Dec 31, 08:01 PM
The Sacramento Bee

Jan. 1--California patients hospitalized over New Year's Eve may awaken to find more nurses on duty today as the nation's first law spelling out how many patients each nurse can treat takes effect in hospitals statewide.

The nurse staffing law, signed four years ago by former Gov. Gray Davis, requires hospitals to have at least one nurse for every six patients on general medical wards.

Passed during a nationwide nursing shortage that continues to worsen, the law drew immediate fire from hospital chains who said it would be impossible to find enough nurses to comply with the law.

Asked at the eleventh hour if they were ready for the law to take effect, Sacramento area hospital executives gave the same answer they've offered all along -- yes and no.

"I'll be candid," said Barbara Nelson, chief nurse executive at Sutter Roseville Medical Center. "We have done everything we can to be ready for the law. It will be difficult for us to say we can comply with the law at every hour of every day on every single shift."

Labor unions that pushed the staffing law through the state legislature maintain that compliance is not only possible but necessary to improve patient safety and hospital working conditions.

"Every major scientific study has documented that safe registered nurse staffing reduces preventable hospital death rates, infections and accidents, and improves the therapeutic environment for recovery," said Deborah Burger, president of the California Nurses Association, which sponsored the law.

Few hospitals dispute those facts. But they bolster their objections to the law with more facts. California has fewer nurses per capita than just about any other state in the nation, and nursing schools here can't graduate new nurses fast enough to meet labor needs created by the state's new nurse staffing law.

Hospitals throughout the Sacramento region have hired hundreds of extra nurses to prepare for the law. They have offered signing bonuses, bolstered wages and benefits, retrained employees to take nursing posts, donated funds to expand area nursing schools, given student scholarships, and even recruited from nurses overseas.

"We have been diligently working on this, and we're as ready as we're going to be," said Jill Dryer, a spokeswoman for Catholic Healthcare West, which owns six area hospitals.

But hospitals here still have hundreds of vacant nursing positions.

Kaiser Permanente, for example, has hired about 600 nurses at its three facilities here since 2002 and reduced its vacancy rate for nurses to 5 percent from 19 percent. But like all the other hospital chains here, Kaiser still needs nurses.

Sutter Health, for example, still needs about 300 nurses at its area hospitals. Local CHW hospitals have about 226 vacancies for registered nurses.

The California Healthcare Association, a hospital trade group, filed suit this week in Sacramento Superior Court claiming that almost all the state's hospitals would be unable to comply with a provision of the law requiring hospitals to meet staffing rules "at all times."

"Those three small words are a problem," said Sutter's Nelson.

Hospitals might, for example, schedule enough nurses to comply with the law, but then find themselves suddenly out of compliance if one nurse needs a quick bathroom break or if one additional patient shows up needing immediate care.

At least one hospital chain, Kaiser, has already planned to comply with the staffing rules while its nurses are on breaks.

"We've been preparing for a number of years and we are going to meet the ratios," said Pamela Johnson, Kaiser's associate director of operations for patient care services in Northern California. "We have made plans to have coverage during lunch and breaks."

Other hospital chains are working on this coverage but unsure how ready they are to provide it for all nurses on all shifts.

"We estimate we will need one additional nurse for every four required by the law in order to staff the meals and breaks," said Dryer, of CHW. "We are committed to taking care of patients, and that does not change at midnight when this law takes effect. What we find difficult, is what 'at all times' will mean for us."

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