7/1/03 UPDATE: Calif Nurse Ratios info here

pickledpepperRN · Jul 2, 2003

San Bernardino County Sun

New nurse staffing law takes effect

Hospitals aim to meet deadline

By ANNETTE WELLS and EMILY SACHS

Staff Writers

Tuesday, July 01, 2003 - Hospital units will be safer and nurses won't have to cut corners when treating patients at least, those are the hopes for the state's new Safe Staffing Law.

Implementation of Assembly Bill 394 came Tuesday as Republicans and Democrats continued their debate over the state's budget.

The law, signed by Gov. Gray Davis in 1999, establishes minimum licensed nurse-to-patient ratios for acute-care hospitals. Most, if not all, local hospitals have prepared for the new law, officials said.

"We're not waiting until Dec. 30 to start hiring more nurses,' said Kimberly Hillhouse-VandenBosch, a spokeswoman at St. Bernardine Medical Center in San Bernardino. "We are aggressively recruiting nurses and (preparing) for the Jan. 1 deadline, but obviously it is going to take a period of time.'

The proposed ratios vary from 1-to-1 for trauma patients to one nurse to six patients in medical-surgical units. The latter ratio is to be reduced to 1-to-5 the following year.

That means better care for patients and less stress for nurses in the units, said Beth Holzberger, an intensive-care nurse at St. Bernardine.

"Patients are going to be safer, and their nurses are going to be better able to take care of them,' she said. "This was a reason why so many nurses left the profession they were no longer able to do nursing safely.'

Under the law, no registered nurse may be assigned to, or be responsible for, more patients than the specified ratios, and additional nurses must be assigned, as needed, by severity of patient illness.

The law also clarifies the roles of registered nurses and licensed vocation nurses. They are not interchangeable.

Jan. 1 is the deadline for hospitals to comply with the new law, but more new nurse-patient ratios are expected by 2008 in:

Step-down units, which house patients just transferred from critical or intensive care.

Telemetry units, where patients are on monitors.

other specialty care units such as oncology and rehabilitation.

In the last three years, because of a nationwide nursing shortage and nurses retiring, many area hospitals have been trying to fill positions through recruitment at community and state colleges.

Randy Edwards, a physical therapist who works at a local hospital, said the need for nurses is high in nearly every department.

Although he said he has never seen a patient hurt by a lack of nurses, the shortage shows itself in stress levels.

"Absolutely, more nurses are better,' he said. "Even patients get frustrated when they need to talk to their nurse. My job (is that) I get to talk to them a little longer, which is nice.'

Some local residents who have spent time at area hospitals said the hospitals seemed sufficiently staffed.

Daniella Lopez, 28, who delivered her son, George, at Loma Linda University Medical Center in March, said that although a nurse practitioner fainted when Lopez was giving birth, there were plenty of other nurses on hand. It wasn't clear why the person fainted.

One nurse stayed with her throughout her son's birth, she said.

Selena Parker, who gave birth to all three of her children at Kaiser Permanente Medical Center in Fontana, said the only waiting she ever does is during checkups, which she considers a normal part of the care.

"They have maybe three or four nurses per doctor,' said Parker, 33, of Colton. "They have a lot of rooms, but just one doctor.'

She said she wouldn't hesitate to give birth again at the hospital.

Three months ago, Gladys Godinez, 81, of San Bernardino, had cataract surgery at Loma Linda University Medical Center.

Nurses did everything from giving her extra blankets to fretting over her well-being, she said. "I had more nurses than I knew what to do with and every one of them was so nice,' she said.

Holzberger, one of about 100 nurses at a celebratory news conference held Tuesday in Monrovia by the California Nurses Association, said progress at St. Bernardine is already evident.

"I just talked to a nurse the other day, and she talked about how hard we still work, but that now it's becoming manageable,' she said. "The question now is, 'How did we do it before?''

Since Davis' signing of the law, hospitals have started implementing the new ratios, said Liz Jacobs, a spokeswoman for the California Nurses Association.

