Legal battles over California's nurse-to-patient ratios won't end anytime soon, but courts so far have rejected hospitals' pleas to loosen the rules.
California's hospitals and Gov. Arnold Schwarzenegger continue to argue with nurses over how to follow a landmark law mandating the ratio of nurses to hospital patients. The dispute landed in court in December and spilled into the streets as the California Nurses Association launched an aggressive campaign to protest the governor's push to relax certain aspects of the ratio.
The nurses' union has won early victories, first in March and again last week, when a state court judge overturned a so-called emergency order Schwarzenegger used to ease provisions of the staffing law.
The governor used the legal maneuver to relax emergency room ratios as of Jan. 1 and delay for three years a tightening of medical-surgical unit ratios to one nurse for every five patients from the 1-to-6 ratio. On March 4, a Sacramento Superior Court judge agreed to overturn the governor's move-though only temporarily, while a lawsuit to reverse Schwarzenegger's emergency order proceeded. The governor and the California Hospital Association, which supports the relaxed ratios, appealed.
Last week, the CNA won its most definitive triumph. Sacramento Superior Court Judge Judy Hersher upheld a preliminary ruling she issued in late May that said Schwarzenegger and the California Department of Health Services overstepped their authority by using emergency regulations to relax the ratios.
The California Health and Human Services Agency and the hospital association will appeal. But in the meantime, hospitals must follow the more stringent ratios.
That has left hospitals scrambling to find 4,000 more nurses than the existing 14,000 existing vacancies in the state, says Jan Emerson, spokeswoman for the California Hospital Association. Hospitals need enough nurses to comply with the ratios every minute of every shift. "The judge's order didn't manufacture more nurses overnight," she says. Hospitals struggle to abide by the ratios as patients arrive and are discharged and nurses come and go on breaks, she says.
Chuck Idelson, spokesman for the nurses union, says ratios actually benefit California healthcare employers. The state Legislature enacted the precedent-setting ratio law to improve patient safety, he says. Ratios attract nurses seeking improved working conditions, Idelson says.
Even as fighting over the governor's emergency order continues, California health officials are working to loosen the ratios via an alternative, permanent regulatory route, Emerson says. She says she expects more legal challenges to follow.
"I think this whole issue is going to be tied up in litigation a long time," she says.
Idelson did not argue that point. If the state tries to relax the ratios again using a permanent regulatory route, "You can bet we would respond very quickly," he says.