NURSING RATIOS WOULD STIFLE CARE FOR PATIENTS.

Byline: Janet Glucksman Local View

NURSES routinely encounter emotional and heartbreaking situations in pediatric hospitals. Kids are sick with infections or exacerbations of their genetic diseases, causing agonizing pain. Sometimes their fragile wings are broken by child abuse.

And now, nurses in pediatric hospitals have a new challenge, one that jeopardizes our kids and threatens the very existence of pediatric hospital care: Assembly Bill 394, California's nursing staffing ratio law.

In effect since Jan. 1, the law is a misguided attempt to rectify burdensome and unsafe nursing practices in California's hospitals. It strictly mandates a specific number of patients a nurse can attend to at any given time, regardless of the medical needs and conditions of those patients. In the process, it dangerously hinders the ability of pediatric hospitals to give excellent care.

Before the imposition of the new law, all hospitals were supposed to adhere to the state's Patient Classification System. They had guidelines to measure the severity of a patient's illness and to staff accordingly.

For example: Patients who required many hours of care were considered a ``high'' acuity, while those who were stable and required minimal attention were rated as a ``low.'' The guidelines made sense and were flexible.

However, many hospitals in California compensated for rising overhead costs - including increased nursing salaries - by keeping acuity ratings low or ignoring them altogether. Thus, they forced nurses to care for greater numbers of very sick patients. Horror stories of nurse-to-patient ratios of 1-to-10 or higher were not uncommon.

But pediatric hospitals could never get away with cheating or ignoring the acuities of their young patients, even if they wanted to. Their population was not the aged, ``might-have-died-anyway,'' demographic, but the vulnerable, ``what-can-we-do-to-save-you'' group.

Pediatric nurses cared for children in small, fluctuating ratios. They worked collaboratively to assist one another when a child rapidly deteriorated into a crisis, or simply to obtain blood from a tiny vein. They prioritized care according to the needs of the child, considering such factors as: How sick is the child? How experienced is the nurse assigned to his or her care? Is a parent present at the bedside?

The nursing care was superb and generous. Camaraderie and flexibility made for excellent, safe conditions. The rules were simple and effective: Keep nurse-to-patient-ratios safely in line with accurate measures of acuity.

Yet, with the new law, it does not matter how sick the child is; only ratios are important. If there is any breach of staffing, the hospital must submit a report and is subject to a fine.

That means that, for example, a hospital would be liable if a nurse helped out to save a child in a life-threatening crisis. Decisions affecting patient care must now include the cynical question: Is it worth the risk of violation?

Pediatric hospitals are now scrambling to stay within the confines of the rigid staffing requirements while providing loving and safe care, but it is not clear how much longer they will be able to continue. Although they are equipped with a fine matrix of nursing staff, they are turning away sick children because the numbers don't precisely match up.

The law compromises care of one of the most vulnerable segments of California's population: our young, innocent children. AB 394 must be modified. Without public support, the cries of our children will certainly be stifled.