State lowers nurse-to-patient ratio

GLENDALE — As part of a phased-in law aimed at adding more registered nurses to hospitals, state-mandated nurse-to-patient ratios were reduced Tuesday for the fourth straight year, even though hospital recruiters say there’s still a serious shortage of nurses in California.

Hospitals have been adding or shuffling staffers to meet the ratios since 2004, when the law was enacted. The California Nurses Assn., which sponsored the bill that created the ratios, says the changes have ensured that registered nurses have a limited amount of patients whom they’re responsible for during a shift.

In this last year of implementation, hospitals are required to lower the ratio in “step down” units — transitional units for unstable patients between intensive care and general medical-surgical floors — from 1-to-4 to 1-to-3. Specialty Care Units, such as oncology or cancer care, and Telemetry drop from 1-to-5 to 1-to-4.

The ratios have helped stabilize a hospital climate that had deteriorated in the mid- to late 1990s, when nurses in some hospital units were accountable for an unmanageable number of patients, said Charles Idelson, spokesman for the California Nurses Assn.

During the same period, many registered nurses were being replaced with nonlicensed personnel, and others fled their nursing careers voluntarily, he said.

“Before the state-mandated ratios, staffing was all over the board,” Idelson said. “Now what we have is a level playing field. All hospitals are required to have minimum staffing.”

But with qualified, registered nurses still hard to come by in California, and while all three of Glendale’s major hospitals claim to be meeting the standards, getting there hasn’t been easy, hospital officials said.

And, due to the constant flux of patient conditions and daily entrance and exit of patients, keeping up with staffing requirements can be a daily puzzle, said Gwen Matthews, chief nursing officer at Glendale Adventist Medical Center.

“It’s very cumbersome,” Matthews said.

“I think it has put the financial constraints on the hospital in California, which absolutely do impact our ability to program and it makes the finances very challenging because it’s really an unfunded mandate.”

Still, Matthews said some hospitals in the state would likely remain dangerously understaffed if not for the required ratios.