St. Bernardine and Kaiser Permanente in Fontana are two of them. Jennifer Resche-Silvestri, a spokeswoman for Kaiser, said the new law is "just a better deal for both the patient and the nurse.'

Holzberger said patients and nurses on the medical-surgical floor and telemetry units will benefit the most from the law.

Luann Sowers, a St. Bernardine telemetry-unit nurse also attending the Tuesday press conference, agreed.

"This will help us tremendously,' said Sowers during a cellular phone conversation. "It will give us more time to spend with our patients, and more time to explain to patients about their procedures.'

To ensure that hospitals comply with the safe-staffing law, additional bills are being introduced authorizing the state's Department of Health Services to conduct unannounced inspections, and to impose fines of up to $5,000 a day to hospitals not maintaining nursing ratios.

One bill is being proposed by the Service Employees International Union (SEIU) Nurse Alliance.

State health officials have no further public hearings planned on the matter, but are accepting public comments until 5 p.m. on July 17.

Written comments may be submitted via fax at (916) 440-7714. E-mails may be sent to [email protected], or through the "Making Comments' link at http://www.dhs.ca.gov/regulation

pickledpepperRN · Jul 3, 2003

http://www.sgvtribune.com/Stories/0,1413,205~12220~1489520,00.html#

Nurse-patient ratios landmark plan for state

Hospitals have doubts, but staffs support plan

By Rodney Tanaka

Staff Writer

Tuesday, July 01, 2003 -

MONROVIA -- The state unveiled proposed nurse-to-patient staffing ratios Tuesday, which nurses say will save lives, money and reduce nursing turnover.

But hospital officials worry that the staffing concept, the first of its kind in the United States, could lead to longer waits for patients and fewer available beds.

Marina Bass, who works at San Gabriel Valley Medical Center, said when she became a nurse six years ago she was told to expect a hectic, stressful environment. Nurse morale is already higher as hospitals hire more help to meet the ratio requirements, she said.

''I will be able to spend more bedside time with patients,'' said Bass, who attended the California Nurses Association's conference Tuesday in Monrovia. ''I will be able to talk about prevention of certain diseases.''

The staffing ratios begin to go into effect Jan. 1, 2004, with more reduction in ratios for some areas in 2005 or 2008. Medical and surgical units will require a 1:6 nurse-to-patient ratio by Jan. 1, 2004, and a 1:5 ratio by 2005.

The state Department of Health Services will accept comments on these proposals until July 17, then finalize the requirements.

Assembly Bill 394, approved in 1999, required the health department to establish minimum nurse-to-patient ratios.

The ratios resulted from several sources, including unannounced visits to hospitals and comments from more than 24,000 letters from across the state.

Staffing hospitals based on these requirements will cost an estimated $422 million in 2004, $652 million in 2005 and $956 million in 2008, according to the state health department.

These costs may result in hospitals having to close entire units down to comply with the law, said Jan Emerson, vice president of external affairs for the California Healthcare Association, a trade association for hospitals.

A hospital with a 10-bed unit that can only afford to staff nurses for five beds based on the new law will have to shut five beds down, Emerson said, so some patients will not be able to get in. Elective surgery may take longer to schedule and patients may have longer waits in the emergency room, she said.

But California Nurses Association spokeswoman Jill Furillo said hospitals will save money in the long run with fewer nurses leaving, which saves an estimated $25,000 per nurse to prepare them for their duties. This staffing increase will also reduce patient mortality rates, she said.

State grants are helping to train nurses, and nursing schools that used to be empty have waiting lists, Furillo said.

Hospitals will need to hire 5,000 more nurses to meet the ratio requirements, Furillo said.

Citrus Valley Medical Center is among the hospitals trying hard to recruit nurses, subsidizing Mt. San Antonio College so they can add more to their nursing program, said Kathy Dawson, Citrus Valley Medical Center vice president of patient care services and chief nurse executive.

More nurses are a good thing for patient care, Emerson said, but California has one of the worst nursing shortages in the nation.

