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A question mark surrounds California’s first-in-the-nation nurse staffing ratios law after Gov. Arnold Schwarzenegger flexed his executive muscle to freeze for three years the implementation of tougher standards that had been mandated to start Jan. 1.

Schwarzenegger’s executive action Nov. 5 could postpone indefinitely the scheduled lowering of nurse-to-patient ratios in medical/surgical units from 1-to-6 to 1-to-5 at about 450 California hospitals. The decision comes in the wake of a dozen hospital closures that the industry partially blames on the financial strain of recruiting and retaining registered nurses to meet ratio requirements.

Meeting the legislative mandate for ratios has cost the hospital industry $422 million in 2004, a figure that would jump to about $550 million in 2005 if med/surg ratios were lowered further, said Jan Emerson, spokeswoman for the California Healthcare Association. The med/surg ratios affect about one-third of all nurses.

“Ratios haven’t been the only factor, but they’re a contributing factor to hospitals struggling to survive along with the high number of uninsured patients, inadequate Medicare rates, and seismic upgrading requirements,” Emerson said. “A big issue is the basic fact that there’s not enough nurses available to fill the ratio requirements.”

Rules announced by the state Department of Health Services also give hospitals the option to suspend 1-to-4 staffing requirements in emergency departments in cases of an “unforeseeable influx” of patients. The action, which must be approved by the state Office of Administrative Law, also calls for a two-year study by the DHS on the impact of ratios on hospitals and patient care issues.

A planned celebration of the milestone safe staffing mandate has turned to political protests by the 70,000-member California Nurses Association, which aggressively sponsored the legislation signed into law in 1999 by former Gov. Gray Davis and that took effect Jan. 1, 2003.

The CNA said Schwarzenegger is showing a “disregard for patient safety” by bowing to the multibillion-dollar hospital industry after the program showed good results in its first year.

“Not only have ratios been very successful, they’ve helped bring more RNs into the California workforce and improved safety conditions in hospitals,” CNA spokesman Chuck Idelson said. “One area where they’ve been particularly effective is emergency rooms, which are also targeted for attack.”

He said the CNA was evaluating its options in opposing the governor’s plan.

The DHS said 78 complaints have been filed against hospital units since the ratios took effect; of those, 15 were found to have staffing deficiencies that required a plan of correction. At no time, however, was patient safety an issue, DHS Director Sandra Shewry said.

Richard Holober, executive director of the Consumer Federation of California, called Schwarzenegger’s action “an attack on patient safety and a gift to the hospital bosses who bankroll his campaign committees.”

Studies have shown a strong correlation between improved nurse-to-patient staffing and lower rates of preventable patient deaths, medical errors, and other adverse outcomes, he said.

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