Governor announces mandated nurse-to-patient ratios for state

By Simon Avery The Associated Press
Wednesday January 23, 2002

LOS ANGELES — Gov. Gray Davis released proposed government ratios Tuesday that would mandate the number of nurses to patients in California hospitals. 

The new rules, still to go through a normal regulatory review process, will make California the first state in the nation to set minimum nurse staffing levels. 

Officials from the Department of Health Services have spent more than two years developing the ratios, which were legislated in a 1999 bill. 

Nurses responded enthusiastically to the requirements, saying they will improve patient care and stem the tide of nurses leaving hospital jobs because of poor work conditions. 

“This is the most sweeping systemic health care reform that you’re going to see,” said Rose Ann DeMoro, executive director of the California Nurses Association, which represents some 40,000 nurses. “This measure will effect every hospital in the state of California.” 

Some other states are watching California’s lead, including Massachusetts, where law makers have discussed a similar plan. 

Julie Pinkham, executive director of the Massachusetts Nurses Association, said the California regulations will likely have a national impact. 

“Nurses across the country are waiting for this. California has put it out there. Now it’s going to go across the nation. It’s long overdue,” she said. 

Under the California proposal, every four patients put through triage in an emergency room will be assured at least one nurse between them. Currently, the ratio averages between 1-to-6 and 1-to-8, DeMoro said. 

In general medical and surgical wards, there will eventually be a minimum of five nurses per patient, compared with a wide range of existing ratios, that vary from 1-to-3 to 1-to-20, she said. 

California already imposes staffing requirements in some hospital units, including intensive and critical care, operating rooms and nurseries, but hospitals have been free to assign nurses as they wanted in other areas. 

The hospital industry said the new rules will be a financial burden and could actually hurt patient care because of a severe nurse shortage in the state. 

“Although hospitals will obey the law, the way we meet the law may have unintended consequences,” said Jan Emerson, vice president of external affairs for the California Healthcare Association, which represents nearly 500 hospitals in the state. 

If a hospital has 10 available beds in its emergency room, but only enough nurses to staff five of them under the new law, the remaining beds will have to be taken out of service, Emerson said. 

Already, California hospitals are operating with 15 percent fewer nurses than they need, and by 2006, the state is forecast to have a shortage of 25,000 registered nurses. California ranks second last among all states in terms of nurses per capita, she said. 

Davis said 5,000 additional nurses will be needed to implement the staffing ratios. That represents the total number of new nurses the state trains each year just to keep up with attrition and population growth, Emerson said. 

The California Nurses Association, however, said there are already enough nurses in the state to meet the proposed ratios. 

“They just won’t work in the hospitals,” said DeMoro. “We must make hospitals an appealing place for nurses to come back.” 

Almost two-thirds of California hospitals lose money today, and some said the new mandated ratios bring an additional financial burden. 

“This is one of those unfunded mandates that can have a negative impact on our industry. It’s difficult to pass the costs on,” said Bill Gleeson, spokesman for Sutter Health, a not-for-profit network of 26 hospitals in Northern California. 

The California Healthcare Association estimates that the new regulations will cost hospitals a minimum of $400 million a year in extra wages and benefits.