California hospitals may need to hire thousands of nurses as soon as this week to avoid violating a fiercely contested state law mandating nurse-to-patient ratios. Then again, maybe not.
Just how many nurses California hospitals must have on hand keeps changing thanks to a bitter, five-month legal scuffle between the California Nurses Association and Gov. Arnold Schwarzenegger's administration over the state's historic nurse-patient ratios.
The nurses' union claimed a victory in the latest round, but it may be short-lived. Early this month, a Sacramento Superior Court judge reversed a legal maneuver by Schwarzenegger that relaxed emergency room ratios during unexpected surges in patients and delayed for three years a Jan. 1 tightening of ratios in medical-surgical units from 1-to-6 to 1-to-5.
Judge Judy Holzer Hersher said March 4 that California's Department of Health Services had overstepped its authority and ordered hospitals to adopt more stringent ratios. March 14 is the earliest the ruling could be enforced. However, California's Health and Human Services Agency, which oversees the health services department, and the California Hospital Association have vowed to appeal and ask a judge to block Hersher's order.
"The department is disappointed in the ruling," said California HHS' Chief Counsel Frank Furtek. California's Department of Health Services argued financial strains and the nursing shortage may jeopardize hospitals' operations and patients' access to care. "We think the court overstepped its authority," he said.
Hospital insiders said the ruling was met with confusion.
"It's a mess," said James Lott, executive vice president of healthcare policy development and communications at the Hospital Association of Southern California. "That's all I can tell you. It's a grand mess."
Hospitals already struggle to follow the ratios as nurses go on break and patient volume fluctuates, Lott said. It won't get any better under more stringent ratios. An estimated 12% of registered nurse jobs were vacant in 2004, said Lott, citing an online survey of California hospitals. Nearly 90% of California's hospitals responded to the statewide survey, he said.
The California Hospital Association estimates 4,000 nurses will be needed under the stiffer ratios, said spokeswoman Jan Emerson.
Catholic Healthcare West needs another 350 to 400 RNs to keep up with the changing law. The San Francisco-based system employs 12,000 RNs at its 40 hospitals-including 36 in California-and has vacancies for another 1,000.
"We intend to comply with the law," CHW spokesman Mark Klein said.
The CNA said hospitals shouldn't wait to adopt stricter standards. "We're dealing with minor technicalities," said spokesman Chuck Idelson. "The hospitals need to be in compliance with the law." The union continued its criticism of Schwarzenegger last week, alleging the administration appropriated $27.4 million in fiscal 2005 to cover costs of adopting strict ratios despite the governor's move to relax the law.