California's controversial nurse-staffing law took one big step toward becoming reality last week as Gov. Gray Davis and the state Department of Health Services approved final regulations on the ratios that are set to take effect Jan. 1.
DHS revised a handful of issues regarding ratios and record keeping after hearing comments from hospitals and nurses last fall during three public hearings.
The revisions in the package approved by the governor and the DHS last week include changes in ratios in three hospital areas by 2008. Step-down units housing patients just transferred from critical- or intensive-care units will drop to 1-to-3 in 2008 from 1-to-4 in 2004, while ratios at telemetry units and specialty-care units, such as oncology and rehabilitation units, decrease to 1-to-4 from 1-to-5 during the same four-year period.
Also, hospitals will be required to document staffing assignments and keep the records for one year, which will help the state make sure hospitals are complying.
The ratios will require hospitals to staff one nurse for every six patients in medical-surgical units in 2004, dropping to 1-to-5 the following year. Intensive-care units would operate with a 1-to-2 nurse-to-patient ratio.
The new ratios were applauded by the California Nurses Association, which called the staffing legislation the beginning of a new era in healthcare. The association, which represents 50,000 nurses in the state, lobbied for the last 10 years to enact the law, the first nurse-staffing legislation in the nation.
"The finish line is finally near," CNA president Kay McVay said.
DHS will accept public comments on the final regulations through July 17, but it is unlikely any changes will be added to the legislation, a CNA spokesperson said.
The California Healthcare Association, which represents 500 hospitals and health systems, is opposed to the legislation. "We are disappointed the department isn't recognizing the impact of nursing shortages on hospitals' ability to meet these ratios," CHA spokeswoman Jan Emerson said. "There are some unintended consequences."
Hospitals will likely have to shut down certain units or reduce the number of beds because they won't be able to meet the mandated ratios, she said. "The bottom line is there are not enough nurses in the state of California," Emerson said.