Published Feb 5, 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.
New staffing law helps, nurses say
By Evan Pondel
The California Nurses Association said Thursday that nurse-to-patient staff ratios have improved at hospitals throughout the state, though hospital officials themselves say they've seen no change.
Since Jan. 1, California hospitals have been scrambling to meet the new state requirements for fewer admitted patients for every nurse. Though the law encountered resistance from hospital operators who continue to grapple with rising health care costs, the California Nurses Association says ratios are improving. A CNA report says more than half of the 111 hospitals it surveyed in California are "generally in compliance with the requirements of the law."
"This information shows we are making progress. It also disputes the hysteria and destabilization that is being promoted elsewhere," said Chuck Idelson, a union spokesman.
The CNA surveyed its members by gathering anecdotal information about each hospital's nurse-staffing situation. Many of the nurses revealed scenarios that vastly differed from the grim realities depicted before the ratio laws went into effect.
Myrna Valmeo, a registered nurse at Glendale Memorial Hospital, said not only does she see the difference in ratios, she feels the difference. "I'm happier now, and so are the other nurses around here," Valmeo said. "Because of the nurse staffing ratios, the quality of care has greatly improved."
That sentiment isn't echoed by the California Healthcare Association, a Sacramento-based organization that represents the interests of hospital operators. The group has been collecting questionnaires from about 300 hospitals since Jan. 1. The most recent data available reveal that 86 percent of the hospitals surveyed are not in full compliance with the law.
"This is not a sustainable situation, and we think that number is going to increase," said Jan Emerson, vice president of external affairs for the CHA. "This speaks to the rigidity of the law."
Karen McDaniel, a labor and delivery nurse at Tarzana Hospital, has noticed some changes, although she said there is still ample room for improvement. "I truly believe the ratios are better in some areas. But the basic premise is that work needs to be done," she said.
For example, some nurses are expected to oversee and substitute for other nurses under the new ratio laws. That means greater workloads for some. "But I will say I have been able to take lunch in the last two weeks for the first time," said McDaniel, who has worked at Tarzana Hospital for 30 years.
Many nurses have welcomed the nurse-patient ratios as a method to improve care and help manage the number of hours required to do the job. But if hospitals are not in compliance with the new laws, some facilities might stand a chance of losing their accreditation. The loophole: There isn't an independent governing body that is enforcing the new ratio laws.
"And it always seems irresponsible for the government to pass a regulation and then not be able to enforce the regulation," said Miriam Piven Cotler, a professor of health sciences at California State University, Northridge. "I'm not an apologist for a hospital, but these ratio laws come at a tough time for everyone. We have gone from a situation of excess capacity to have to close emergency departments."
The Department of Health Services has surfaced as the most authoritative in terms of enforcing the ratios. However, budget constraints continue to thwart most state agencies, and Cotler said the Joint Commission on Accreditation of Healthcare Organizations might be the only viable alternative. Instead of the CNA or the CHA conducting studies, Cotler also said it might be in society's best interest if an independent entity conducts a study on staff ratios.
"Instead of tokenism, using the money spent on some of these surveys could be allocated to train more nurses," she said. "Or the universities could get involved in the surveys. There just isn't any grant money."
Evan Pondel, (818) 713-3662 [email protected]
Seems like a conflict between the "Glass half full" versus "half empty" attitude.
Survey: Most hospitals meet safety, nurse-to-patient ratio requirements
By ANNETTE WELLS, Staff Writer
SAN BERNARDINO - A year ago, it wouldn't have been uncommon for a registered nurse to handle up to a dozen patients at St. Bernardine Medical Center.
That is no longer the case.
"Today, it is down to six, and I really have to hand it to our administration because I know some hospitals are still dragging their feet," said Beth Holzberger, an intensive care unit nurse at St. Bernardine about her employer meeting the state's new nurse-to-patient ratios.
"It's not like we don't still have some problems, but things have improved tremendously at St. Bernardine."
St. Bernardine was one of three hospitals in San Bernardino County surveyed by the California Nurses Association last month in compliance with the new law which took effect Jan. 1.
Community Hospital of San Bernardino and St. Mary Medical Center in Apple Valley were the other two hospitals, said Chuck Idelson, a California Nurses Association spokesman.
In all, 111 hospitals, about 30 percent of general acute care hospitals in California, were surveyed from mid- to- late January.
The results, based on interviews with registered nurses, showed that 68 percent of the hospitals have improved staffing conditions and 59 percent of them are generally in compliance with the requirements.
"There's still a lot of misinformation being propagandized by the hospital industry against the law, but what needs to be understood is without it, it could mean severe consequences for public health," Idelson said.
"When this law is fully implemented it has the potential for saving thousands of patients' lives as well as promoting health and safety. That is certainly what the public wants and deserves."
Holzberger, who is chairwoman of the California Nurses Association's Professional Performance Committee, said a year ago, intensive care unit nurses feared sending their patients up to the medical floors because of the unsafe staffing.
Even before the law took effect, intensive care unit nurses had a 1:2 or 1:1 ratio depending on how critical the patient was, she said.
"When it came time for us to send those patients upstairs, we would worry," she said. "Now we can send them up and not have that little bit of fear."
Though most hospitals seem to be on the right track, Holzberger and Idelson said some aren't.
As a word of advice, Holzberger said graduating nurses should inquire about a hospital's ratios before accepting employment.
"I wouldn't go to a hospital that isn't at ratio," she said. "It gives an indication of a lot of things."
California Nurses Association officials say they plan to continue monitoring ratio compliance and pursuing improvements to assure safe staffing. The organization also has plans for more surveys in the future.
sharann, BSN, RN
Amazing how the hospitals who "last year" cried, "we just CAN'T find any RN's or we WOULD hire more" have found some! Amazing, when they had to they do.
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