Community colleges face severe cuts because of the state budget crisis, while 70 percent of California's nurses are educated at community colleges, she said.

''At the same time, the state is telling hospitals to hire more nurses and cutting the very schools that produce these nurses,'' Emerson said.

Rodney Tanaka can be reached at (626) 962-8811, Ext. 2230, or by e-mail at [email protected].

pickledpepperRN · Jul 4, 2003

http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/07/02/BA223985.DTL

State issues new draft on nursing

1 caregiver for 6 patients by next year

Sabin Russell, Chronicle Medical Writer

Wednesday, July 2, 2003

URL: http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/07/02/BA223985.DTL

California health officials released on Tuesday a new and somewhat tougher version of the Davis administration's first-in-the-nation rules telling hospitals how many nurses they must hire to take care of patients.

The latest draft came after months of public hearings and intense lobbying by hospital owners who opposed the new rules as inflexible and expensive and by health care unions, who were divided over the details.

The state Department of Health Services held firm to its earlier proposed guidelines calling for a ratio of 1 nurse for every 6 patients in the general medical wards of California hospitals by January 1. In addition, it set a January 2008 deadline for hospitals to increase the number of nurses in certain specialized units that treat cancer and heart patients, and in "step- down" units that care for patients recovering from surgery.

Officials also stuck to a plan that the nurse-to-patient ratio must shrink to 1 nurse to 5 patients in January 2005. Release of the draft is one of the final steps in a lengthy administrative process. The plan is expected to become effective at year end.

"This is historic. This is a major, major victory in this battle," said Rose Ann DeMoro, executive director of the 50,000 member California Nurses Association, which drafted the law ultimately signed by Gov. Gray Davis in October 1999.

DeMoro credits a lobbying campaign, in which nurses mailed 24,000 letters to the state health department, with fending off what she said were hospital industry efforts to delay or water-down the regulations.

The decision is a clear-cut victory for labor unions representing nurses, but within the labor movement itself, rival unions differ on how the latest rules are interpreted. At issue is whether the new state requirements can be met only by hiring Registered Nurses -- as the RN-only California Nurses Association insists -- or if hospitals can also comply with the rules by hiring lesser trained, lower-paid, Licensed Vocational Nurses. The Service Employees International Union, which includes both RNs and LVNs, favors the latter interpretation.

Although the latest draft allows up to half of the nurses included in the ratios to be LVNs, DeMoro contends that fine print in the new regulations virtually requires that hospitals meet their staffing targets by hiring RNs alone.

In practice, CNA officials contend, hospitals are already staffing up their hospitals by hiring RNs in anticipation of the new rules. In Northern California alone, according to CNA statistics, Kaiser hospitals have hired 896 registered nurses, and 64 LVNs in the past six months. "In other words, 93 percent of their new hires have ben RNs," said California Nurses Association spokesman Chuck Idelson.

But Jan Emerson, spokeswoman for the California Healthcare Association, representing nearly 500 hospitals in the state, believes the new rules clearly favor a mix of LVNs and RNs. "The CNA clearly lost," she said. "They are trying to rewrite history."

Emerson also acknowledged that the new rules are not what the hospital industry wanted. The tighter requirements for specialty nursing units by 2008, were a surprise, she said. "This is the first time we heard that proposal, or that date."

The state health department initially set out to draw up its own guidelines for nurse-to-patient ratios, but ultimately commissioned the University of California to develop a method of determining the minimum staffing requirements. The process of drawing up the regulations, and airing them through the public hearing process, has taken three and one-half years.

Emerson said that the hospital industry does not dispute the goal of hiring more nurses. The issue, she said, is that there aren't enough nurses to hire. "The problem is you have to factor in reality. Reality is that there is a nursing shortage."

She also warned that the current hiring binge for nurses, who can earn up to $100,000 a year at some Bay Area hospitals, is driving up health care costs in a down economy. "The average consumer believes that nurses are not paid enough," Emerson said. "But I'm not sure they have connected the dots: that rising salaries are a major contributor to the issue of rising health care costs."

