California Gov. Gray Davis has until Oct. 10 to sign legislation that would set nurse staffing ratios for acute-care hospitals. The bill is believed to be the first such measure to pass a state legislature.
To the chagrin of the 475 hospitals in the state, which represent nearly 10% of the nation's acute-care facilities, the California Legislature on Sept. 9 passed the nurse staffing bill promoted by the California Nurses Association.
Davis has not indicated whether he will sign the bill.
The passage of the measure hasn't stopped the California Healthcare Association from stepping up its lobbying campaign to defeat the bill. The CHA has asked its hospital members to send letters to the governor's office describing what the law will cost in money and disruptions.
The bill instructs the state Department of Health Services to set minimum nurse-to-patient ratios for all hospitals by Jan. 1, 2001.
It also prohibits hospitals from assigning unlicensed staff to perform such clinical functions as assessing patients, dispensing medications and performing invasive procedures. The bill covers registered nurses and licensed vocational nurses.
In model federal legislation called the Patient Safety Act, the American Nurses Association proposes requiring hospitals to disclose their staffing mix and staffing ratios to the public, but the ANA has never pushed for legislated nurse staffing ratios.
"Our concern about ratios is that if you establish a minimum, that can also become a ceiling," said Joan Meehan-Hurwitz, ANA director of communications.
The ANA said that nationwide the only legislation like the pending California bill is a California law that mandates nurse-to-patient ratios in intensive-care units and operating rooms.
The CNA bill allows the DHS to raise the nurse staffing ratio in those units but not diminish them.
An earlier version of the bill that included specific ratios would have cost the state's hospitals $700 million per year, the CHA estimated. Until the ratios are established, the association can't estimate the cost of the bill that passed.
"We don't know how the DHS will set the ratios," said Dorel Harms, CHA vice president for professional and clinical services. "There are no specific regulations in the legislation. We hope they will convene a group of the interested parties" to write them, she said.
At the Healthcare Association of Southern California, Executive Vice President Jim Lott said his members strongly oppose such "cookie-cutter ratios" as the bill requires.
The bill also includes some inequities, Lott said. Public hospitals in Los Angeles are exempted from the regulations for one year. The county system didn't request that, but Assembly member Sheila Kuehl, a Democrat from Santa Monica, wrote it into the bill.
"That suggests that the Legislature thinks it's OK for indigent people to have a different standard of care" than others do, Lott said.
The CNA mounted a vigorous campaign, including rallies in major cities, to support the bill. Jill Furillo, CNA legislative director, said the bill passed because of "overwhelming calls by nurses and patients across the state to stop the hemorrhaging of safety standards in California hospitals."
The CNA says California hospitals have a lower nurse-to-patient ratio than hospitals in any other state.
Harms said the CHA supports a patient classification system that evaluates each patient's needs and sets staffing accordingly. That is what state law, which went into effect in January 1997, now requires. It hasn't been determined how well the system works, she said.
The fact that the governor is a Democrat elected last year with the broad support of unions, including nurses associations, would seem to indicate he'll sign the bill. However, Davis' declared intent to govern from the center, coupled with the hospital industry's serious concerns, might give him sufficient reason to reject it.