|
Continued from Page 1
Strict interpretation
Strict interpretation of the law requiring ratios to
be maintained “at all times” is almost impossible
to meet, Patton said. Some hospitals are trying to comply
by hiring extra nurses through agencies at premium prices.
The cost of hiring eight to 10 nurses to fill in for
breaks and absences could cost as much as $1 million
a year, Patton said.
Patton also said many ER departments are strained and
adding more diversion hours, when ambulances are turned
away because of hospitals’ inability to maintain
the required 1-to-4 nurse to patient ratio at all times.
Kathleen Dracup, DNSc, FNP, RN, dean of the University
of California, San Francisco School of Nursing, said
the ratio law was passed because many hospitals in California
used too few nurses in some busy units, jeopardizing
patient safety.
“We have anecdotal reports of 10 patients for
one nurse on surgical/medical floors. Years ago that
might have been safe because patients weren’t
as sick and stayed for longer times. Now, the patient
population is older, sicker, more vulnerable and needs
to be assured that enough nurses are available.”
Dracup said UCSF met the nurse staffing requirements,
but like many other hospitals, was blindsided somewhat
by a strict ruling late last year from the California
Department of Health Services that ratios had to be
maintained at all times.
“This means that a nurse who has five patients
on a med/surg floor, for example, must have a nurse
substitute when they’re away from the bedside
on a break, during lunch or in an educational meeting.
In the past, nurses have substituted for each other,
giving them a lot of flexibility.”
UCSF, she said, has hired a rotating staff to fill
in for nurses when they leave the bedside for short
periods. “Most hospitals were caught off guard
by this rule and it’s going to take awhile for
them to figure out how to do it,” Dracup said.
Another barrier to meeting ratios is the continuing
nursing shortage, Dracup said. Although UCSF has a good
retention rate among its 1,700 nurses because of the
attractive work environment and opportunities, other
hospitals aren’t so fortunate.
“Unfortunately, the shortage continues unabated
and projections outstrip supply because of the aging
population,” said Dracup, adding that even a 17
percent increase in nursing school enrollments nationally
won’t stop an estimated shortage of nearly 500,000
to 1 million nurses by 2020.
The DHS has estimated that 5,000 additional nurses
would be needed to meet the mandate at an annual cost
of $900 million for all hospitals in the state. The
department also estimates the state will have a shortfall
of about 30,000 nurses by 2006.
In the first three weeks of the mandate, the DHS received
67 requests for flexibility and waivers from hospitals.
Nine were denied, two were found to be in compliance
and one waiver was approved. The other cases are pending.
“Hospitals can request waivers, but they have
to be rural and meet certain conditions,” said
DHS spokeswoman Lea Brooks.
Brooks said 54 complaints also were filed over noncompliance,
mostly anonymously, and these were reviewed to determine
if patient lives were at risk. The department ended
up investigating just one case. “We found the
hospital was clearly not meeting the ratios; however,
we did not find patients at risk.” In such cases,
Brooks said, hospitals must prepare a plan of correction.
|
Reply
to Article