Hospitals working on nurse ratios

State regulations require more staff for some types of patients

January 11, 2008 

AM Memorial Nurse

Memorial Medical Center nurse Lana Frederickson accesses a Pyxis medicine control unit in the Intensive Care Unit Thursday.

ADRIAN MENDOZA 01102008 — Modesto Bee

  • NURSING RATIOS


    New nursing ratios, effective Jan. 1:
    • Transitional care (patients released from intensive care): One nurse to three patients (formerly 1-to-4)
    • Patients on monitors: One nurse to four patients (formerly 1-to-5)
    • Specialty care, such as cancer treatment: One nurse to four patients (formerly 1-to-5)

Local hospital officials said they were complying or at least close to meeting the state's final phase of nurse-to-patient ratios that went into effect this month.

The regulations, designed to improve patient care, require hospitals to increase nursing staff for patients on heart monitors, for cancer patients and others receiving specialty treatment, and for patients recently released from intensive care.

"We started staffing up for it a long time ago," said Catherine Larsen, spokeswoman for the 423-bed Memorial Medical Center in Modesto.

Since March, Memorial has recruited 114 nurses to staff the 112 new beds in its North Tower and meet the staffing ratios throughout the hospital and also is using temporary nurses to comply with the rules, she said.

Meeting the standards has been challenging, she said, because of Memorial's increased patient census and the nationwide nursing shortage. In addition, other hospitals are recruiting nurses to meet the requirements.

Former Gov. Davis signed the minimum nurse-to-patient ratios into law in 1999 and the state implemented the rules in phases, starting in 2004. The requirement is one nurse for every five patients in medical-surgical areas, instead of the previous 1-to-6 ratio.

The staffing ratios met with resistance from the hospital industry, which argued it would be hard to find qualified nurses and hospitals would be financially burdened. Gov. Schwarzenegger also waged a legal fight to extend deadlines for meeting the ratios, but gave up in 2005.

$3M a year for 33 new nurses

Doctors Medical Center of Modesto needed to hire 33 nurses to comply with the standards, mainly in the cancer treatment department and telemetry units where patients are on monitors, said Linda Levenson, chief nursing officer. It is filling those 33 positions with 42 recently hired nursing school graduates.

The graduates won't start working at the 398-bed hospital until the end of the month, so the hospital is paying overtime to its staff and has 25 temporary nurses to meet the ratios, Levenson said.

Based on industry standards for wages and benefits, an additional 33 nurses can cost a hospital more than $3 million a year.

Levenson said the nursing staff has appreciated the extra help, because the staffing ratios apply to busy units at DMC. As they hire more nurses, however, many hospitals including DMC have cut back on nursing assistants.

Larsen said that despite the cost, Memorial has retained its nursing assistants. The regulations pertaining to specialty care seemed unclear to Memorial officials, so the hospital is going to the 1-to-4 staffing ratio in all of its medical-surgical areas, she said.

Memorial and DMC were trying to avoid the costs of using nurse staffing agencies. As of this week, Memorial had 40 temporary or "traveler" nurses and DMC had contracts with about 25.

Emanuel Medical Center in Turlock did not discuss the specifics of meeting the staffing ratios. "We are meeting or are pretty close to meeting all the guidelines," said John Gilbert, spokesman for Emanuel.

Emanuel is in the process of recruiting nurses to fill 18 positions at the hospital, he said.

Susan Mendieta of Oak Valley Hospital in Oakdale said the 35-bed facility is meeting the requirements with existing nursing staff. The community hospital is faced with fewer staffing requirements than larger hospitals because it doesn't provide as many specialty services. To meet the specialty care requirement, Oak Valley is going to one nurse for every four pediatric patients, she said.

Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or 578-2321.

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