Davis Reveals Plan to Limit Hospital Nurses to 5 Patients

California would become the first state in the nation to limit the number of hospital patients assigned to each nurse under regulations proposed Tuesday by Gov. Gray Davis.

The new rules ultimately would prohibit hospitals from assigning a nurse to more than five patients in large hospital units devoted to patients recovering from surgery and serious illnesses. That’s half the number typically assigned in many facilities, and half what the hospital industry had proposed.

The rules would be phased in; initially nurses would be allowed to treat six patients.

The proposed standards also limit nurses in emergency rooms to one trauma patient, pediatric nurses to four child patients, and obstetrics nurses to two mothers in labor.

Nurses’ unions and consumer advocates applauded the proposal.

“This is the most sweeping health care reform that we’ve seen,” said Rose Ann DeMoro, executive director of the California Nurses Assn., one of the unions that represents registered nurses. “I can’t think of anything that’s as prominent in the everyday life of the patient.”

But hospital industry officials and others said that the rules face tremendous practical obstacles in a state that has been among the hardest hit in a severe national nursing shortage. 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.

“Several thousand new nurses must be employed to meet these requirements,” said Duane Dauner, president of the California Healthcare Assn., which represents hospitals. “But are they available? And is there money to pay them?”

It was unclear Tuesday how the administration planned to enforce the rules, although a Health Services department spokeswoman said current fines and procedures would remain in effect. Those details, Davis said, would be worked out over the next 18 months.

The rules are designed to prevent patient neglect and injuries after years of cutbacks to hospital nursing staffs. They are expected to be implemented over two years, beginning in July 2003.

The announcement reflects the rising status of health care as an issue in the governor’s race. The Democratic governor pointed to his health care record during his State of the State speech earlier this month.

Much of Tuesday’s announcement had the flavor of a political event. Davis made the announcement in Los Angeles, flanked by union members in the courtyard of an urban hospital, St. Vincent Medical Center.

Davis was careful not to criticize the hospital industry, promising that “there is still a free market” and hinting that the state would provide financial and other incentives to help hospitals recruit nurses.

“You can decide who to hire and what to pay,” Davis said. “But you have to have quality care.”

The new rules, which must be aired at public hearings and still could be revised by the state Department of Health Services, are being watched carefully in other states. Nursing unions and patient advocates are pushing similar proposals in Massachusetts, and plan to roll out a national campaign.

In this state, nurses such as Trande Phillips, a Kaiser Permanente nurse from Northern California, say the strict standards mean that she will stay in the profession.

“I felt like I really needed to leave nursing if we didn’t get these ratios,” said Phillips, a member of the California Nurses Assn.

Phillips said she recently took care of 16 seriously ill children--including one who was recovering from surgery--with just two other nurses.

“I don’t want to risk patients’ lives and I don’t want to risk my license,” she said.

Relie DemaAla, a nurse at Glendale Memorial Hospital and Health Center and a member of the California Nurses Assn., said she has been asked to care for up to 11 patients at a time on her night shift. At times, she said, patients have been hurt while awaiting a nurse.

“We’re just running from room to room,” DemaAla said.

Some representatives of the nursing profession said the new standards don’t go far enough. “We don’t think they’re good enough....We’re pleased that the ratios are out but we’re going to fight to improve them,” said Beth Kapell, a lobbyist for the Service Employees International Union, another union that represents California nurses.

The staffing rules are the result of two years of jostling among hospitals, nurses and others to comply with a 1999 bill requiring health care regulators to develop new standards. The state already regulates the number of nurses required per patient in intensive care units and nurseries.

Although the hospital trade group, the California Healthcare Assn., did not sharply criticize the plan Tuesday, Dauner said officials plan to voice their concerns during public hearings. He said hospitals are particularly concerned about the maximum number of patients assigned to emergency room nurses. If there aren’t enough nurses on hand, he said, hospitals might have to turn patients away from emergency departments.

Cost is also a factor. Kaiser Permanente, the state’s largest HMO, has discovered that. It voluntarily pledged last year to hire one nurse for every four patients in its large medical and surgical units, which will cost up to $200 million and require recruiting 2,000 more nurses.

The new rules also add to the pressures on the managed care industry, which has pushed hospitals to accept less money to care for patients, helping fuel the reduction of nursing staffs.

“Increasing the number of nurses relative to patients is going to raise hospital costs, and ultimately raise health plan premiums,” said Walter Zelman, president of the California Assn. of Health Plans, the HMO trade group. “In many cases, that may be appropriate and necessary ... to improve quality, but it doesn’t get around the reality that we’re facing cost increases that many people are having difficulty paying.”

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Times staff writer Dan Morain contributed to this report.