 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Diana M. Bontá, RN, DrPH, Brenda Klutz, and Gina Henning. California Department of Health Services, 714 P Street -- Suite 1253, Sacramento, CA 95814, 916.657.1425, dbonta@dhs.ca.gov
The California Code of Regulations requires each hospital to have and use a Patient Classification System (PCS). This is intended to ensure that hospital staffing is based on individual patient acuity. However, it has been a widespread perception of working nurses and their labor organizations that the PCS does not always trigger increased staffing in response to patients’ needs. Consequently, the Legislature passed and Governor Gray Davis signed AB 394: The Safe Staffing Law (Kuehl, Chapter 945, Statutes of 1999).
The new law mandated that the California Department of Health Services (CDHS) establish “minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit …[T]hese ratios shall constitute the minimum number of nurses that shall be allocated.” California will lead the nation as the first state to improve the quality of hospital care by mandating that licensed nurses be at the bedside, accessible and available to meet the needs of patients.
CDHS began implementation by contracting with researchers at the University of California to perform an exhaustive literature search. The University concluded that there was no hard, scientific data indicating the number of patients nurses can safely and effectively handle while providing patient care.
Next, the data was reviewed that had been collected by the California Office of Statewide Health Planning and Development (OSHPD) regarding hospital usage and staffing, number of beds, productive nursing hours per patient day, numbers of admissions and discharges, etc. However, due to the limitations of OSHPD data, and because CDHS wanted a baseline, real-world picture of staffing in California’s hospitals, the decision was made to design and administer our own study.
A stratified representative sample of California’s 495 hospitals was created, and 90 were selected for on-site, unannounced surveys conducted by CDHS nurse surveyors. Staffing data was gathered for all three shifts on 17 days. Demographic data on the nurses also was collected. When data entry was completed there were 1,700 variables and over 34,000 pages of data, giving CDHS a firm foundation for regulations.
The proposed regulations were drafted and made public for comment. CDHS received >24,000 written submissions containing multiple individual comments, and the hearing transcripts alone were more than 700 pages. The feedback was principally from labor organizations representing nurses and from hospitals.
The regulations were finalized and will be in effect January 1, 2004. The content of these regulations will be described and discussed.
Learning Objectives:
Keywords: , Nurses
Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employment