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California's New Nurse-To-Patient Ratios Go Into Effect

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California's new nurse-to-patient ratios went into effect Thursday, and while several San Fernando Valley hospitals reported few staffing problems on New Year's Day, some officials expressed concern for the months ahead.

``The first day of the year is not too bad, but we don't have as many patients as we expect to have later in January,'' said Ann Dechairo-Marino, senior vice president for patient care services at Northridge Hospital Medical Center's Roscoe Boulevard Campus.

We've hired 78 RNs and five LVNs in the last three months, but we're not able to meet all our vacancies,'' Dechairo-Marino said.We've had a couple of units that didn't quite meet ratios. We're very concerned that with the flu season, we're going to have to close our emergency room more often and possibly restrict or cancel elective surgeries.''

While some hospital units have had minimum nurse-to-patient staffing requirements for decades, the new law, which was passed in 1999, mandates ratios for all units - such as one nurse for every four patients in emergency rooms.

Daphne Yousem, director of marketing and public relations for Encino-Tarzana Regional Medical Center, predicted the facility would have no problems meeting the requirement.

We're staffed. We're prepared,'' she said.We've been planning for this for a long time.''

The California Healthcare Association, which represents most of the state's acute care general hospitals, has maintained that the nationwide nursing shortage will make it extremely difficult for hospitals to meet the new staffing ratios.

If hospitals are not able to do so, they will be forced to reduce access to patient care by canceling elective surgeries, discharging patients sooner and delaying new hospital admissions, according to the CHA.

But Jill Furillo, spokeswoman for the California Nurses Association, which sponsored the law, predicted most hospitals would start the year either in compliance with the new ratios or nearly so.

``We know there are some hospitals that aren't going to be in full compliance, but they've made very good-faith efforts, and we're working with them and will continue to work with them,'' Furillo said.

``A very small minority of hospitals are in denial about this and have spent most of their time fighting this rather than making plans for it,'' Furillo said.

On Tuesday, the CHA filed a lawsuit against the California Department of Health Services in Sacramento Superior Court, challenging the requirement that the ratios be maintained even when nurses take breaks or go to lunch.

``CHA is not seeking a delay or a repeal of the nurse-to-patient ratio law,'' said C. Duane Dauner, president and CEO of CHA.

``In hospitals throughout California, nurses are assigned to specific patients at the beginning of their shifts and remain assigned to these same patients throughout the duration of their shift, including when the nurse takes a break,'' Dauner said.

``Under DHS' newly revised interpretation of patient assignments, a nurse won't even be allowed to take a short break without an additional nurse being assigned to replace him or her.''

But the California Nurses Association accused the CHA of using ``sneaky and devious'' tactics to attempt to sabotage the new ratios.

``It probably should have been expected,'' said CNA President Deborah Burger.

After all their other maneuvers to get around the ratios, they turn to the courts on New Year's Eve with a specious argument against the regulations that they could have - but chose not to - raised at any time over the three years since the law was enacted,'' she said.It's sneaky and devious.''

CNA said the ``at all times'' wording has been in the regulations since June, inserted by the DHS to align the new regulations with the provision covering lunches and breaks in the previous staffing ratios, which have applied to intensive care units since 1975.

The disease process does not recognize meal times and break times,'' Furillo said.As we say in the nursing profession, a patient can `crash' - experience severe changes in their condition - at any time.''


(The Houston Chronicle web site is at )

c.2004 Los Angeles Daily News

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