Luisa Blue, president of the Nurses Alliance, a coalition of the nursing organizations sympathetic to the SEIU's position, said that new nursing ratios are a good thing for patients, but not good enough. The latest proposal sets a ratio of 1 nurse to every 5 patients in cancer and heart monitoring units in January, and will not require the 1-to-4 ratio until January 2008. Similarly, the "step-down" unit ratios do not drop to one-to-three until then. "We feel they need to be implemented sooner," she said.

The SEIU has also called for a 1-to-4 nurse-to-patient ratio in general medical wards, far below the 1-to-6 ratio required in January. That ratio can be reached, the union contends, by hiring LVNs.

Much of the bad blood between the rival nursing unions can be traced to an SEIU decision to work with Kaiser Permanente, which endorsed the one-to-four ratio and the use of LVNs. Kaiser spokeswoman Lea Rubio said that Kaiser has already meet the 1-to-6 patient goal in Northern California, and plans to reach the 1-to-4 target with a mix of RNs and LVNs.

pickledpepperRN · Jul 4, 2003

http://www.calnurse.org/cna/press/7203.html

Senate Health Committee Approves Key Bill to Enforce Landmark RN Staffing Ratio

Law

One day after state officials announced the final plan to implement a law sponsored by the California

Nurses Association requiring safe RN staffing ratios in California hospitals, the State Senate Health

and Human Services Committee Wednesday afternoon approved a new CNA-sponsored bill to

strengthen hospital industry compliance with the ratios.

AB 253, introduced by Assembly member Darrell Steinberg (D-Sacramento), establishes tough

penalties, including fines of up to $5,000 a day, on hospitals that continue to violate the ratio law. The

law also extends the ability of state health officials to conduct unannounced inspections. The bill

passed the Assembly in June.

The ratio law, AB 394 requires minimum RN staffing for all hospital units, and is a critical measure to

restore the patient safety net in California hospitals. All hospitals will be required to meet the staffing

levels by January 2004, and with the release of the final ratios on Tuesday, the state is moving forward

with that deadline.

"Enactment of AB 253 would send a clear message to hospitals and the public that the state will not

tolerate unsafe staffing and willful violation of the ratio law that puts patients at risk," said CNA

President Kay McVay, RN.

CNA Regulatory Policy Specialist Vicki Bermudez, RN told the Senate Health Committee that the

enforcement bill as a critical component of completing the work begun with the ratio bill. Recent

studies in the Journal of the American Medical Association and the New England Journal of Medicine,

documenting improved patient safety with safe RN staffing, demonstrates that Californians have waited

long enough for safe, effective RN ratios.

"California hospitals have had five years to prepare," since the law was signed in 1999," Bermudez

noted, chiding hospitals that "have not done their job who now want to be permitted to avoid complying

with the law."

Presently, however, the Department of Health Services has only limited mechanisms to crack down on

hospitals that violate the law, for example, fines of only $50 per patient in areas where violations occur.

"The original bill did not address the enforcement mechanisms for this important patient safety law,"

Steinberg said upon introducing the bill. "It is essential that we provide the DHS with effective tools to

ensure compliance with the regulations."

In addition to CNA, supporters of AB 253 Wednesday included the Congress of California Seniors and

the Older Women's League. Opposition was led by the hospital industry.

pickledpepperRN · Jul 4, 2003

From the web site:

http://www.calnurse.org/finalrat/ratio7103.html

The final regulations are out--and proposals by the

California Nurses Association to protect RN

professional practice and patients are a key part of

the rules hospitals must follow to comply with the

CNA-sponsored Safe Staffing Law.

As of January 1, 2004 California hospitals will be

required to be staffed according to the minimum

ratios approved by Governor Gray Davis and the

Department of Health Services (DHS).

CNA brought more than 500 RNs to the DHS

hearings last fall--and submitted close to 25,000

letters to the DHS.

