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Hospitals that are out of compliance also can self-report
and, as of Jan. 21, 86 reports were received from hospitals
that weren’t complying with the ratios in some
patient care units. One report involved a dispute over
the interpretation of the roles of RNs and LVNs and
the DHS decided the hospital was in compliance, Brooks
said.
“Anytime a new law takes effect, there’s
a transition period when clarification is needed,”
Brooks said. “For nearly 28 years, we’ve
had nurse-to-patient ratios in intensive care units.
What’s different is that ratios are now specified
in the law for other hospital units.”
| CNA
reports better staffing under new ratio law
OAKLAND, Calif.—One
month after mandatory nurse staffing ratios took
effect at California hospitals, the California
Nurses Association reported that 68 percent of
the surveyed hospitals had improved their staffing
conditions as of Feb. 4. About 59 percent of hospitals
were generally in compliance with the requirements
of the law, the CNA added.
The survey covered 111 hospitals, or nearly 30
percent of the general acute care hospitals in
California, from mid- to late January. The results
were based on interviews with registered nurses
in the hospitals, said the CNA, which sponsored
the mandatory nurse staffing ratio law.
The law, which is the first nurse staffing ratio
law in the nation, took effect Jan. 1.
The CNA announced plans Jan. 13 to survey RNs
on every unit in hospitals across the state to
measure compliance with the new law.
The announcement came on the heels of a California
Hospital Association statement that called 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.”
The CHA filed a lawsuit Dec. 30 in Sacramento
County Superior Court, just two days before the
new law went into effect.
~Rebecca Ray
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Jean Ann Seago, Ph.D., RN, a researcher on nursing
issues and associate professor in the UCSF department
of community health systems, said many hospitals are
looking for creative ways to comply with the nurse staffing
mandate. “One director of nursing created units
of 12 patients attended by two RNs and an LVN to take
care of covering for lunches and breaks. It’s
a solution that makes sense, meets the ratio and assures
continuity of care.”
The California Healthcare Association, a hospital trade
group, has filed a lawsuit, which is pending, challenging
the section of the law that requires nurses to be relieved
by “competent” and qualified caretakers
during breaks, lunch and short absences.
“My own feeling is that ratios are not going
to solve all the patient care problems, but it’s
certainly a step in the right direction,” Seago
said.
Nursing organizations themselves are split on the ratio
issue, and the American Nurses Association, while working
for adequate staffing levels for patient safety, opposes
ratios because of the inflexibility nurses have once
legislation takes effect.
Michelle Campbell, MSN, RN, president of the Pennsylvania
State Nurses Association, an ANA affiliate, said once
mandates are set, they’re difficult to change
and could result in loss of access to care in some regions.
“Unfortunately, the nurses aren’t available
to meet these ratios,” Campbell said. “I
think a lot of providers would hire more nurses if they
could.”
The California Nurses Association, which sponsored
the ratio law in California, split with the ANA several
years ago over the issue and is a founding member of
the American Association of Registered Nurses, which
advocates for ratio laws. The AARN has 80,000 members
in California, Massachusetts, Maine, Pennsylvania, St.
Louis and southern Arizona.
Regardless of their differences, nursing organizations
are united behind research from the University of Pennsylvania
and elsewhere that shows that higher levels of nurse
staffing result in improved patient outcomes, including
mortality.
Linda Aiken, Ph.D., RN, a leading researcher on the
nursing shortage at Penn, found that patients scheduled
for routine surgery were 31 percent more likely to die
in a hospital with a patient-to-nurse ratio of 8-to-1
than in a hospital with a ratio of 4-to-1. The study
was published last year in The Journal of the American
Medical Association.
Also, a Joint Commission on the Accreditation of Healthcare
Organizations report said low numbers for nursing staffs
were a factor in 19 percent of medical errors resulting
in deaths or serious injuries in hospitals. Nurses’
inadequate orientation and training were cited as factors
in 58 percent of serious errors.
“The rationale for ratios is an important thing
for people to know,” UCSF’s Dracup said.
“Clearly, research shows outcomes related to patient
safety, morbidity and mortality are related to the number
of nurses per patient and the education of the nurses.”
Contact John
Leighty at johnsan@aol.com.
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