Too Many Patients to Cover, Nurses Say

Los Angeles County hospitals are endangering patients by violating a new state law that limits the number assigned to each nurse, a group of nurses said Wednesday.

Wearing their hospital scrubs, 25 nurses staged a brief sit-in at the downtown Los Angeles offices of county supervisors, demanding that standards that took effect in January be enforced.

The legislation, signed by former Gov. Gray Davis five years ago and debated ever since, sets staffing ratios that assign nurses no more than eight patients at a time. In some hospital units, each nurse can be assigned only two patients.

On her Tuesday night shift in Los Angeles County-USC Medical Center’s emergency room, nurse Cynthia Mitchel said, two nurses scrambled to care for 50 patients. The law required 13 nurses.

Other county nurses described emergency rooms so crowded that patients often wait up to 16 hours to be seen and up to four days for a hospital bed once admitted.

“Why don’t you come down here on a Friday night when we’ve got five or six patients rolling in the door and there aren’t enough nurses?” Mitchel asked an aide to Supervisor Zev Yaroslavsky. “Anyone could be in an accident at any time, and if they need trauma care, guess what? They’re coming to us.”

The county operates five hospitals with 3,350 nurses. To comply with the law, it needs 1,204 more nurses.

Despite attending job fairs and running ads in nursing publications, the county is continuing to lose nurses, statistics show. By June, 91 fewer nurses were on staff than in November.

The nurse staffing ratios were promoted by the California Nurses Assn., which said that safer working conditions would improve patient care and encourage more people to become nurses. But the rules were opposed by the hospital industry as costly and difficult to follow amid a nationwide shortage of nurses.

After the law took effect, the California Healthcare Assn., a trade organization that represents hospitals, conducted a six-month survey of 300 facilities and found that 85% did not comply with the staffing ratios at least part of the time. The lapses were caused largely when nurses took short breaks and were not replaced, said Jan Emerson, a spokeswoman for the association.

Concerned that county hospitals would be unable to hire enough nurses to meet the standard, supervisors wrote to Gov. Arnold Schwarzenegger in December and February asking the state to waive sanctions for noncompliance.

The county got no response, said county Department of Health Services spokesman John Wallace.

“Our goal is to be compliant,” he said, “but unfortunately, because of the nursing shortage, we’re not able to be.”

The governor’s office referred a reporter’s inquiries to the state Department of Health Services, where spokeswoman Lea Brooks said that Los Angeles County has not been granted an exemption from the rules.

Hospitals that request “program flexibility” must draw up a staffing plan to show they meet the intent of the ratios; 13 hospitals have been granted such flexibility.

Since the law took effect, the department has received 130 reports of violations statewide and required a plan of correction in 19 cases, including one at the county-run Rancho Los Amigos National Rehabilitation Center in Downey. The department is investigating an alleged violation at County-USC.

The state health department cannot impose fines on hospitals.

One by one, aides from each supervisor’s office met with the group, assuring them that the county was trying to hire more nurses.

“Nurses really go by networking and word of mouth, and if the working conditions are bad and the workloads are enormous ... the nurses aren’t going to come here,” said Maureen Ballard, a county nurse who works at Men’s Central Jail. “And the ones who come aren’t going to stay.”