Your voice has been heard.

pickledpepperRN · Jul 7, 2003

http://www.sacbee.com/content/business/v-print/story/6984827p-7933712c.html

Giving clout to nurse staffing

Two bills would enable regulators to make hospitals pay for violations found during inspections.

By Lisa Rapaport -- Bee Staff Writer - (Published July 6, 2003)

The law is clear. It says nurses on intensive-care units can treat no more than two patients apiece.

But in the 27 years the law has been on the books, not a single California hospital has been fined for staffing violations uncovered during inspections by state regulators.

In the beginning, there was no punishment because it took until 1993 for another law to give the Department of Health Services the power to fine hospitals.

After that, state health officials said they issued no fines because they didn't have the resources to respond if hospitals contested the inspection results. Violations also went unchecked because inspectors did not revisit hospitals to see if staffing problems were fixed.

Now, as California nears a January deadline to enact a sweeping new law detailing how many patients each nurse can treat in every hospital unit, two bills moving through the state Legislature would give regulators the power to make hospitals pay when their staffing levels are out of line.

"Enforcement to date has been practically nonexistent," said Assemblyman Darrell Steinberg, D-Sacramento, author of one of the bills. "A law is a piece of paper, and it only becomes meaningful if there are the right kind of incentives for people to follow it."

Currently, the Department of Health Services inspects most hospitals every three years. Hospitals typically get three to six months' notice of the visit. State officials do surprise inspections only in response to complaints of unsafe care.

When inspections turn up violations, regulators send hospitals the equivalent of a fix-it ticket. Then, hospitals send back a letter outlining how they will solve the problem.

That, essentially, closes the case. Regulators do not return to hospitals to see if violations were fixed.

Steinberg's bill, AB 253, would empower state health officials to do surprise hospital inspections. When violations are found, first-time offenders would pay $1,000 a day until they demonstrate that nurse staffing levels are up to standards. Repeat offenders could be fined $5,000 a day.

Those fines could help pay for additional hospital inspectors.

A Senate bill by Joseph Dunn, D-Garden Grove, also calls for surprise inspections and similar fines for nurse staffing violations. SB 1005 also allows regulators to fine hospitals for violating other state health laws unrelated to nurse staffing.

Though local hospital officials concede that state enforcement of staffing violations has been lax, they say they struggle to comply with the staffing law at a time when there is an acute shortage of nurses.

"State fines and surprise inspections will only make the situation worse," said Carol Robinson, director of hospital and clinics at UC Davis Medical Center in Sacramento. "I don't have a solution to the (nursing) shortage, but lack of money is a big part of the problem, and that will only be exacerbated by fines."

Furthermore, the strict formula laid out by nurse-to-patient ratios doesn't neatly compute in the minute-by-minute reality of most hospital wards. One nurse on a quick bathroom break, or the sudden arrival of a transfer patient from the emergency room, could add up to a violation of the staffing law, hospital executives fear.

The unions largely responsible for pushing California's new nurse-to-patient staffing ratio law support these efforts to ensure that the law gets enforced. Labor leaders said patients will get better care, and more nurses will seek work in California hospitals when staffing levels are enforced.

"(It) would send a clear message to hospitals and the public that the state will not tolerate unsafe staffing," said Kay McVay, president of the California Nurses Association.

California's new nurse staffing law, scheduled to take effect in January, allows nurses to treat as many as six patients on the general medical wards, where most people recover from illness and injuries. On more critical wards, nurses are permitted fewer patients. The tightest rules cover trauma cases, where each nurse is assigned to one patient.

Both Steinberg and Dunn said they hope to reconcile differences between their two bills and have a new enforcement law on the books by January. Both bills have cleared their houses of origin and await hearings in appropriations committees.

"It seems that business entities will rarely move forward unless their bottom line is impacted," said Dunn. "Fines are the only motivation for many institutions to get them to do the right thing."

