Nursing News:
California hospitals in trouble over ratios

By Harry Saltzgaver
Starting in January, California hospitals were required to comply with state-mandated nurse-patient ratios. The law, AB 394, actually was passed in 1999, but the health department and hospital representatives have been negotiating ways to meet the requirements.
The negotiations didn¹t work. Under the current regulations, hospitals must be in compliance with nurse-patient ratios every minute of every day. That includes every department, from the emergency room to the intensive care unit. Required ratios vary with the type of care being provided. In the general medical and surgical recovery wing, one nurse is expected to take care of six patients, while there is supposed to be one nurse for every two patients in the intensive care unit. The ratio is one to four in the emergency room.
While there is a general nursing shortage, hospitals typically can meet those targets at the beginning of a shift, according to Byron Schweigert, CEO of Long Beach Memorial Medical Center. It is the first time three patients come into the emergency room at the same time, or even when a nurse goes on break, that becomes the problem. ³We can try to anticipate the need, but if there is a significant spike in the patient load, there is no way we can stay in compliance,² Schweigert said. ³At the beginning of the year, we told the Department of Health Services we would self-report when we were out of compliance. After a month or so, they told us the didn¹t want them any more because they couldn¹t do anything with them.
Schweigert said he and other hospitals continue to keep track of the ³violations,² but are turning their attention to getting the regulations changed. He said that the vast majority of hospital staff have opted to do the best they can to serve patients and break the ratios when necessary.
Ray Jankowski, CEO at Community Hospital of Long Beach, said the added regulation is just putting another burden on struggling California hospitals. For newer, smaller operations such as Community who are having trouble attracting enough permanent nurses, there is a direct hit to the bottom line, Jankowski said. ³We¹re forced to bring in more and more outside people, registry nurses,² Jankowski said. ³In the first place, we need to bring them up to speed and there is a loss of continuity. Then there is the cost.
³I typical registered nurse will make in the low $30s (per hour). When you hire per diem nurses, they¹re in the high $30s. But when you have to go to the registry to meet the ratios, you¹re talking in the $60s and $70s an hour. Even without benefits, that¹s very costly.
³Add the fact that the Medicare reimbursement is essentially flat, and we¹re in trouble. California¹s hospitals are already over-regulated, and this regulation is not adding any value while it is adding costs. If the state legislature doesn¹t act this year, the ratios are supposed to become even more stringent next year. Schweigert and Jankowski have joined with the Hospital Association of Southern California in a lobbying effort to change the law, and has won the Long Beach Chamber of Commerce to its side. The Chamber¹s Government Affairs Committee has endorsed the effort to change the law.
In the meantime, Long Beach Memorial has taken steps to deal with the broader issue of nurse shortages. Another state ratio law, this one limiting one instructor to 12 nursing students, has caused a severe lack of space in nursing schools. Schweigert said that 432 candidates applied last year for the 72 available slots in the California State University, Long Beach, nursing program.
To ease that shortage, Memorial has partnered with CSULB to bring nursing education to the hospital campus. In a program first announced in January, Memorial is establishing a satellite nursing campus at its hospital complete with a simulator laboratory and clinical experience.
³We decided to work pro-actively,² Schweigert said. ³We provide the class space, the teachers.² When we¹re done, we will have added another 108 students per year to the program, and we¹re setting it up with three semesters a year so the can get their bachelor of science in nursing in two years instead of the three it takes now. ³We¹re also making an offer to all the nurses in the program to pay for their education ‹ tuition, books, fees, the whole thing ‹ if they will in return agree to work here for two years. We think that will ultimately go a long way to resolve the shortage, at least in Long Beach.²
Copyright Gazette Newspapers,Inc. 2004.