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The hospital industry was disappointed with a Superior Court judge's decision to uphold the "at all times" provision of California's nursing staffing law, according to Dorel Harms, RN, vice president of the California Healthcare Association.

A judge’s ruling upholding the “at all times” provision of California’s bellwether nurse staffing law came as good news to Malinda Markowitz, RN, who works in the medical/surgical unit at Good Samaritan Hospital in San Jose, Calif.

Before the new minimum nurse-to-patient ratios, Markowitz often felt overwhelmed with the number of patients she had been assigned.

“There were times when I didn’t know if I could adequately take care of patients,” Markowitz said. “I was frightened for my patients and frightened for myself.”

She’s pleased the law remains intact, including a requirement that the ratios be maintained during lunches and breaks. In May, a superior court judge upheld the “at all times” section by rejecting a challenge filed Dec. 30 by the California Healthcare Association on behalf of the hospital industry.

Numerous states are watching California’s ratio laws with interest and similar legislation is being pursued in Pennsylvania, New York, and Massachusetts.

The most advanced proposal is in Massachusetts, where a bill has been passed by the state senate that would phase in ratios of 1-to-4 in medical/surgical units in all Massachusetts hospitals during a three-year period, with 10 hospitals required to adopt the ratios in the first year, 15 more in the 2006, and the remainder in 2007.

“California’s nurse staffing model has laid the groundwork for nursing groups across the country,” said David Schildmeier, spokesman for the Massachusetts Nursing Association, adding that the court ruling on the “at all times” provision was closely watched across the nation.

Schildmeier is optimistic that the Massachusetts legislation will pass, and he hopes this will help inspire the growing movement toward safe staffing laws.

Ratio’s benefits

Although Markowitz still has a busy schedule, she said the minimum 1-to-6 nurse-to-patient ratio mandated in med/surg for 2004 has relieved job stress and allows her to give patients more personal attention. When the ratio changes to 1-to-5 as required by the law in January, Markowitz believes she and other nurses will finally find time for an often neglected responsibility — providing emotional and spiritual support to patients.

“Patients are older, sicker, and more fragile than in the past and need more complex treatments and medications,” said Markowitz, who started at Good Samaritan as a nursing assistant in 1978 and then transitioned to med/surg after earning her nursing degree. “We need to be able to anticipate what patients need and be there to provide it before they ask us.”

Julie Clayton, RN, chief nursing officer at Good Samaritan, said the facility has worked hard to meet the ratios, hiring 34 nurses this year and budgeting $4 million for recruitment and retention programs to help meet the mandate with its staff of about 650 nurses. However, the hospital also paid $50,000 in overtime penalties to nurses in the first three months of this year because of difficulties in meeting the “at all times” provision of the ratios.

Dorel Harms, RN, vice president of the health care association, said the hospital industry was disappointed with the judge’s decision and that many of the state’s 500 hospitals will have a difficult time complying with the “at all times” provision because of the nursing shortage and financial considerations. She said the association would look at additional legal options for challenging the legislation.

“As a result [of the ruling], hospitals may have to delay admitting new patients, discharge patients sooner, or cancel elective surgeries — all in an effort to comply with the experimental nurse ratio regulations,” Harms said.