Guest Column

2005 Nursing Crisis - California Style

By Mike Kirchubel

On November 4th, 2004, two days after the GOP-dominated national elections, an emboldened Governor Arnold Schwarzenegger issued an “emergency” regulation to stop the 5:1 patient to nurse ratio law for three years.  Interestingly, his “Finding of Emergency,” his official excuse for stopping the law, read as if it were copied from the hospital lobby’s web site. Was this a real emergency?  Was the Governor protecting Californians from a real danger, or was he merely parroting the hospital industry’s propaganda and doing their bidding?    


The closure of the tiny, 39-bed Santa Teresita Hospital in Duarte was hailed by the California Hospital Association (the hospital owner’s lobby) as the “tragic consequence of unrealistic nurse ratio regulations” and it figured prominently in Schwarzenegger’s “Finding of Emergency.” In reality, this failure was actually caused by years of “severe financial distress” and nurses who worked there reported they were “generally meeting the ratios without difficulty.”  The real kicker to this story is this, the letter announcing the hospital’s closing is dated January 6, 2004.  5 days after the 6:1 ratios started.  Now tell me, who, besides our Governor, would really believe that 5 days of intolerable 6:1 ratios caused the downfall of this poor little hospital?  Santa Teresita became the “poster child” for the hospital industry’s anti-nurse crusade. Their letter (with the date) is proudly displayed on the CHA web site as if it were mathematical proof that ratios = evil.


The California State Office of Health Planning and Development reports that the year BEFORE the ratios started, 10 California hospitals failed.  Unfortunately, the hospital owners had no one else to blame in 2003.


The Governor’s “Finding of Emergency” cites California’s nursing shortage as the main reason for delaying the ratios.  Ironically, the nurses’ law was the primary factor in the dramatic RN increases seen over the last few years as California hospitals aggressively hired nurses to comply with the ratios. For the 5 year period from 1990 to 1995, the number of active California RNs grew at a rate of less than 2,000 per year.  From 1995 to 2000, the rate was 3,000 per year.  But, from June 2000 to June 2004, this rate exploded to 10,000 a year!  And, for the last six month period from June 30th, to December 31st, 2004, an average of one thousand active status RNs were added to California’s roles each month.


This welcome and spectacular trend was instantly reversed by the chilling effect of the Governor’s “emergency” delay tactic.  The January 2005 numbers showed a drop of over 300 active RNs as hospitals that had hired in anticipation of the scheduled January 1st 5:1 ratios suddenly discovered they were “overstaffed.”    


Certainly it costs something to hire more RNs and there are as many guesses for how much as there are guesses for how many nurses we’ll need to fill those ratios.  But, amazingly, there may be no cost at all.  There have been dozens of independent studies showing that an enriched RN presence actually saves the hospital money. These studies show that when the RN staffing is pumped-up, wonderful things begin to happen:  there are fewer wound infections, fewer cases of pneumonia, fewer pressure ulcers, fewer urinary tract infections, the patients get better educated on issues of health, their disease and treatment, they get up and move around sooner, and they go home earlier. 


Kaiser, our nation’s largest HMO, and not known for being fast and loose with it’s cash, has decided to go ahead with the 5:1 ratios this year in spite of the Governor’s “emergency.”  This makes perfect sense from Kaiser’s vantage.  The company makes money from its member’s monthly premiums and must spend that money, providing healthcare, when its members are sick.   Kaiser’s fiscal health equates to its members physical health.  When Kaiser’s patients spend less time in the hospital, everyone is happy. 


But that’s not true with traditional hospitals.  They get paid by the patient or his insurance company to provide services.  The more infections, ulcers, medication errors, late antibiotics, infiltrated IVs, pneumonias, falls, poor patient education, and time spent in the hospital, the more money they get paid.  I figure the best thing the hospital owners could do (if they only cared about their bonuses and not about the health of us Californians) is eliminate as many nurses as possible from the hospitals.  Come to think of it, that’s exactly what happened in the 1990’s and that’s what led the nurses to push for their ratio law. Interesting, huh?


On March 4th, the Superior Court of California will hold a hearing in Sacramento to decide if the Governor acted in good faith when he declared a state of “emergency” and unilaterally delayed the ratio law.  Will the “evidence” he presented in his “Finding of Emergency” prove that he acted in our best interests, or in the best interests of the special interests?   Stay tuned.


Mike Kirchubel lives in Fairfield, CA. Contact at