The California Nurses Association plans to hold rallies at nearly 70 hospitals and medical centers on Wednesday to protest waivers that allow facilities to staff some units below state prescribed nurse-to-patient ratios, as nurses are transferred to more critical patients.
The union fears the reshuffle will place a heavier burden on nurses in non-critical departments amid an increasing patient load.
Union representatives will meet at Kaiser Los Angeles Medical Center, Providence Little Company of Mary Medical Center Torrance, Alhambra Hospital Medical Center, Anaheim Global Medical Center, Keck Hospital of USC, St. Bernardine Medical Center in San Bernardino, and Methodist Hospital of Southern California in Arcadia, among others throughout the state.
In 2004, California became the only state to set minimum nurse-patient ratios. For most hospital departments, the law requires a minimum ratio of one nurse to five patients, although it is one to two for intensive care units.
Governor Gavin Newsom issued an executive order in March that waived the application of nurse-to-patient ratios as part of his state of emergency to fight the COVID-19 pandemic. The general waiver expired on June 30, but hospitals experiencing an increase in patients or a staff shortage related to the coronavirus can still request a waiver by submitting a form to the state.
The California Department of Public Health reported on Tuesday that the state had 519,427 confirmed cases of COVID-19 to date with a seven-day average of 7,554 new cases per day.
Hospitals overwhelmingly support emergency waivers, although this often requires nurses to treat more patients than would be allowed under normal circumstances.
Two sides of the question
There are arguments to be made on both sides.
Nurses say nurse-to-patient ratios make the workplace safer while improving healthcare. Fewer patient assignments mean fewer registered nurses in California are missing out on changes in patient conditions due to their workload. And that, they say, translates to fewer patient deaths.
A 2010 research project indicates that nurse-to-patient ratios are the most effective nursing reform to protect patients and keep experienced nurses at the bedside.
“The state has seen larger declines in mortality and more improvements in other indicators than other states,” said Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.
But hospitals see California law as an inflexible and unique mandate. The California Hospital Association says the COVID-19 pandemic has strained the state’s healthcare workers with outbreaks that can be “intense, sudden and unpredictable.”
According to the association, COVID-19 patients need extra care and time, putting even more strain on intensive care staff. Additionally, staffing shortages nationwide mean that every hospital in need of additional healthcare workers is accessing the same nurse registries, making it impossible to meet California staffing needs.
“We didn’t have to request the waiver, but we understand the need for a hospital to do it,” said Carmel Nicholls, executive director of intensive care services at Providence Little Company of Mary Medical Center Torrance. “We are supporting emergency relief because there are other hospitals that are unable to get the nurses they need to take care of patients.”