California Becomes First State to Mandate Nurse-to-Patient Ratios
By KAY BENSING, MA, RN
On October 10, the California Nurses Association (CNA) hailed the signing of nurse:patient ratio legislation that makes California the first state in the nation to require safe hospital staffing and pledged to begin work immediately to implement the new law. The CNA-sponsored bill was signed by Governor Gray Davis.
"This is one of the most significant days in the history of nursing," proclaimed CNA president, Kay McVay, RN. "This bill will save the lives of countless numbers of patients needlessly endangered by unsafe conditions."
"This is a signal that nurses' and health care consumers' concerns over nurse staffing have reached critical mass," commented American Nurses Association (ANA) president. ANA supported the bill's passage.
"Too often managed care has meant managed cost. If the health care industry continues to dig in its heels and fight for false economies on the backs of patients and RNs, we can expect more and more bills on the floors of state legislatures calling for mandated minimum nurse-to-patient ratios," noted Dr. Malone.
Ratios to be Established
California AB 394 went through several major changes before it reached its final form, most notably that specific numeric ratios were removed from the bill. As it stands now, the California Department of Health Services (DHS) is mandated "to adopt regulations establishing minimum, specific and numerical licensed nurse-to-patient ratios for all hospital units." according to CNA's press release. Presently, ratios exist for intensive care units and operating rooms.
The law also prohibits hospitals from requiring unlicensed, minimally-trained personnel to perform nursing functions such as invasive procedures, patient assessment, patient education and administration of medication.
Originally the law was to go into effect by Jan. 1, 2001. However, hospitals expressed their concern that they could not meet this timetable. A compromise was struck to ensure the Governor's signature--it will now be implemented on Jan. 1, 2002.
The hospital industry made defeat of the nurse-to-patient ratio bill "its top legislative priority this year," noted CNA Executive Director Rose Ann DeMoro. "The reason is that this is the only genuine reform that actually affects the delivery of patient care at the bedside. At a time when the industry has placed cost cutting ahead of safe care, this law allows the health care professional to regain control over the health care system from the bottom up."
While ANA supported passage of the nurse-to-patient ratio bill, Dr. Malone voiced concerns about its implementation. "While we're glad that passage of the California nursing staffing mandate has once again focused public attention on RN understaffing, we're also concerned that mandated minimum ratios don't become staffing ceilings," she cautioned.
"If an institution simply states that it has met a mandate because it has x number of RNs per patient in a unit that fails to address other significant concerns. Some of these nurses may be floaters who may be newly graduated nurses who need to become acquainted with the protocols of the unit to which they're assigned," Dr. Malone explained. The California bill requires that nurse "floats" and other temporary nursing personnel receive orientation to a unit.
Kay Bensing is a consultant to ADVANCE.