California Is Overriding Its Limits On Nurse Workloads As COVID-19 Surges

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30 Дек 2020, 18:00

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Nerissa Black works as a telemetry nurse at the Henry Mayo Newhall Hospital in Valencia, Calif. Since early December, she’s been tasked with caring for six critically ill patients per shift instead of four.

Nerissa Black

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Nerissa Black

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Unionized nurses in California held a rally Aug. 5 as part of a National Day of Action to increase awareness, they say, of ways nurse staffing ratios in hospitals can have an impact on patient safety.

Nerissa Black

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Nerissa Black

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Hospitals’ next step is to try «team nursing,» Coyle says, pulling nurses from other departments, like the operating room, for example, and partnering them with experienced critical care nurses to help care for COVID-19 patients.

Joanne Spetz is an economics professor who studies health care workforce issues at the University of California, San Francisco. She says hospitals should have started training nurses for team care over the summer, in anticipation of a winter surge, but they didn’t, either because of costs — hospitals lost a lot of revenue from cancelled elective surgeries that could have paid for that training — or because of excessive optimism.

«California was doing so well,» she says. «It was easy for all of us to believe that we kind of got it under control, and I think there was a lot of belief that we would be able to maintain that.»

The California Nurses Association has good reason to be defensive when it comes to the integrity of the patient ratio law, Spetz says. It took 10 years of lobbying and activism before the bill passed the state legislature in 1999, then several more years to overcome multiple court challenges, including one from then-governor Arnold Schwarzenegger.

«I’m always kicking their butt, that’s why they don’t like me,» Schwarzenegger famously said of nurses, drawing broad ire from the nurse’s union and its allies.

Nurses prevailed in the court of public opinion and in law; rules that put a legal cap on the number of patients per nurse finally took effect in 2004. But the long battle has made nurses fiercely protective of their win. They’ve even accused hospitals of using the pandemic to try to roll back ratios for good.

«This is the exercise of disaster capitalism at its finest, where [hospital administrators] are completely maximizing their opportunity to take advantage of this crisis,» says Roberson.

Hospitals deny they want to change the ratio law permanently, and Spetz says it’s unlikely that they’d succeed if they tried.

The public can see that nurses are overworked and burned out by the pandemic, she adds, so there would be little support for cutting back their job protections once it’s over.

«To go in and say, ‘Oh, you clearly did so well without ratios when we let you waive them, so let’s just eliminate them entirely,’ I think, would be just adding insult to moral injury,» Spetz says.