Nurses Hail California Safe Hospital Staffing Law
Mandates Staffing Levels on All Units

Nurses from across the nation are joining the California Nurses Association (CAN) in hailing the signing last month of landmark legislation that will make California the first state in the nation to require safe hospital staffing. Gov. Gray Davis signed AB 394 on Oct.11, 1999, a bill authored by Assembly member Sheila Kuehl (D-Santa Monica) and sponsored by CNA.

"This is one of the most significant days in the history of nursing," said CNA President Kay McVay, RN. "This bill will save the lives of countless numbers of patients needlessly endangered by unsafe hospital conditions."

"I am really pleased that the governor understood how important it was to sign this bill," said Kuehl. She called the signing a "historic day for California families. It will rebuild the safety net in California hospitals. This is a dramatic victory for the thousands of nurses and patients and the CNA who worked tirelessly to achieve this powerful reform."

AB 394 requires the State Department of Health Services to adopt regulations establishing minimum, specific, and numerical licensed nurse-to-patient ratios for all hospital units as presently exist for intensive care units and operating rooms. It also prohibits hospitals from requiring unlicensed, minimally trained personnel to perform nursing functions such as invasive procedures, patient assessment, patient education, or administration of medication.

The DHS will begin the process of establishing the ratios in January. At the governor's request, Kuehl has agreed to introduce follow up legislation next year to adjust the date of final adoption of the regulations.

Here in Massachusetts, there was enthusiastic praise for the bill’s passage, because of the signal it sends to the health care industry and policy makers of the need for fundamental change in health care regulation.

“I’m extremely excited about this and hope to see this trend continue,” said Karen Higgins, chair of the MNA Cabinet for Labor Relations. “For years, nurses have been in this battle to assure that patients get the care they deserve. In fact, registered nurses in Massachusetts at seven different facilities have gone as far as threatening to strike over the issue of inadequate staffing. I am thrilled to see a state legislature willing to help us achieve our goal of safe care by mandating nurses needed to assure safe patient care. Perhaps it can motivate our legislature to do the same.”

Higgins was referring to the legislature’s consideration of a similar MNA bill, "An Act to Ensure Sufficient Nursing Care", which the MNA has filed three years in row. Each year, including this legislative session, the Joint Committee on Health Care has placed the bill in study committee.

MNA Director of Legilsation and Govenrment Affairs Gloria Craven is "hopefully, the California passage will stir the Massachusetts Legislature to again look seriously at the need for safe staffing,” she said. “The Massachusetts legislation, not a ratio bill, looks at the staffing based on the patients' acuity of illness, their functional level and the standards of nursing practice that nurses are held accountable to. It is our hope that the Massachusetts legislature will focus on what's important, safe and quality patients care delivered by skilled, licensed professional nurses that meets the needs of those patients."

In addition to requiring ratios and limiting the unsafe use of unlicensed staff, AB 394 mandates additional nursing staff as needed based on individualized patient needs and severity of illness. It also restricts unsafe assignment of nursing staff to hospital areas for which they lack proper clinical training or orientation, a growing problem in hospitals.

AB 394 was prompted by a growing crisis in nursing care and patient safety standards in California hospitals that has seen California fall to next to last in the nation in the average number of nurses to patients.

According to the 1999 Dartmouth Atlas of Health Care data, the national average of RNs is 3.22 per 1,000 population. The California average is just 2.27 per 1,000. Only Washington State is lower, at 2.19. (By contrast, some other large states with big urban areas -- New York, 3.68, Pennsylvania, 3.66, Missouri, 3.89).

Recent research by the non-profit Institute for Health and Socio-Economic Policy (IHSP) documented that fewer California patients are well enough to be discharged home, coinciding with a drop in the number of full-time RNs and staffed hospital beds.

Analyzing 18.2 million California hospital patient discharge records, and other data from state agencies and the hospital industry, the IHSP found an 8.8 percent increase in the average number of patients for which each full-time RN must care from 1994-1997, and a 7.2 percent fall in the number of full time employed RNs from 1994 to 1997.

The report also showed an increase in acuity levels -- the severity of illness of hospital patients -- at the point of hospital discharge increased by over 3 percent for the categories of "major acuity" and "extreme acuity" from 1993 to 1997.

"Nurses today are required to care for many more patients than they were a few years ago. Nurses are stretched so thin they often have little time to render the most basic care patients and their families need," McVay noted.

"As a result of years of downsizing, managed care influenced cutbacks in services, and an end to hospital-based training programs, our nursing care infrastructure has been badly damaged. Many nurses have also voluntarily left the hospital setting.

"We have already seen a decline in the turnover rate in hospitals with safer staffing levels. With the enactment of AB 394, and the establishment of statewide staffing ratios, nurses will return to hospital floors and we can restore uniform safety standards for everyone," said McVay.