About the Writer

---------------------------

The Bee's Lisa Rapaport can be reached at (916) 321-1005 or [email protected].

ainz · Jul 7, 2003

Excellent example of how nurses uniting and using the political system to get laws changed. The "for-profits" are dreading this day.

pickledpepperRN · Jul 9, 2003

From the Palm Springs Newspaper.

Their Desert Hospital is owned by Tenet

Funny the CNA already got nursing scholarships, reinstated some of the nursing programs that were eliminated in the 1990s, Got extra $$$ for LVN to RN programs with a seamless continuation for those LVNs returning for their RN, and many of us unsuccessfully lobbied the University of California to restart their entry level BSN programs.

Our Voice: Nurse-patient ratios no cure-all

State in dire need of more nurses to fill posts first

The Desert Sun

July 8th, 2003

Nurse-to-patient ratios, slated to become effective Jan. 1, on the surface seem logical, even innovative. But at a time when there is a severe nurse shortage in California with a 20-30 percent vacancy rate, it's questionable whether it's in the state's best interest to push forward.

The California Department of Health Services should allow for considerable wiggle room before it casts the ratios in stone. If it doesn't, full implementation could only worsen the nursing shortage in addition to costing hundreds of millions of dollars to implement.

The regulations, slated to be phased in beginning in 2004, stem from 1999 legislation that made California the first state to mandate nurse-to-patient ratios, thus limiting the number of hospital patients assigned to each nurse.

Current regulations set nurse-to-patient ratios for intensive and critical-care units, operating rooms, nurseries and acute respiratory-care wards. The new mandate will expand the ratio concept to all hospital departments, with ratios varying from 1-2 to 1-6.

Anyone who has ever spent any time in a hospital knows the fewer patients a nurse has to care for, the more undivided attention and care you receive. Who wouldn't want more individual care?

Nurse-patient ratios would all be well and good -- if there were enough nurses to fill the slots. But there aren't. Where will California -- the hardest hit in a severe national nursing shortage -- get the 30,000 new nurses the state's Employment Development Department estimates the state will need in the next three years? According to the U.S. Department of Health and Human Services, California ranks 49th among states in its share of registered nurses, with 544 nurses per 100,000 residents.

If the state is serious about setting minimum staffing levels in hospitals, it needs to be equally serious about helping hospitals find more nurses to hire. Training is one way, but it's not the only way.

The state should consider opening more slots for nursing students at state universities, recruiting nurses from other states and bringing back into the fold California nurses who have left the profession. Also vital to recruitment is making it easy for nurses to transfer their licenses from other states.

California should also consider a loan-forgiveness program for nursing students.

Another option to the nursing shortage program is raising the ceiling on the number of years nurses may work beyond retirement.

Hospitals, too, have a role in this statewide dilemma. They must improve pay and working conditions or no amount of training is going to work.

Nurse-to-patient ratios sound good on the surface, but there needs to be more substance behind it before it's fully implemented.

roxannekkb · Jul 9, 2003

Nurse-patient ratios would all be well and good -- if there were enough nurses to fill the slots

But as we all know, there are more than enough nurses to fill the slots. Hospitals which offer an environment that is supportive to their staff have no trouble finding nurses. They don't need to offer bogus sign-on bonuses or monogrammed mugs--their reputation speaks for itself.

Nurse patient ratios that are mandated are a terrific start, but not the only problem that nurses face. If a hospital wants to be able to meet the mandate, they shouldn't be whining about how there "aren't enough nurses." Instead, they should be bending over backwards to clean up their act, so that they have to put nurses who want to work for them on a waiting list! :cool: :cool:

casper1 · Jul 11, 2003

Congratulation, California,

I'm happy for you. Let's hope that other states take you lead. It's about time, that the patient comes first and not the bottom line. Nurses are constantly struggling to provide quality care in spite of constant administrative roadblocks placed in our way. Nurses need to be able to spend time with their patients, not filling out forms and doing paperwork. The people of california are lucky they have legistators who care about them. It's time the rest of the country jumped on the bandwagon.

live4today, RN · Jul 11, 2003

I'm going back to Cali!

