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Facts Matter on Staffing Ratios

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This year marks the 15th anniversary of the implementation of nurse staffing ratios in California. Unsurprisingly, coordinated and cohesive labor interests are pushing to enhance the penalties for infractions and expand oversight for staffing ratio compliance.

Their claim is that increased penalties — an additional $30,000 for the first infraction (even with zero threat of patient harm) and $60,000 (again, with zero threat of patient harm) for subsequent infractions — will improve patient safety.

You all know better.

In truth, these efforts, manifesting in the form of Senate Bill 227 (Leyva, D-Chino), are little more than a blatant attempt to compel hospitals to hire more nurses, regardless of whether patients would be safer or overall quality would improve.

Let’s look at the facts:

  • Compliance with nurse staffing ratios adds about $3 billion in costs annually to California’s health care system. At a time when the state is working to make care more affordable for all, duplicative, punitive penalties will only increase costs.
  • Every day, hospitals staff at levels well above the required minimum to account for these factors, but a single unexpected emergency or illness throws off the entire calculation.
  • Because nursing is as much art as it is science — and nurse leaders need flexibility to shift their staff based on ever-changing variations in patient acuity, surge events, and other factors — scheduling and minute-to-minute staffing decision-making should be in the hands of clinical professionals, not the state government.
  • Infractions are incredibly rare: over a 10-year period through 2017, representing more than 35 million hours of hospital operations, the state found a mere 634 infractions — less than 1/500th of 1% of hospital hours, the vast majority of which posed little to no risk of patient harm.
  • Nurse staffing ratios, coupled with a significant increase in protected time for California workers (Family Medical Leave Act, the California Family Rights Act, California paid sick leave, Kin Care, and more), along with a maldistribution of available nurses in some areas, have created a logistical nightmare for staffing.
  • The law that implemented the staffing ratio requirements also required the state to assess ratios’ effectiveness after five years — but that report was never issued. In other words, nobody can say with certainty if these 15-year-old ratios are actually helpful to patients.

This is why your CHA is fighting hard against SB 227, a bill similar to the one that swept through both houses of the Legislature last year and died only via a veto by former Gov. Jerry Brown.

There are similar challenges this year. The idea of “more nurses per patient” is a popular one, and it’s hard to explain why that doesn’t necessarily mean better care for patients.

This fight will be a slog, and it may again take intervention at the highest levels to avoid doubling down on a law whose impact on quality, safety, and overall value is wholly unknown.

– Carmela