Nursing Rules Not Ready Yet

Finding the right nurse-to-patient ratio for California hospitals is proving harder than expected, delaying the release of new state-mandated staffing guidelines.

The state has yet to finish developing the regulations, which were supposed to take effect by Tuesday. They may not be ready for several months, according to officials.

“We’re not going to meet the Jan. 1 deadline,” said Lea Brooks, spokeswoman for the state Department of Health Services, the agency charged with setting the ratios. “It’s a very complex, very time-consuming process and we’re still analyzing the data we gathered.”

Gov. Gray Davis signed a bill in 1999 requiring minimum staffing levels in hospital units, making California the first state to do so. Such requirements already existed for some hospital areas, including intensive care units and operating rooms.

Nurses unions support requiring levels as high one nurse for every three patients, saying more nurses would ease excessive workloads, improve patient care and make the job more attractive amid a shortage.

The hospital industry has proposed levels as low as one nurse for every 10 patients, saying that there aren’t enough nurses available for blanket increases, that hospitals should have discretion on staffing levels and that there is no proof that more nurses equal better care.

Both sides have spent months waiting for the new guidelines.

Jan Emerson, a spokeswoman for the California Healthcare Assn., said the hospital industry group is “philosophically opposed” to mandatory staffing levels, but would wait until the new rules are out before taking a position. “Let’s see what the regulations are and what the plan is,” she said.

Jill Furillo, director of government relations for the California Nurses Assn. union, was equally diplomatic about the delay.

“I understand that [the state] is working really hard on them,” she said. “We need them, but we also want to make sure that whatever they do, they do it right.”

The rules were supposed to take effect last January, but lacking an agreed-upon “magic number” of the optimal nurse-to-patient ratio, the state postponed implementation for a year to develop guidelines.

The Department of Health Services took proposals from the hospital and nurses associations, commissioned staffing-ratio studies by the University of California and made unannounced visits to 80 acute-care hospitals throughout the state to observe the quality of care at different staffing levels and different times of day, according to Brooks. She said a public-comment period of at least 45 days will follow issuance of the draft regulations.

“We’re committed to holding meetings at sites throughout the state in recognition of the high interest in this issue,” she said.

Gov. Davis cited the “erosion in the quality of patient care” when he signed the bill, at a time when managed-care cost pressures led many hospitals to reduce nursing staff.

California ranked next-to-last in a March 2000 federal survey measuring states’ ratio of nurses per 100,000 residents, with 544. The national average was 782.

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Nurse Ratios

The Department of Health and Human Services conducted a national sample of registered nurses in March 2000. California ranked 49th of the 50 states in the ratio of registered nurses to residents.

Most nurses per 100,000 residents

1. Massachusetts: 1,194

2. South Dakota: 1,128

3. Rhode Island: 1,101

4. North Dakota: 1,096

5. Iowa: 1,060

Fewest nurses per 100,000 residents

46. Oklahoma: 635

47. Arizona: 628

48. Texas: 606

49. California: 544

50. Nevada: 520

National average: 782