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Staffing Ratios Go into Effect in California in 2004

By Roger P. Gilson Jr.
  • January 3, 2003

In 1999, California became the first state in the nation to enact nurse staffing ratio legislation. More than three years later, implementing regulations are still in draft form and are not expected to be released as final until November, 2003. The ratios are scheduled to take effect January 1, 2004.

Governor Gray Davis announced the Department of Health Services proposed ratios in September, 2002, establishing a one to six, nurse to patient ratio for general medical and surgical units. DHS plans to lower that ratio to one to five a year after the ratios become effective.

At a series of hearings held by DHS on the proposed ratios, both the 15,000-member United Nurses Association of California and the Service Employees International Union, which represents some 35,000 licensed nurses in California, called for lower ratios for general surgical-medical units to one to four. Both unions also called for the state to lower proposed ratios for pediatrics, stepdown/ telemetry, and telemetry units to one to three. Under the DHS proposal, the state would set the ratio for pediatrics and step down/telemetry units at one to four, and one to five for telemetry units.

The California Nurses Association, which represents 45,000 registered nurses, said the ratios should pertain only to registered nurses. In a statement handed out at the hearing, it denounced attempts by SEIU and the hospital industry to include licensed vocational nurses (LVNs) in the ratio calculations as "a direct violation of the intent of the law."

Meanwhile, the hospital industry warned that rigid ratio requirements could exacerbate an already acute nursing shortage in the state. Under the DHS ratio proposals, it is estimated that an additional 5,000 nurses would be needed to augment the 264,000 nurses now working in California hospitals.

Advocates for rules establishing nurse-topatient staffing ratios are hailing the findings of a study published October 23, 2002, as evidence that hospital understaffing is jeopardizing patients' lives. The study, published in the Journal of the American Medical Association, found that increasing a registered nurse's surgical patient load from four to six surgical patients was accompanied by a 14 percent increase in patient mortality. An increase from four surgical patients per nurse to eight per nurse would be accompanied by a 31 percent increase in mortality, according to the study. The JAMA study also cited a strong link between increases in nurse burnout and job dissatisfaction as patient loads increased. (View full text of the study, Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction, by Linda H. Aiken and others.

Editor's Note: Unions that have targeted health care workers are continuing to pressure state legislatures to enact staffing ratios and no mandatory overtime measures. These issues are being used not only in legislative campaigns but in organizing campaigns and at the negotiating table. Using these issues to solidify support among nurses and other staff, the SEIU and other, traditionally non-health care unions view the health care sector as critical to their overall survival.

Health care employers must be prepared to meet these challenges if they hope to remain free of union involvement when dealing with critical workplace issues such as staffing, overtime, the nursing shortage, increasing wage rates, and tighter reimbursement schedules.

©2003 Jackson Lewis P.C. This material is provided for informational purposes only. It is not intended to constitute legal advice nor does it create a client-lawyer relationship between Jackson Lewis and any recipient. Recipients should consult with counsel before taking any actions based on the information contained within this material. This material may be considered attorney advertising in some jurisdictions. Prior results do not guarantee a similar outcome.

Reproduction of this material in whole or in part is prohibited without the express prior written consent of Jackson Lewis P.C., a law firm that built its reputation on providing workplace law representation to management. Founded in 1958, the firm has grown to more than 900 attorneys in major cities nationwide serving clients across a wide range of practices and industries including government relations, healthcare and sports law. More information about Jackson Lewis can be found at www.jacksonlewis.com.

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