Hospitals show difficulty meeting nurse ratio requirements

Daily Sundial

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Hospitals throughout California are under pressure to satisfy a new requirement that calls for one nurse on duty for every five patients, at all times.

Some hospitals are falling short.

The law requires that hospitals adhere to staffing levels set by the state’s Department of Health Services. In 1999, when the law was passed by then-governor Gray Davis, the department decided on a 1-to-6 ratio that would begin in 2004. By January 2005, the law stated that the ratio would change to 1-to-5.

In order to ensure that they are complying with the new 1-to-5 nurse-staffing ratios, hospitals have started hiring temporary nurses from outside the state, and making resident nurses work longer shifts.

“There (are) not enough nurses to enable these ratios to work,” said Jan Emerson, spokesperson for the California Hospital Association.

The U.S. Bureau of Labor Statistics ranks California 49th nationwide in the number of registered nurses per capita.

According to Emerson, in order for the ratio requirements to be implemented practically, 18,000 more nurses would need to be immediately hired in California.

Emerson said that in order for hospitals to fully comply with the order, five nurses per patient would have to be in every unit, every minute of the day.

“If the hospital is out of ratio for five minutes, (they’re) technically breaking the law,” Emerson said. “If a nurse takes a bathroom break or steps away to take a phone call, she needs to reassign her patients to another nurse, or else the hospital is in violation.”

The shortage of nurses has forced hospitals to turn away ambulances and non-life threatening surgeries, Emerson said.

Deborah Burger, a nurse at Kaiser Hospital in Sonoma, sees the ratio requirement as a necessity.

“These ratios are absolutely necessary to provide safe care to patients and get them out of the hospital alive,” Burger said. “If that requires (the hospitals) to close a bed because they don’t have a nurse, then that’s what they have to do.”

Burger, who is also the president of the 60,000-member California Nurses Association, said the ratios will make hospitals safer for both nurses and patients.

“Over time, we’ve been able to prove that better staffing improves patient health,” Burger said.

Burger said she finds the allegation that California is suffering from a nurse shortage hard to believe.

“(University of California) hospitals all follow the 1-to-5 ratio,” Burger said. “Kaiser hospitals do even better.”

According to the California Nurses Association’s website, the number of actively licensed nurses in California has increased by more than 43,000 in the past five years.

Despite the increase, it still may not be enough. Many hospitals are still in need of nurses, and these institutions are seeking outside help.

Some hospitals are enlisting the help of staffing agencies to send nurses from around the country, called “travel nurses.” Travel nurses make about $8 more per hour than permanent hospital staff nurses, and their rooms and transportation are often covered by the agency.

While some may see this as a temporary Band-Aid solution to a growing statewide problem, Emerson said hospitals need to do what they can to hire more nurses and fulfill ratio requirements.

“We just don’t have enough nurses in the state, and that’s a big problem,” Emerson said.