Nursing

Hospital group files suit in opposition of new CA ratio law

Nurse Leader Weekly, January 19, 2004

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Most California hospitals say they can't heed the new state law mandating smaller nurse-to-patient ratios than currently exist in most hospital departments. These hospitals say their lack of compliance leaves them vulnerable to lawsuits, loss of reimbursement dollars, and cutbacks in patient services.

In response, the California Healthcare Association (CHA) has filed a lawsuit against the California Department of Health (CDH) in an effort to ease the law, which took effect January 1, and which requires round-the-clock compliance. The lawsuit addresses the requirement that the ratio be met at "all times," including during breaks and lunches. Traditionally, nurses would cover for one another when one goes on break, to lunch, or to the rest room. The suit seeks to loosen the regulation to require that the ratio be met only at the beginning of a shift.

Hospital officials say the state's nursing shortage has made it difficult to hire enough nurses to cover breaks, said Jan Emerson, spokeswoman for the CHA. "Hospitals have been put in the position to violate the law."

The CDH has already received some complaints that hospitals aren't complying with the law, and some hospitals have reported to the department that they aren't able to meet the new standard, said Lea Brooks, a department spokeswoman.

According to Brooks, the CDH will send officials to hospitals to investigate complaints. Citations could be issued to hospitals found out of compliance, but those citations don't carry a financial penalty. A hospital would then need to submit a plan to get into compliance. Hospitals that have requested leniency will be handled case by case.

The CDH has suggested that hospitals reduce patient volumes to better match their number of nurses by cutting back on elective surgeries, discharging patients more quickly, or by not admitting as many patients, according to the lawsuit.

"That's not an option," said Emerson. "A hospital's mission is to care for patients, not turn them away."

The pressure on hospitals to hire more nurses is expected to get worse. Patient volumes are expected in increase in the next several years as the state's population increases and baby boomers age. In addition, the ratios in some units will tighten in the next few years. Currently, medical-surgical units have a ratio of one nurse for every six patients. In January 2005, the ratio will tighten to one nurse for every five patients.

California now ranks 49th in the number of registered nurses per 100,000 population, according to the U.S. Department of Health and Human Services.

The state Employment Development Department estimates California needs to hire an additional 30,000 registered nurses in the next three years. Meanwhile, hospitals can expect to be challenged on the ratios. The nurses' association has started to recruit union members to be official monitors in hospitals where they have a presence.

Source: The Silicon Valley/San Jose Business Journal



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