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New Law on Nurse-Patient Ratios Draws Mixed Reaction
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10-18-99 Sacramento, Calif. California became the first state to mandate nurse-to-patient staffing ratios Oct. 10, when Gov. Davis signed Assembly bill 394 into law. Written by Assemblymember Sheila Kuehl, D-Santa Monica, the bill directs the California Department of Health Services (DHS) to develop specific staffing ratios for licensed nurses working in general acute care hospitals and acute psychiatric hospitals. Despite strong objections by the hospital industry, Davis signed the bill, calling registered nurses "a critical component in guaranteeing patient safety and the highest quality of care." The California Nurses Association (CNA), which represents 30,000 nurses in the state, fought for the bill and is pleased with the outcome. "This is so significant because it is going to allow nurses to have some control over their patient care," said Kay McVay, RN, CNA president. "You can't have control when you're on roller skates, as it's been for the last five or six years." But hospital organizations do not share that perspective. "The hospitals are very disappointed and are very concerned about the fact that we don't have nurses to fill these slots at this time," said Dorel Harms, MS, RN, vice president of quality and professional services for the California Healthcare Association. "For the legislature to pass, and the governor to sign, a bill that the hospitals cannot comply with because there are not the number of nurses available is of great concern." Many feel the new law will have national implications as the rest of the country faces similar issues. "This is a signal that nurses' and healthcare consumers' concerns over nurse staffing have reached critical mass," said Beverly L. Malone, PhD, RN, FAAN, president of the American Nurses Association, in a written statement. "If the healthcare industry continues to dig in its heels ... we can expect to see more and more bills on the floors of state legislatures calling for mandated minimum nurse-to-patient ratios." Kuehl initially introduced the bill at the request of the CNA in 1997, but found that personal experiences reinforced her support. "I liked the idea of it because, like many in my generation, I have spent time in hospitals with my parents," she said. "It became clear to me that nursing was being stretched thinner and thinner, and I could see how dangerous that was for the patient and how burdensome and troubling to the nursing staff." The lengthy and difficult job of hammering out the specifics of the mandate now falls to the DHS. "It is probably going to be a bloody fight," McVay said, "but it is one we need to do because it will benefit the vast majority of the California public." "I don't think it's necessarily going to be 'bloody,' " said Jim Lott, executive vice president of the Healthcare Association of Southern California. "We know from the governor's office that there will be an earnest attempt to involve as broad a spectrum of providers as possible, and if the administration is serious about their approach, I think this can be worked out and done rationally and reasonably." AB 394 originally called for an implementation date of Jan. 1, 2001. But when Davis agreed to sign the legislation, he requested that Kuehl introduce another bill in the next legislative session delaying implementation by at least a year, which she agreed to do. If that bill passes, the earliest implementation date will be Jan. 1, 2002. University of California hospitals and other tertiary facilities with staffing demands unique to teaching institutions will be given more time to comply with the law.
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