Department of Health Services Issues Emergency Regulations to Delay Some State Nurse Staffing Rules for Hospitals

[CAL/AAEM News Service]

Department of Health Services Issues Emergency Regulations to Delay Some State Nurse
Staffing Rules for Hospitals

Source: California Healthline
(http://www.californiahealthline.org/index.cfm?Action=dspItem&itemID=107251&classcd=CL353)

Date: November 5, 2004 

  
The Department of Health Services on Thursday proposed emergency regulations that would
ease the state's new nurse-to-patient staffing ratio requirements in an effort to reduce
"the heavy financial burden the rules have placed" on hospitals, the Los Angeles Times
reports (Chong, Los Angeles Times, 11/5).

In 2003, DHS announced the regulations to implement a law signed in 1999 by former Gov.
Gray Davis (D) that was intended to increase patient safety and ease the state's nursing
shortage by improving working conditions. Under the new rules -- the first such
guidelines in the nation -- a nurse will not have to care for more than eight patients at
a time (California Healthline, 7/2/03). One part of the rules that lowered to six the
number of patients each nurse in medical-surgical units could be assigned was implemented
on Jan. 1, 2004 (Russell, San Francisco Chronicle, 11/5).

Under the regulations announced in 2003, the nurse-to-patient ratio for medical-surgical
units was scheduled to be lowered to 1 to 5 by Jan. 1, 2005. In addition, the regulations
stated that licensed vocational nurses could comprise no more than 50% of the licensed
nurses assigned to patient care and that only registered nurses could care for critical
trauma patients. The rules also required at least one triage nurse in an emergency
department to be a registered nurse. In addition, the rules said that nurses in telemetry
and step-down units could care for no more than three patients at a time by 2008
(California Healthline, 7/2/03). 

 
Proposed Changes
Under the proposed changes, DHS would delay until at least January 2008 lowering the
nurse-to-patient ratio in medical-surgical units to 1-to-5 (San Francisco Chronicle,
11/5). DHS also would give hospitals the option of temporarily suspending compliance with
staffing ratios for emergency departments -- currently set at 1-to-4 -- in case of an
"unforseeable influx" of patients (Feder Ostrov, San Jose Mercury News, 11/5).

In addition, the proposed changes would reverse a requirement stipulating that hospitals
must replace nurses on bathroom breaks. Under the proposed changes, nurses would be
considered on duty during bathroom breaks or while making telephone calls if they are
physically located in the unit, according to the Contra Costa Times.

The proposed changes have been submitted to the Office of Administrative Law, which is
expected to approve them within 10 days (Silber, Contra Costa Times, 11/5). A public
hearing on the changes likely will be held in mid-January. The proposal also would move
up the deadline for a planned study of the effect of the state's nurse staffing
requirements to make results available to DHS by early 2007. 

 
Facility Closures Contributed to Decision
DHS officials said they believed it was urgent to revise the new rules after 11 hospitals
cited the staffing requirements as contributing to facility closures or service
reductions. According to the Los Angeles Times, 68 hospitals across the state have
petitioned DHS for waivers from the ratios or greater flexibility to handle their
implementation. The California Healthcare Association estimates that 85% of hospitals in
the state currently do not meet the existing nurse-to-patient ratio requirements (Los
Angeles Times, 11/5). 

State officials said that hospitals that have complied with the new ratios have had to
turn away ambulances, leave beds empty and reduce support staffing levels to make funds
available for nurse salaries. "We never intended for people to be denied immediate care
because the hospital could not meet the staffing ratios," Brenda Klutz, deputy director
for licensing and certification for DHS, said (Rapaport, Sacramento Bee, 11/5).

DHS Director Sandra Shewry, who announced the proposed changes, said, "These changes
provide common-sense flexibility for hospital emergency departments and clarify language
in current regulations." She added, "Because we do not yet understand the impact of these
groundbreaking ratios on the state's fragile health care delivery system, we must move
forward cautiously" (Los Angeles Times, 11/5). 

 
Supporters' Reaction
Jan Emerson, a spokesperson for CHA, said the proposed changes are "a step in the right
direction," adding, "We've been having conversations" with the administration of Gov.
Arnold Schwarzenegger (R) for "nearly a year about the overall fragile state of our
health care system" (San Francisco Chronicle, 11/5).

Klutz said DHS decided to delay the new ratios until 2008 so that officials could perform
a two-year study to ensure the requirements do not have unintended consequences. She
added, "We really believe that the minimum ratios we've had in place since Jan. 1 are
really good for patient care. (But) when we start to hear these signs and symptoms, we
really have an obligation to slightly pause" (Contra Costa Times, 11/5). 

 
Opponents' Reaction
However, Jamie Court -- president of the Foundation for Taxpayer and Consumer Rights, a
consumer advocacy group that supported the nurse staffing rules -- said, "This is pure
political payback for the governor's biggest contributors -- this from a governor who
said he would not be beholden to special interests" (San Francisco Chronicle, 11/5).

Deborah Burger -- president of the California Nurses Association, which supports the
existing regulations -- said, "We're furious that [Schwarzenegger] has bowed to the
pressure of the hospital industry in weakening patient protections for the citizens of
California" (Contra Costa Times, 11/5). Burger warned that easing the requirements will
mean fewer nurses to care for patients, which could lead to longer waits in hospital EDs
(San Jose Mercury News, 11/5). She also said that the revised regulations for EDs are "so
vague that they can do virtually whatever they want" (San Francisco Chronicle, 11/5). 



=====
Cyrus Shahpar & Brian Potts 
Managing Editors, CAL/AAEM News Service 
UC-Irvine



		
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