Nurses Say Eased Rule Risks Care

Some Orange County hospitals said Friday they were grateful the Schwarzenegger administration is considering a plan to relax future nurse-to-patient staffing rules while others said they would have had no problem meeting them.

Nurses said that easing the requirements will lead to only one thing: poorer care.

Sandra Shewry, the governor’s director of health services, this week suggested that emergency rooms be exempted from the required staffing ratios when they experience unexpected increases in patients. She also proposed that the state postpone the Jan. 1 implementation of the regulation requiring that nurse-to-patient ratio in medical-surgical wards change to 1 to 5 from the current 1 to 6.

Orange County supervisors expressed their concern in February joining with their Los Angeles County counterparts to write Gov. Arnold Schwarzenegger a letter.

The supervisors then asked the Department of Health Services to waive sanctions for hospitals that don’t comply with the staffing levels as long as they try to recruit more nurses.

“Compliance with these regulations should be consistent with providing high-quality patient care, but should not risk the closing of hospitals or a reduction in hospital capacity,” they wrote.

Hospitals say the problems are the difficulty finding nurses and the increased costs that go with having more of them on duty.

In a letter to the governor, the California Healthcare Assn., which represents hospitals, quoted a state study that said California will be short 30,000 nurses by 2006 and 97,500 four years after that. The letter also said California ranks 49th in the nation in nurses per capita.

John D. Gilwee, who heads the Hospital Assn. of Southern California’s Orange County office, said his group is “delighted” about the possible changes. “This is something hospitals have been asking for for a long time,” he said.

But not all hospitals found the staffing requirements overwhelming. Debra Shipnuck, a spokeswoman for Kaiser Permanente, said staffing levels at the HMO’s medical-surgical wards already are better than 1 to 5. The levels are expected to drop to 1 to 4 in January, as required by their contract with the California Nurses Assn.

Rick Martin, chief nursing officer at Hoag Memorial Hospital Presbyterian in Newport Beach, said his institution has prepared for the lower ratios by hiring almost 100 newly graduated nurses in the first half of the year.

“We understand there will be a greater expense for us, but we have that commitment,” he said.

Officials at Anaheim Memorial Medical Center, however, welcomed the proposal to relax the staffing standards.

“We’re very pleased there’s going to be a moratorium so we can study it and everyone can catch their breath,” said Melinda Beswick, the hospital’s CEO and a former nurse.

She echoed the feelings of others that the biggest problems were filling in for nurses who go on breaks. Because the law does not allow another nurse on the floor to cover the position, hospitals are required to maintain higher levels of staffing.

“The costs to the organization are unsustainable,” Beswick said.

She said her hospital begins each shift in compliance with the regulations, but because of the breaks, it often fails to meet the ratio as the shifts progress.

The hospital recently hired 42 nurses from around the world on 18-month contracts to help meet the staffing demands.

“I empathize with the nurses for their tremendous workload,” she said. “I don’t want to end up further relaxing the ratios. I just want the opportunity to [adjust staffing] in a reasonable manner so I can preserve patient safety and sustain the financial viability” of the hospital.

Nurses opposed any changes. Maureen Berry, a nurse at UCI Medical Center in Orange, said fewer nurses equals more errors and poorer care.

“What I feel for are the patients,” she said. “Now they’ll have to wait longer when they push the call button because the hospital industry basically stated this is not a priority.”