Nursing a Grudge

It looks like a spoof of a low-budget horror flick. California’s action-hero governor is being stalked by, well, nurses.

Dressed in hospital scrubs and practical shoes, they’ve crashed speeches and fundraisers from the West Coast to the East. They staged a mock funeral with coffins and a New Orleans-style jazz band in front of the state Capitol. One even snagged a ticket to a movie screening attended by the governor, only to be whisked away and later questioned by one of his bodyguards. When she asked why she posed a threat, the bodyguard told her, “You were wearing a nursing uniform.” Yikes!

Gov. Arnold Schwarzenegger triggered the protests when he issued an emergency order suspending a new law -- hard won after years of lobbying by the nurses union -- requiring more nurses in hospital wards and emergency rooms. With his usual swagger, Schwarzenegger dismissed the protesting nurses as just one of many “special interests” who don’t like him because “I am always kicking their butts.”

It turns out they kicked his. A Superior Court judge earlier this month ruled that the governor had misused the emergency order and had no authority to suspend the law.

This would all be amusing if it were not a distraction from the real horror story -- a nationwide nursing shortage that is particularly severe in California and that will grow worse as aging nurses retire faster than they can be replaced. The governor and the nurses need to put aside posturing and work together or the state’s already precarious healthcare system will be short an estimated 70,000 nurses by 2020.

California last year became the first state in the nation to require minimum staffing ratios for hospital nurses. Signed into law five years earlier by then-Gov. Gray Davis, the ratios were to be phased in over several years. As of last year, for example, medical-surgical wards had to have one nurse for every six patients. In January, that ratio was supposed to drop to one for every five patients.

Many hospital officials claim that the ratios are overly rigid and could push some hospitals, already squeezed by managed care, cuts in federal aid and soaring numbers of uninsured, to close. Even those that could afford to hire more staff might have to shut departments and turn patients away because of the nursing shortage.

It may seem counterintuitive, but the California Nursing Assn. argues that the new ratios could help ease the shortage. Nurses have long complained about being assigned as many as 25 patients, far too many to do their jobs safely. Better working conditions could woo back those who have left the field.

Lest these two sides seem overly black and white, we should point out that there are hospitals -- Kaiser Permanente is one -- that have embraced the lower nursing ratios. And there are nurses who worry that the ratios may have unintended negative consequences, much as reducing school class sizes a decade ago prompted teachers in poor neighborhoods to seek new openings in wealthier ones.

It’s because of this gray area that we urge the governor and the nurses to seek a compromise. Freeze the ratio in medical-surgical wards at 1 to 6. Make the 1-to-4 ratio now required in emergency rooms more flexible without throwing it out. And limit the freeze to two years, the time researchers say they need to begin evaluating the results, good and bad, of the new staffing requirements.

In the meantime, there are plenty of other short-term crises that Schwarzenegger, nurses and hospitals need to work together to address. The first is a federal directive issued in January that makes it harder for nurses from the Philippines and elsewhere to get work visas in the United States. Overseas nurses have played a vital role in filling the U.S. shortage; the Philippines even has schools solely for training nurses for the U.S. market. Rep. Tom Lantos (D-San Mateo) has introduced a bill that would recapture unused work-based immigration visas for foreign nurses.

Even better than relying on foreign nurses is training more nurses in California. Schwarzenegger on Friday announced a $13-million effort to do just that, spreading the money among major nursing schools. It won’t instantly rehabilitate the governor’s reputation among nurses, but more efforts like this would at least start making the staffing ratios a nonissue.