California RNs Say JCAHO Report Falls Far Short of What's Needed to Protect Patients -- Ratios and Retention First.

Business & News Editors/Health Writers

OAKLAND, Calif.--(BUSINESS WIRE)--Aug. 7, 2002

Today's report by the Joint Commission on Hospital Accreditation -- that inadequate nurse staffing leads to nearly a quarter of unexpected hospital patient deaths or injuries -- fails to offer workable solutions that can resolve the current nursing shortage and enhance patient protection, said the California Nurses Association.

"The JCAHO study provides further evidence of an increasing crisis in patient safety and our nursing infrastructure," said CNA President Kay McVay, RN. "But it falls far short in explaining the source of the crisis and in presenting the effective solutions needed."

"Today's shortages that kill and harm patients are the direct product of a decade of failed market-based health care industry policies that restructured the delivery of care and drove nurses out of hospitals," said McVay. "And it hasn't stopped -- as illustrated by hospital RN turnover rates that continue to skyrocket to from 18 to 26 percent across the nation."

"Until our policy makers pass strong legislation and regulations that protect patients, and hospitals implement meaningful changes to stop the hemorrhaging of their RNs, all other proposals, including those by JCAHO, will have little or no effect," McVay said. In fact, turnover rates are highest among younger RNs, the very people being offered lucrative sign-on bonuses and other exotic perquisites.

California, however, offers a model that is being watched by nurses and health care experts across the country. In late 1999, Gov. Gray Davis signed the first law in the nation, sponsored by CNA, to mandate safe staffing levels, with minimum nurse-to-patient ratios. Davis followed that up with an allocation of $60 million for programs, in concert with CNA, to retrain and recruit nurses who will be more willing to work in hospitals that have safer staffing standards.

Concurrently, CNA is negotiating landmark agreements with California hospitals to establish improved patient care conditions, such as innovative approaches to address unsafe staffing and bans on mandatory overtime, as well as enhanced compensation and retirement programs. These solutions "are critical to retaining career RNs and recruiting new nurses," McVay noted.

CNA has for years described the origins of the hospital nursing shortage as the product of market-driven medical care, characterized by reckless restructuring, downsizing, displacement of RNs by unlicensed staff, and for many RNs a loss of trust in their employers.

In 1995 CNA brought testimony -- including over 2,000 reports by bedside RNs -- to the National Institute of Medicine in 1995 about the growing threat to patient care, and warned that these trends would push nurses away from the hospitals and the profession because they would no longer be able to safely care for patients.

The Institute failed to propose the immediate solutions recommended by CNA, but did commission another study which eventually led to the report "To Err is Human" which concluded that up to 98,000 patients die in hospitals annually due to preventable mistakes.

"In California, we decided to move forward on our own by campaigning for enactment of the ratio law, and pressing the hospitals to initiate changes," said McVay.

The ratio law is in the process of implementation -- and should be in full force by next year. Public hearings on the regulations are expected later this summer or fall.

In negotiations affecting thousands of RNs this year, CNA has won dramatic gains intended to assure retention and recruitment, for example, establishing secure pension plans for nurses, post-retirement health benefits, restrictions on unsafe staffing practices, and compensation up to nearly $100,000 for long term career RNs.

"Short of a more fundamental overhaul, such as universal healthcare and the elimination of market-based medical care, only through comprehensive approaches, such as we have underway in California, can we rebuild our nursing infrastructure, reduce the nursing shortage, and assure greater protection for our patients when they need hospital care," McVay said.