New Rules Will Tighten Nurse-Patient Ratios

State regulators Tuesday announced rules limiting the number of patients that nurses can care for, despite strong objections from the hospital industry.

Under the new regulations -- the first of their kind in the nation -- a nurse will not have to care for more than eight patients at a time. In many hospital units, the limit will be four to six patients for every nurse.

The rules, drawn up by the state Department of Health Services, are expected to go into effect Jan. 1. A few of the ratios won’t apply until 2008 to soften the financial effect on hospitals.

The new ratios could bring about noticeable changes for patients.

For example, the ratios call for one nurse per five patients in medical-surgical units, where most hospital patients are placed, by 2005. At present, about half the hospitals in California are meeting that requirement, said Gina Henning, a manager specialist with the Department of Health Services.

“When patients and families go to hospitals, they will know that nurses aren’t overtaxed and that they aren’t spread too thin to provide quality care,” Henning said.

The regulations are the result of a law signed by Gov. Gray Davis in 1999. The issue was studied for more than two years.

Although many nurses celebrated the announcement, some hospital officials said the new rules are unreasonable because their industry is suffering financially and battles a chronic shortage of nurses.

Many nurses are reaching retirement age and young women, in particular, are opting for other careers.

“The bigger issue, even if money was no object, is that there’s a severe nursing shortage in California,” said Jan Emerson, spokeswoman for the California Healthcare Assn., which represents hospitals. “No one disagrees that the ratios would be good for patient care, but given the nursing shortage, how do we make this happen?”

Jill Dryer, a spokeswoman for Catholic Healthcare West, a nonprofit that operates 37 hospitals in California, agreed, saying, “We can’t manufacture nurses.”

The Department of Health Services estimated last fall that the new rules would cost hospitals roughly $480 million a year.

Emerson said that comes on top of other financial burdens, including the expense of caring for the state’s 7 million uninsured people and complying with state-mandated seismic upgrades that will cost hospitals $14 billion by 2008. Proposed budget cuts to Medi-Cal would also hurt hospitals, she said.

Many nurses argue, however, that they are responsible for many more patients than they can reasonably handle, leading to mistakes and burnout.

These nurses and their unions say there wouldn’t be a nursing shortage if hospitals hadn’t overburdened them in recent years and driven them from the profession.

“Why aren’t there any nurses?” said Ingela Dahlgren, 52, a nurse in critical care at Northridge Hospital Medical Center and a member of the Service Employees International Union. “The reason is no one wants to go into a profession where you work yourself half to death, the stress is unbelievable, there are rarely any thank-yous, the reimbursement is poor, you have tiny vacations if you can get them and the work increases every month.”

Officials with the three unions that represent nurses in the state said the new rules are on the right track but aren’t ideal. The unions all complained that some of the rules will take too long to go into effect and that some of the ratios still need to be toughened.

Not all hospitals had negative reactions to the new rules. “We are glad to see the state adopt the ratios,” said Jim Anderson, a spokesman for Kaiser Permanente, the state’s largest HMO, with 30 hospitals in California. He said that Kaiser dropped any opposition to the rules in hopes of improving the company’s relationship with its nurses.

“If the nurses are happier doing what they do -- which is care for patients -- we think they will stay in the profession and those who have left the job will want to come back,” said Anderson.