"Hospitals bemoan nursing rule."
"Rural facilities call lower patient-staff ratio challenging."
"New law increases demand for nurses."
"Nurses feel pressure of new law."
"Lodi hospital fails to meet nurse ratio."
"Hospitals: Ratios leave us at risk."
"Nursing crisis growing in California."

The list above represents a tiny sample of the headlines that have appeared in California newspapers since Jan. 1, when the nation's first nurse staffing ratio law went into effect. The headlines tell a story of confusion, anxiety and uncertainty over the mandated staffing minimums, cast against the backdrop of a war of words between the California Healthcare Association and the California Nurses Association.

The CNA announced plans Jan. 13 to survey RNs on every unit in hospitals across the state to measure compliance with the new law.

According to a news release, the union would like to complete the survey by Jan. 30 and publicize the results. "With the audit, we hope to provide a more detailed answer for patients and their families to assess how their local hospitals are faring," CNA President Deborah Burger, RN, said in the news release.

The announcement came on the heels of a CHA statement calling the suspension of acute care services at Santa Teresita Hospital in Duarte a "tragic consequence of California's unrealistic and unachievable nurse-to-patient ratio regulations."

C. Duane Dauner, president of the CHA, said, "The stated goal of these untested regulations is to protect and enhance quality patient care.

Unfortunately, the manner in which the California Department of Health Services has chosen to interpret these regulations is instead jeopardizing the public's access to care."

The industry association made a similar argument in a lawsuit filed Dec. 30 in Sacramento County Superior Court, just two days before the new law, signed by then-Gov. Gray Davis in 1999, went into effect.

Nurses across the state are expressing a broad range of opinions about the new law. [Two letters to NURSEWEEK, published in the Readers Forum (See Page 5), reflect the mixed emotions. One praises the intent of the new law but raises concerns about its impact on patient care. Another reader reports she was disciplined after complaining that the new requirements were not being met.]

News media accounts from across the state suggest that the impact of the new law differs from city to city, from facility to facility and even from unit to unit. For example, Kaiser Permanente, which is not supporting the CHA lawsuit, reports that it is in compliance. Other hospitals report that they are unable to meet the requirements and are asking the state for leniency, which officials say will be considered on a case-by-case basis.

Although hard numbers remain elusive, early indications are that hospitals in rural communities may face the biggest challenges. The Lodi News-Sentinel reported that Lodi Memorial Hospital was unable to comply despite closing 12 of its beds while searching as far away as Ohio for 35 new nurses.

"We don't have trees we pick nurses off," Anna Engman, director of nursing for Mayers Memorial Hospital in Fall River Mills, told the Redding Record Searchlight.

"Our plan is we're going to do our best."

Contact Tim Graham at timg@nurseweek.com

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