davis uses its own per-diem pool, floats nurses from one unit to another, or calls in folks from their day off when it needs more nurses, Gan said.

    Sutter Medical Center in Sacramento meets or exceeds the new ratios, said spokeswoman Nancy Turner.

    "We staff on acuity and our patients require more than 1-to-6 or even 1-to-5," she said. "We've been at 1-to-4 or 1-to-5 for at least four years."

    Sutter, too, has vacancies. There were 151 across the region last month, but the health system fills open slots with registry or travel nurses as needed.

    "CHW intends to comply with the law," said spokeswoman Mary Beth TeSelle. "We are staffing to meet the 1-to-5 ratio.

    "However, we continue to be challenged by the 'at all times' provision which requires meal and break relief."

    Per-unit staffing ratios are one thing. The all-times rule is harder to meet, especially in emergency rooms where patient numbers fluctuate a lot.

    Nobody locally will state flat out that they meet that standard every minute of the day -- but all say they are trying.

    "We have been and are staffed within the ratios," said T. Abraham, a spokesman for Marshall Medical in Placerville. The 105-bed community hospital does use registry and travel nurses when it has to, but even so it "still struggles ... at all times," he said.

    "The nearest hospital is 30 miles away and the volume changes quickly in our emergency room," Abraham said. "We accept patients, even if it causes us to go above the ratios."

    Staffing boom
    Nurse staffing agencies that pick up the slack for hospitals, and send in warm bodies when there aren't enough to meet patient need, have scored big on the California ratio law and nationwide nursing shortage -- but say there hasn't been a big uptick since the recent court action.

    "Yes, we are in overdrive and get a tremendous amount of orders on a day-to-day basis," said Cheree Love, president of Response I Medical Staffing in El Dorado Hills. "But most hospitals have been preparing for the last year. They started beefing up before January."

    World Health Alternatives Inc., a publicly traded company in Pittsburgh that bought Citrus Heights-based Pulse Healthcare Staffing Inc. last year, gets daily calls for 10 or 20 nurses at this hospital or that one, but that's been going on for a while, said Paul Gunnoe, division president for World Health travel nursing.

    What the ratio law has done is exacerbate demand elsewhere in the country because California hospitals are willing to shell out the dollars to get the nurses they need to meet the ratio law.

    "California is the biggest consumer of services," Gunnoe said, "but I guess you can say we are in overdrive all over the country."
  4. by   kid80
    . stop crucification of patients in dire need of nurses and get in overseas nurses and stop their crucification too .happy easter to mr arnold
  5. by   Kabin
    It makes more sense to open more nursing school slots for the many Americans that want to attend nursing school. I recall 15 or so years ago, in San Diego, there was an influx of foreign nurse that barely spoke English it frustrated the heck out of patients. I can't even imagine what it would've been like to work with them day after day.
  6. by   kid80
    [what do you suppose would be the gestation period of that ,it is definitely a long term solution,remember there are a lot of nurses whohave valid scores eg 590,/800 in cgfns and 7.5 bands in ielts academic,what about them.
  7. by   pickledpepperRN

    San Francisco Bay Guardian

    Stop the cash machine

    by Rose Ann DeMoro
    Executive Director, CNA

    CALIFORNIANS IN THE Schwarzenegger era face one of the most dangerous times in our history for our most fundamental values, including quality education, safety standards for patients, retirement security for families, respect for the rights of working people, dignity for the most vulnerable members of society, and the preservation of democracy.

    That's why tens of thousands of Californians have already taken to the streets to protest Gov. Arnold Schwarzenegger, why his popularity is plummeting, and why scores are mobilizing to greet him at an exclusive fundraiser April 5, 6 p.m., at the Ritz-Carlton, at Stockton and California Streets.

    Schwarzenegger rode into office under the guise of a populist, buttressed by his silver-screen image and a personal fortune through which he perpetrated the myth that he "could not be bought."

    But once in office, he has cloaked the most strident corporatist agenda of any California governor in the rhetoric of "reform" and shattered all records for fundraising from wealthy donors, who are opening their wallets with glee at the prospect of deregulation, privatization, increased corporate influence over our daily lives, and the wholesale auctioning of public resources to the highest bidder.

    Even after months of protests, Schwarzenegger continues to portray draconian initiatives as common-sense measures opposed only by narrow "special interests" - nurses, teachers, firefighters, students, public employees, and, most pointedly, unions - while he devalues patients, work, and the whole of California's diverse population.

    Take a quick look at some of his current proposals:
    The privatization of pensions for public employees - a transfer of hundreds of millions of dollars to Wall Street and the advance guard of the Bush administration's plan to privatize Social Security.

    The rollback of minimum-safety rules for hospital patients, part of a not-so-hidden agenda for the deregulation of all health care protections and the enrichment of his health care industry donors.

    Reduced funding for education and employment security for teachers, which accelerates an assault on public education that could cement a permanent chasm between those who can afford private education and those who can't.

    Mean-spirited attacks on the poor and disadvantaged, symbolized by the new regulation to seize the homes and other assets of the families of Medi-Cal recipients.
    An offensive against working people, including restrictions on the right to meals and breaks, vetoes of bills to raise the minimum wage and curb outsourcing, and the much ballyhooed workers' compensation plan that cut disability payments for workers injured on the job by as much as 70 percent.

    Undergirding this program is a relentless attack on many of the principal institutions that encourage and support political and economic democracy (and thus are seen as an economic burden inimical to his ultracorporatist agenda).
    Examples include:
    Usurping the legislature through bogus "emergency" regulations and the cynical manipulation of the initiative process through threats to the legislature to cave in to his proposals or face elections in which he can overwhelm opponents with massive fundraising.

    Undermining the legal system by floating court decisions and restricting legal redress against corporate abuse.

    Manipulating the media through staged events and the production of fake video news releases.

    Demonizing unions in an effort to silence the collective voice of working people.

    This is not just a bad infomercial. In Schwarzenegger's world, no one is safe when democracy and our basic protections and rights are under assault, except for the big corporations that are abetted by their cheerleader in Sacramento.

    Schwarzenegger once said in an interview with the Los Angeles Times that he won't stop fundraising - because no one's asked him to. Join us at the Ritz to do just that. Let's shut down his cash machine.

    Rose Ann DeMoro is executive director of the California Nurses Association. For more information on the protest, go to www.calnurses.org or call (510) 273-2240.
  8. by   Hawaii RN
    Quote from fergus51
    I'm realistic enough to see the importance of pr. The NY Times isn't just read in NY despite what you may have thought. I have no qualms about my dues going to pay for it. If you can get mandatory staffing ratios, I'll be happy to pay some of your bills too. Until then, I'm afraid you're on your own since you don't get something for nothing
    We in Hawaii are happy for your win against the gov.
    How much dues money is your "leadership" spending trying to raid The Hawaii Nurses Association. They sent shiny flyers to 3800 plus of our memebers a few times. They have filed a law suit against us to reverse our affiliation with the UAN. Why is your leadership spending your dues money in other states. We have taken our State nurses association back, you should take yours back too.
  9. by   SmilingBluEyes
    Quote from kid80
    [what do you suppose would be the gestation period of that ,it is definitely a long term solution,remember there are a lot of nurses whohave valid scores eg 590,/800 in cgfns and 7.5 bands in ielts academic,what about them.
    what was that? I cannot fathom what you are trying to ask here.
  10. by   mdfog10
    I am sorry you feel that way. I am very happy with CNA and what WE are accomplishing.