NEWS ARCHIVES
Nursing News:
Nurse-patient ratio law threatens to leave hospital beds idle
by ERIC W. JEPSON, Tehachapi News Reporter
Television cameras have been showing a regular stream of angry nurses protesting Governor Schwarzenegger for issuing an emergency order to delay implementation of a new patient-to-nurse ratio as required by a law signed by Gray Davis in 1999. The ratio was to take effect at the beginning of this year.
California Nurses Association, a union of registered nurses that has 58,000 dues-paying members, was instrumental in the billıs original passage and has come out in force against the governor, who replied, in part, by saying he is ³always kicking their butts.² The dialogue between the CNA and the governorıs office has not since noticeably improved.
Both sides claim that the otherıs stance, if followed, will be detrimental to patients. Schwarzenegger claims the higher costs associated with the required hiring of more RNs will result in further bed and hospital closures thus leaving patients without adequate facilities, and the CNA says that without more RNs per patient, care will necessarily decline as one-on-one time will decrease.
While recognizing that both arguments have been oversimplified for the sound-bite market of multimedia news, it is reasonable to say that were a chalk line to be drawn on the pavement, Tehachapi Hospital would step over to the governatorıs side.
Tehachapi Hospitalıs nurses do not belong to the CNA and feel that the 1:5 ratio required by the law is not good policy. In fact, they say that it has been tried before.
According to a press release written by three Tehachapi Hospital nurses, ³This 1:5 ratio has been tried before. It was called Primary Care Nursing. It failed because nurses wanted to do critical thinking, procedures with the physicians, documentation of the patientıs events and not do the bed baths, feeding, turning and changing patients.
³This 1:5 ratio means that the hospitals will have to make pay cuts in other areas of nursing resulting in the loss of Licensed Vocational Nurses (LVN) and the Certified Nursing Assistants who provide so much help to the Registered Nurses (RN). There is only so much money allotted for nursing salaries in any facility budget. When extra RNs are mandated, there isnıt enough money for other salaries.²
Tehachapiıs nurses feel that ³Team care always works better better for the patient.²
The reasoning is this: hire more RNs by laying off LVNs and nursing assistants. Then RNs must do all that the LVNs and assistants had done: feeding, bathing, lifting and other tasks that do not require an RNıs education. The demands imposed by these important but simple tasks reduces the time that RNs can spend making decisions that require their ³substantial amount of scientific knowledge or technical skills,² to use a description pulled from the CNAıs Web site.
With team nursing, others handle the more menial tasks and the RNs can focus on what only they are qualified to do.
The nursesı release reads, ³The CNA wants to do good things for nurses and it would be wonderful to have a 1:5 ratio with LVNs and Certified Nursing Assistants but, financially the hospitals cannot afford to keep these employees Many non-union nurses look at the mistakes made in the past and realize that this road has been traveled before it did not work then and it will most likely not work now.²
According to the California Hospital Association, nine hospitals closed in California in 2004, representing 1,458 beds.
Additionally, the U.S. Bureau of Labor ranks California 49th nationwide in the number of RNs per capita.
³Since there werenıt enough nurses to staff all the beds in the state last year, it stands to reason that the only hope that hospitals have to comply is to close more beds this year,² said Tehachapi Hospital CEO Ray Hino.
Joeanne King, who volunteers at Tehachapi Hospital, has expressed concern for ³gravely ill emergency patients who have been successfully stabilized in our hospital and are awaiting for transport to a large hospital with an Intensive Care Unit and specialized care, held for hours, and in one case more than a day, until a bed could be located. Calls were made to every appropriate facility in the state and beds were not available because there were no nurses to staff the beds.²
Patients stabilized at Tehachapi Hospital but who need care from a larger hospital have had to wait long periods of time, up to 24 and 48 hours, for a bed to open up not that beds did not exist, but that properly staffed beds did not exist.
While the patient waits, the nurses or other hospital staff call statewide in search of an open bed. Patients have been sent to UCLA, Delano, Madera even out of state wherever a bed can be found.
The CNA won the first round of legal battles, fighting the governorıs continuing of last yearıs 1:6 ration until 2008, but the California Hospital Association and the governor have not given up.
And Tehachapi Hospital is on their side.