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By Jeffrey Obser 

Daily Planet correspondent 

Busloads of East Bay nurses will join an estimated 2,000 colleagues from around the state at a rally in Sacramento Thursday to demand that the state sharply limit the number of patients assigned to them. 

Under a 1999 state law intended to improve nurses’ working conditions, the State Department of Health Services must establish maximum ratios of patients to nurses in over a dozen categories of hospital care by Jan. 1, 2002. The DHS, which was to issue preliminary guidelines last spring under the law’s terms, has yet to announce a plan or schedule public hearings. As the clock winds down, nurses’ unions and the health care industry are vying fiercely to persuade the agency – and Gov. Gray Davis, who must sign off on a final plan – to adopt widely divergent schemes. 

“The nurses, who have the most direct experience with how many patients at what degree of seriousness can actually be served by a nurse without compromising their safety, would want the ratios to be as low as possible,” said state Sen. Sheila Kuehl, D-Los Angeles, who sponsored the legislation. 

“The hospitals, which maintain that they cannot afford the very lowest ratios and also maintain that there are not sufficient nurses to meet low ratios, are requesting higher ratios,” she said. “The administration, including the DHS, has the unenviable task of establishing ratios that are both safe and affordable.” 

The law, signed by Gov. Gray Davis on Oct. 10, 1999, also restricts nurses from wards for which they are not properly trained, and prohibits using unlicensed personnel for sensitive tasks such as medicating and patient education. 

State health care regulations in place for over 20 years already require one nurse for every two patients in intensive care. The California Nurses’ Association, one of two unions advocating low ratios, wants a three-patient limit for nurses in emergency, pediatrics and telemetry (remote monitoring of vital signs, mainly for cardiac conditions ), and one patient per nurse during labor and delivery. 

By contrast, the California Healthcare Association, a medical industry group, advocates an upper limit of six patients per nurse in emergency and pediatrics, and 10 per patient in telemetry. Under the DHS guidelines, three mothers giving birth would share one nurse, and up to 12 mental health patients could be assigned to one nurse, compared to four under the CNA’s proposal. 

In pediatric intermediate care, the union envisions a maximum of three children per nurse. The industry association calls for six. 

“Now how would you like your brand new baby to be taken care of, if there was something a little bit wrong that required a critical care nursery, by a nurse who had five other people?” said Sharon Blaschka, a nurse at Alta Bates Hospital in Berkeley who said she would attend the rally along with about 80 others from the area. 

“Setting up ratios like this that are so huge is just going to destroy an already unstable health care system, and it’s going to run the nurses into the ground,” Blaschka said. 

“I think the greater issues here are working with the nursing schools and making sure that more nurses enter the field,” said Carolyn Kemp, spokesperson for Alta Bates-Summit Medical Center. “The graying of the profession is what we’re all dealing with right now.” 

Jan Emerson, spokesperson for the California Healthcare Association, a medical industry group, cited Department of Labor statistics that California has only 566 nurses per 100,000 inhabitants, compared to a national average of 798. The industry, she said, is supporting a Senate bill that would allocate $120 million annually to help train 4,000 more nurses per year throughout the state. 

Emerson warned that the law could result in curtailed patient access to health care. 

“If CNA’s ratios were adopted, 95 percent of hospitals in California would not be in compliance,” she said. “If a hospital cannot meet (the requirements), the only enforcement mechanism the state has is to close it down” if repeated citations produced no result, she said.  

Kay McVay, president of the California Nurses Association, said that lowering nurse-to-patient ratios would help the industry to save money and provide better care by reducing both turnover and costly temporary workers.  

“I believe that if we get the ratios we’re requesting we’ll be able to provide more access than we’re providing now,” McVay said. 

“The hospital industry needs to realize they would have better outcomes, their costs would be cut and they would probably experience better financial gains if they adopted a richer RN-to-patient ratio.” 

Both sides agree that the current crisis stems from cost-cutting measures implemented in the early 1990s at the advent of managed care. 

“The nursing shortage is a direct result of that initial activity by HMOs to get business by reducing prices,” said Carol Wallisch, chief of staff to state Sen. Sheila Kuehl. “So now they’re stuck with nurses not wanting to be nurses anymore and having huge workloads, and it’s really tough. (HMOs have) gotten themselves in a terrible position now. Nurses are just exhausted.” 

Emerson, the California Healthcare Association spokesperson, said that about 10 years ago, when insurers began implementing a monthly flat-fee system called “capitation,” hospitals had to cut back to a “bare minimum” of staff or face going out of business. 

“So, 20-20 hindsight. If we could do things differently we would, but that’s not about today.” 

The California Nurses Association rally will take place at the State Capitol Thursday from noon to 2 p.m.