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Palo Alto Online

Publication Date: Friday, January 30, 2002

Hospital may have to hire more nurses Hospital may have to hire more nurses (January 30, 2002)

New state law mandates minimum nurse-patient ratios

by Don Kazak

Stanford Hospital may be forced to hire more nurses under the terms of a new law that Gov. Gray Davis announced last week.

But it could create financial trouble for Stanford Hospital, which is trying to recover from huge losses in recent years.

The new regulations establish an overall minimum ratio of one nurse per every six hospital patients.

Nursing unions had pushed for ratios of 1:3, while the state's hospital industry pushed for ratios of 1:10.

Nurse-patient ratios are sometimes hot-button issues between nurses' unions and hospitals, often expressed in "patient safety" terminology. That was one of the issues between Stanford nurses and the hospital in the 51-day nurses' strike in the summer of 2000, although money was the overriding issue.

Stanford Hospital officials couldn't be reached for comment on how the new regulations will affect the hospital. "We just don't know yet," said a hospital spokeswoman.

A member of the Stanford nurses union -- the Committee for Recognition of Nursing Achievement, or CRONA -- said she believes some day shifts at the hospital already meet the 1:6 nurse-to-patient ratio. But the evening shifts are closer to 1:7 and overnight shifts closer to 1:9, said Kim Griffin, CRONA spokeswoman.

Nurse-patients ratios also undoubtedly vary between types of nursing units. While some nursing units are general medical, others specialize more, with one unit devoted to cardiac care patients, for instance.

The 1:6 ratio affects the general medical-surgical nursing units. The state already has mandated minimum staffing levels for the most specialized units, including intensive care, operating rooms, the neonatal intensive care unit, intermediate care nursery, and the well baby nursery (the last three of those being at the adjacent Lucile Packard Children's Hospital).

The regulations also establish minimum staffing levels for other units, such as 1:2 ratios in delivery rooms and recovery rooms, 1:4 in emergency rooms but 1:1 in trauma units (Stanford has one), and 1:4 in pediatrics, which would be all the general medical-surgical beds at Packard Hospital.

"We hope it will have a positive impact," Griffin said of the new regulations. "We hope it provides a safe standard for nursing care."

The law's passage comes at a time when the Bay Area, the state and the country all have nursing shortages. Hospitals regularly hire "agency" nurses to fill out shifts, but such contract nurses are much more expensive on a per-day basis than regular staff.

Kaiser Permanente may have set a precedent for the law when it reached an agreement last summer to adopt a 1:4 nursing ratio.

"The rest of the country is watching this very carefully," Griffin said.

When the nurses' strike was settled at the end of July 2000, the hospital had some 1,635 nurses, many of them part-time (flex-time is a big part of the nurses' profession). That number may be lower now, Griffin believes.

E-mail Don Kazak at


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