California's hospitals will wait longer than they hoped to learn how many patients their nurses can legally care for under the state's first-of-its-kind staffing law. The state's Department of Health Services has yet to issue draft regulations over which hospitals and nurses have been lobbying since the Legislature approved the landmark legislation in 1999.
As of last week, the DHS had scheduled "no definitive date" to release preliminary regulations, said Lea Brooks, a DHS spokeswoman. Hospitals and nursing groups that have proposed their own ratios have been expecting since spring to hear the government's proposal. The DHS, Brooks said, is still engaged in the "complex effort" of gathering and analyzing data to determine appropriate ratios.
Hospitals have proposed a ratio of one nurse for every 10 patients in medical/surgical units, miles away from the one-to-four ratio proposed by the Service Employees International Union Nurse Alliance and the United Nurses Associations of California, which together represent 46,000 nurses in the state. The California Nurses Association has proposed a ratio of one nurse to every three patients in medical/surgical units.
Once the DHS issues draft ratios, it will open a 45-day public comment period and hold at least one public hearing in Sacramento.
The California Healthcare Association is concerned that if ratios aren't codified until late in the year it could be difficult for the state's 470 hospitals to meet new staffing standards by Jan. 1, 2002, when the law becomes effective.
"We realize we're running out of time," Brooks said. "We're working as fast as we can."
The process of determining which ratios to implement has cooked up a stew of controversy in which California's hospitals and nursing unions continue to swim. One point of contention centers on whether a nursing shortage complicates the task of hiring enough nurses to meet minimum-staffing requirements.
"We believe the staffing ratios will begin to correct the problems of the nursing shortage," said Beth Capell, a legislative advocate for the SEIU, which represents 35,000 nurses in California. "Hospitals that improve their staffing will find it easier to recruit and retain nurses."
That's not how the California Healthcare Association and some independent researchers view the situation. Most licensed nurses are already working, they argue, and even if the ratios do attract new people to the profession it will take years for them to materialize-too long to meet the law's requirements.
"The ratios proposed by the (California Nurses Association) and SEIU are not workable in the immediate future," said Jan Emerson, a spokeswoman for the CHA. "If what you're after is the best outcome for the patient, it's going to take years of adjusting the ratios and applying scientific research."
The SEIU has been persistent about making sure the industry and government officials consider its perspective. SEIU officials want more than one public hearing after regulations are proposed so that more nurses can comment on the rules. Armed with kazoos, drums, tambourines and other noisemakers, SEIU-led protesters participated in three rallies last week against what the group called the "powerful hospital industry."
Union representatives also argued that most California hospitals already staff their units at levels near those supported by the unions. Recent research, however, suggests otherwise. The medical/surgical units in 85% of California's hospitals are not in compliance with SEIU's proposed ratio, according to an analysis released in July by the San Francisco-based Public Policy Institute of California, a not-for-profit research group.
According to that analysis, each hospital in California will spend from $200,000 to $2.3 million per year to comply with the mandatory ratios.
Even SEIU representatives acknowledge the potential difficulty of staffing under tough new standards. If the DHS proposal meets the SEIU's standard of one nurse to every four patients in medical/surgical units, "it could be difficult for hospitals to meet that ratio," said Lisa Hubbard, an SEIU spokeswoman.