Governor Praised, Criticized Over Nurse Staffing Veto

Hospital administrators in Ventura County praised Gov. Pete Wilson on Wednesday for rejecting a bill to set minimum nursing levels in hospitals, but local nurses said the veto shows the governor puts profits ahead of patient safety.

Wilson refused to sign a bill backed by the California Nurses Assn. that required state officials to set baseline ratios of nurses to patients depending on the type of care. He said current regulations adequately protect patients and that the new regulations would tie the hands of hospitals.

“We applaud his decision because the government should not be involved in the staffing of private businesses,” said Monty Clark, who represents the hospital industry in Ventura County. “It would have been a hit to hospitals financially, and we don’t see any evidence to substantiate the charge that the quality of care in hospitals has dropped.”

Studies of patient readmission and death rates have shown no problem, he said. And about half of California hospitals are already losing money on their operations, according to Clark’s group, the California Healthcare Assn.

But harried nurses--citing studies showing California nursing levels among the nation’s lowest--said they see the difference in quality every day.

Not only do hospitals have fewer nurses because of meager payments from health-maintenance organizations, but patients are much sicker than years ago because of managed care policies, they said.

“I think the governor’s just a silly son of a gun,” said Kris Ortiz, a supervising nurse at Santa Paula Memorial Hospital. “Does he want to be a patient in a hospital without enough nurses to give him his drugs on time? What if it was his mother or his father or his child who needed care but the nurse wasn’t around because she was taking care of three other patients?”

Reduced hospital budgets prompted by HMO payment cutbacks have been balanced on the backs of veteran nurses, who have been replaced in recent years by less expensive and less qualified nurses’ aides, said Jill Furillo, spokeswoman for the California Nurses Assn.

And the remaining nurses have been overworked because their patients are sicker than ever, Furillo said. She said studies nationwide have confirmed a correlation between patient health and nurse staffing.

“These changes are pervasive, and they’ve absolutely put patients in jeopardy,” Furillo said. “We have numerous examples of where patients have been put in jeopardy--we call them near-misses--or have actually been harmed because of understaffing. The industry’s defense was basically, ‘This is going to cost us money.’ ”

Nurses recognize that many hospitals are struggling to stay in business, she said, but they believe cuts should not endanger patients.

Samuel Edwards, administrator of Ventura County Medical Center, said nurse staffing at the county’s only public hospital has picked up in recent years because patients are coming in more seriously ill.

“Patients have to be sicker to get in and managed care drives them out quicker,” Edwards said. “Now patients on our medical-surgical floor look pretty much like those in intensive care. People we used to have in the hospital for observation just aren’t there anymore.”

Deborah Bartlett, the county hospital’s nursing director, said she generally agrees with the concept of minimum staffing levels for nurses. But she wants nursing leaders, not state bureaucrats, to set them.

She is leery too of any regulations that set mandatory staffing levels department by department, because, she said, that could keep hospitals from putting scarce resources where they are needed most.

“You really should be staffing to the needs of the individual patient,” she said. “What happens when you place a flat number into law is that it doesn’t always take into account the needs of the patient.”

Bartlett said the ratio of nurses to patients at the county hospital has actually improved in recent years.

Hospitals have recently begun to try to lure nurses back, nursing professor Barbara Thorpe of Oak View said. But because nurses fled the profession and nursing schools enrolled fewer students, there is actually a shortage.

“What happened initially was that they laid off the expensive professional nursing staff,” said Thorpe, chairwoman of the nursing department at Cal State Dominguez Hills. “But now the HMOs and the hospitals are looking for nurses again because of the acuity of the patients.

“Frankly, you have to have a high level of care for these very sick patients and that means there’s a demand again for the high-level professional nurse.”

* MAIN STORY: A3