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ONE YEAR UNDER CALIFORNIA'S MANDATORY NURSE-PATIENT RATIO LAW
(January 3, 2005)
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California is the only state in the nation with mandatory nurse-patient ratios. The implementation began about one year ago. Here's a report on the first year of these mandatory ratios for California acute care hospitals.
The law which mandated these ratios, Assembly Bill 394 (AB 394), was passed and signed into law in the autumn of 1999 by Governor Gray Davis. It took the California Department of Health Services until the autumn of 2003 to write the regulations implementing AB 394. These mandatory ratios were to be implemented in phases. The first phase began on January 1, 2004. California acute care hospitals have been operating for one year under the first phase.
This phase mandated these ratios:
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- pediatrics, emergency rooms, step down wards: 1 nurse to 4 patients;
- oncology and telemetry wards: 1 nurse to 5 patients; and
- medical-surgical wards, psychiatric and mixed wards: 1 nurse to 6 patients.
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Mandatory nurse-patient ratios were established years ago for intensive and critical care wards, operating rooms, nurseries, and acute respiratory care wards.
The California Healthcare Association (read hospital association) claimed the law would almost destroy California hospitals. The California Nurses Association (CNA), a union, and the organization most responsible for the passage of AB 394, claimed thousands of RNs, who quit nursing because of the heavy workload, would flock back into nursing. Neither of these things have happened.
The winners so far in this huge policy struggle in professional nursing are the patients. The research by Linda Aiken, PhD, RN, and her colleagues at the Center for Health Outcomes and Policy Research, at the University of Pennsylvania, clearly demonstrates in hospitals with high patient to nurse ratios, surgical patients experience higher mortality and failure to rescue rates. When AB 394 first passed, the California Healthcare Association proposed the ratio for medical-surgical wards be one nurse for 10 patients.
On January 1, 2005, the medical-surgical ward ratio was supposed to go from one nurse to six patients, to one nurse to five patients. However, Governor Arnold Schwarzenegger issued an emergency regulation, in early November, blocking this. A few days later, at a state-wide ceremony honoring California women, he called California nurses a "special interest", and bragged he would "kick their butt". Just before Christmas, CNA filed a lawsuit against the Governor claiming this action illegally subverted the California Legislature.
The dominant player in California health care, the non-profit HMO Kaiser Permanente, continues to support AB 394 and says it meets the law in all areas of their many acute care hospitals.
Hot News will continue to closely follow this issue, and report on it periodically.
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