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MASSACHUSETTS NURSE NEWSLETTER ::
November/December 2007
Panel from California wows crowd and committee at hearing
Even as the wildfires in Southern California
threatened their homes, a group of nurses and
health care executives from California testified
before the Joint Committee on Public Health
on Oct. 24 about how well safe nurse staffing
limits are working in that state.
California is the only state in the country
that has instituted limits on the number of
patients a nurse must care for at one time. The
limits were implemented about three years
ago. Since that time, the number of actively
licensed RNs in California has increased by
over 60,000.
Furthermore, the California Health and
Human Services agency reports that hospitals
in the state have not had difficulty meeting the
new requirements. “Our data shows that hospitals
have been able to meet the lower ratios.
Hospitals had to follow the new rules and discovered
they were not as burdensome as they
had feared.” (Los Angeles Times, 2005)
At the public hearing in Boston on H.2059,
The Patient Safety Act, Public Health Committee
members got to hear firsthand about
California’s experience with a similar law. First
to testify was Karin Berntsen, RN and patientsafety
expert, who is the director of quality, risk
and care management at Alvarado Hospital in
San Diego.
Berntsen offered the committee a unique perspective
on the issue as she is not from the union
side—she is a health care executive, and looks at
the staffing problem both as a manager and as
someone concerned about patient safety.
“The hospital industry’s practice of increasing
patient loads is a counterintuitive approach and
it is dangerous for patients,” Bernsten testified.
“The evidence is clear: Reducing the number
of patients a nurse cares for at one time is associated
with reduced hospital mortality and
reduced adverse patient events.”
Berntsen acknowledged that there was resistance
from hospitals in California when the
safe staffing legislation was passed. “Hospitals
resisted this legislation quite vigorously,” she
said, “and predicted disaster if it passed. But
despite this initial resistance, the results of
California’s staffing law are actually quite positive.”
She went on to testify that H.2059 “has the
potential to be even more effective [than California’s
law]. It has been well thought out—it is
extremely flexible and it promotes staffing plans
that are balanced for all hospitals.”
Joining Berntsen on the panel was Michael
Jackson, an emergency department nurse also
from the San Diego area. He reported that staffing
limits in California have actually made EDs
work more efficiently by ensuring that there is
enough staffing to move patients through tests
and procedures more quickly.
Also testifying was Melroy Green, a radiology
technician from the Los Angeles area.
Green reported that before the limits in California,
he and other ancillary staff were forced
to provide nursing services to patients because
the nurses were stretched so thin. This was
dangerous for everyone—patients, ancillary
staff, and nurses. Now, he says he can actually
do the job he was trained to do because there
are enough nurses to care for patients.
Finally, Jill Furillo, an RN and the Southern
California director of the California Nurses
Association testified. She encouraged legislators
to take the hospital industry’s predictions
of chaos and disaster with a grain of salt.
“We heard the same predictions in California,
and it was all just scare tactics,” she said. “Hospitals
haven’t closed because of our law and ER
wait times for ambulance crews transferring
their patients to the hospital have improved.
Ambulances are actually getting back out into
the field more quickly. Furthermore, California’s
nursing shortage was far worse than the Massachusetts’
shortage, and with the improvement
in working conditions, nurses are flocking back
to the bedside in California.”
Furillo also encouraged legislators to challenge
hospital administrators on-site who were
wearing stickers with the word “Ratios” with a
circle and line through the word. “What that
sticker means,” Ms. Furillo said, “is that they
think there should be no limit. They want the
freedom to assign a nurse 25 patients if they
want to. No ratios translates into no limits, and
that’s just not safe for patients.”
All of the testimony from this panel was particularly
poignant given the wildfire situation
in California. Berntsen’s husband and son had
been evacuated the day before the hearing, and
even as she testified, she was waiting to hear
that her house had survived the wildfires.
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