I already have a RN license in that state since I worked there for quite sometime before. I've always loved that beautiful state, now I can go work there as a nurse with safe patient ratios.

YES!!! :nurse:

pickledpepperRN · Jul 11, 2003

Originally posted by spacenurse
From the Palm Springs Newspaper.
Their Desert Hospital is owned by Tenet
Funny the CNA already got nursing scholarships, reinstated some of the nursing programs that were eliminated in the 1990s, Got extra $$$ for LVN to RN programs with a seamless continuation for those LVNs returning for their RN, and many of us unsuccessfully lobbied the University of California to restart their entry level BSN programs.
Our Voice: Nurse-patient ratios no cure-all
State in dire need of more nurses to fill posts first

The Desert Sun
July 8th, 2003

Nurse-to-patient ratios, slated to become effective Jan. 1, on the surface seem logical, even innovative. But at a time when there is a severe nurse shortage in California with a 20-30 percent vacancy rate, it's questionable whether it's in the state's best interest to push forward.

The California Department of Health Services should allow for considerable wiggle room before it casts the ratios in stone. If it doesn't, full implementation could only worsen the nursing shortage in addition to costing hundreds of millions of dollars to implement.

The regulations, slated to be phased in beginning in 2004, stem from 1999 legislation that made California the first state to mandate nurse-to-patient ratios, thus limiting the number of hospital patients assigned to each nurse.

Current regulations set nurse-to-patient ratios for intensive and critical-care units, operating rooms, nurseries and acute respiratory-care wards. The new mandate will expand the ratio concept to all hospital departments, with ratios varying from 1-2 to 1-6.

Anyone who has ever spent any time in a hospital knows the fewer patients a nurse has to care for, the more undivided attention and care you receive. Who wouldn't want more individual care?

Nurse-patient ratios would all be well and good -- if there were enough nurses to fill the slots. But there aren't. Where will California -- the hardest hit in a severe national nursing shortage -- get the 30,000 new nurses the state's Employment Development Department estimates the state will need in the next three years? According to the U.S. Department of Health and Human Services, California ranks 49th among states in its share of registered nurses, with 544 nurses per 100,000 residents.

If the state is serious about setting minimum staffing levels in hospitals, it needs to be equally serious about helping hospitals find more nurses to hire. Training is one way, but it's not the only way.

The state should consider opening more slots for nursing students at state universities, recruiting nurses from other states and bringing back into the fold California nurses who have left the profession. Also vital to recruitment is making it easy for nurses to transfer their licenses from other states.

California should also consider a loan-forgiveness program for nursing students.

Another option to the nursing shortage program is raising the ceiling on the number of years nurses may work beyond retirement.

Hospitals, too, have a role in this statewide dilemma. They must improve pay and working conditions or no amount of training is going to work.

Nurse-to-patient ratios sound good on the surface, but there needs to be more substance behind it before it's fully implemented.

Letter to the Editor of the desert Sun:

Where will RNs come from to meet the ratios?

The Department of Health Services (DHS) has projected that California will need 5,000 RNs to meet the ratios, effective this January. That is the same number of RNs who graduate every year from California's 72 nursing schools.

RNs have known for a long time what the New England Journal of Medicine documented, that without proper patient to RN ratios, there can only be patient injury and death.

RNs must have the final say as to what is safe and appropriate patient care. Only then will nurses return to hospitals.

Now, RNs leave the profession in droves, preferring to work in a less stressful, more safe environment. If we provide a hospital setting that allows RNs to give the care they were taught to give, the profession would attract more nurses and retain the ones we now have.

In Victoria, Australia, ratios were enacted in 2001 and by February 2002, the full time RN workforce had increased by 16.5%.

The California Nurses Association used the Australian success as their guide when authoring the safe Staffing Bill, AB 394.

Sanctity of life, preserved by RNs is the only way to ensure safe patient outcomes.

Stephanie Salter RN, CCRN