And you thought it couldn't get worse? Yesterday, Maryland's nurses pushed state lawmakers to mandate nurse ratios in hospitals. Nursing unions across the country are lobbying state houses for similar laws.
As usual, California led this unfortunate trend with their "Safe Staffing Law", AB 394. California Gov. Gray Davis signed the bill into law on October 11, 1999. In 2004, the California Department of Health Service estimated that AB 394 will add $1 billion annually to health care costs when it goes into effect January 1, 2005. The average cost per hospital to comply is estimated to range from $3 million to $5.3 million. The Governator has since put the brakes on implementation, much to the consternation of the nurses union.
The irony of these laws is the mandate to hire more nurses in the face of a shortage -- 5,000 more nurses in the case of California. The results are unit and hospital closures with fines thrown in for spice. During a 6 month survey by the CHA 85% of all hospitals could not meet the ratios on every unit and every shift. Almost a dozen hospitals closed in California in 2004. Do closed units and hospitals really improve patient care?
This is some serious, ah, stuff. What can be done to reduce open staff positions? Yes, improve patient flow (actually, improve patient flow to reduce your LOS). The Healthcare Advisory Board has estimated that a 300 bed hospital can effectively gain 18 nurse FTEs with a half day LOS reduction. A reduction of this size is well within reach with through patient flow optimization.
Perhaps a more rational legislative approach would be to mandate patient flow optimization in hospitals. I could support that.
3/4/05 Update: The Governator's efforts to block the Safe Staffing Law suffered a temporary setback in a court ruling yesterday. They're back in court today for oral arguments.
Schwarzenegger... called the nurses [union] "special interests" whom he said "don't like me in Sacramento because I kick their butt." He laughed and then added, "I love them anyway."
3/8/05 Update: The California Nursing union ups the ante, protesting during a visit of the Governator to Washington DC. Here is a press release from the protesters.
3/15/05 Update: The Governator loses in court.
California hospitals are about 4,000 nurses short of meeting the new rules and many can't afford to pay high levels of overtime, which nurses can also refuse to work, Emerson said.
"If they can't comply, the hospitals may have to downsize the number of beds available, cancel procedures and deny admissions," Emerson said.
3/19/05 Update: You can find more posts on this story here.