Capacity Is Squeezed at Hospitals in O.C.

Staffing shortages, growing patient demand and other factors are squeezing hospital capacity in Orange County, according to a report released Thursday by a Washington think tank.

A state law that was supposed to improve patient care by raising the nurse-to-patient ratio to 1 to 5 took effect in March. But the requirement to add nurses has aggravated a hospital-bed shortage in Orange County, where competition for nurses already was fierce and salaries far exceed the national average, said a report by the Center for Studying Health System Change.

Hospitals can put patients in only as many beds as can be staffed. As a result, some Orange County hospitals have temporarily closed units and diverted emergency room patients because they were unable to meet the nurse staffing ratios, according to the report.

The average hourly pay for nurses in the state varies from $30 to $45 an hour, according to the California Nurses Assn.

“The new mandate has intensified pressures on Orange County hospitals by driving up personnel costs and making it difficult to keep some hospital units staffed and open,” said Paul B. Ginsburg, president of the nonpartisan health policy group that is funded principally by the Robert Wood Johnson Foundation.

The new ratio is having a similar effect on hospitals throughout the state, said Jan Emerson, a spokeswoman for the California Hospital Assn.

“Nearly all hospitals are grappling with capacity issues and the nursing shortage,” she said. “There are more than 14,000 vacant nurse positions in hospitals statewide, and salaries are the highest in the nation. The ratios are still very much a problem.”

Orange County is one of 60 areas in which the think tank conducts periodic household and physician surveys and is one of a dozen sites that it visits every two years to investigate changes in the healthcare marketplace.

The study found that Orange County had 1.9 hospital beds per 1,000 residents, compared with an average of 3.1 for other metropolitan areas across the country.

Orange County’s bed shortage has been worsening for many years as population growth has outpaced hospital construction. The closure this year of the bankrupt 162-bed Brea Community Hospital further tightened capacity.

The state-ordered staffing mandate took effect after a court struck down Gov. Arnold Schwarzenegger’s attempt to delay the change from 1 nurse for every 6 patients in medical surgical units to 1 to 5.

Orange County hospitals were not able to consistently keep staffing levels up to the new mandate, said Jessica May, a research analyst for the think tank.

“Hospitals were noting that on occasion that they will temporarily have to close units or beds or to divert [patients away from] emergency rooms because they simply don’t have the staff to meet the requirements,” she said. “But we didn’t hear [the ratios] were significantly affecting patients’ ability to access care or services.”

The research team visited Orange County in March, the month the new mandate took effect.

Vicki Bermudez, a nurse and regulatory policy specialist for the California Nurses Assn. union, noted that Kaiser Permanente and University of California hospitals embraced the new ratios and hired more nurses before March.

Those hospitals that have trouble meeting the ratio often rely too heavily on temporary nurses and engage in other employment practices that make them unattractive places for nurses seeking permanent jobs, she said.

“It’s just-in-time staffing,” Bermudez said. “That is a formula for failure.”