UPDATE ON CALIFORNIA'S MANDATORY
NURSE TO PATIENT RATIO LAW
What's happened to patient care in California since the first in the
nation mandatory nurse-to-patient ratio law went into effect on January
1, 2004?
The California Nurses Association (CNA), a union, has engaged Governor
Arnold Schwarzenegger in a massive political struggle over the ratio
law. When the ratios went into effect, for example, the ratio for
med-surg patients was one nurse to six patients with each
patient/hospital ward with their own ratio. On January 1, 2005, the
med-surg ratio was to change to one nurse to five patients. In late
2004, Governor Schwarzenegger issued an emergency executive order
delaying this change. Upon the issuance of this Executive Order, the
CNA launched a massive statewide public relations campaign. This
included demonstrating against the Governor at his public appearances
with the purpose of blasting this decision. CNA also sued. This spring the courts sided with CNA, saying the Governor couldn't arbitrarily not obey this law. The new lower standards went into effect this spring.
In August, the first study to examine some of the effects of this law on
patient care was published in POLICY, POLITICS & NURSING PRACTICE.
Nancy Donaldson, RN, DNSc, FAAN, from the University of California San
Francisco School of Nursing, was the lead researcher. Here are some of
the findings so far:
- hours of patient care per patient day, by RNs, increased almost 21%;
- number of patients per RN each day decreased 17.5%;
- hospitals did not increase their use of LVNs (LPNs) allowed under the
law, or nurses supplied by outside staffing agencies or registries; and
- there were no significant changes in the incidence of patient falls or
the prevalence of pressure ulcers.
A related study was published in the August issue of the journal,
MEDICAL CARE, from the American Public Health Association. This study
concluded adding RNs to a hospital staff saves lives and is cost
effective. Adding RNs costs less than other interventions, and about
half of the additional labor cost is offset by shorter hospital stays
for patients. This study showed, for each patient added to a nurse's
work load above four patients, there was a 7% rise in the risk of death
for the nurse's patients.
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