Features

California Nursing Association (CNA) organizers and member registered nurses (RNs) met outside Alta Bates and Summit Medical centers Friday to protest what they call a scheme to sidestep a new law that takes effect on Jan. 1 mandating patient-to-nurse staffing ratios. 

AB 395, signed into law by Gov. Gray Davis in 1999, establishes a ratio of six patients per nurse, with even lower numbers in intensive care units. But CNA charges that hospitals are skirting the law by hiring Licensed Vocational Nurses (LVNs) who must be supervised by RNs and can’t perform many of the duties required in patient care. 

CNA organizers point out that LVNs can’t assess patient conditions, which must happen at least once every 24 hours. Thus, an RN already assigned to cover six patients might still have to perform assessments of other patients assigned to LVNs, increasing and possibly doubling their workloads. 

CNA says this is also a violation of the Nursing Practice Act and have filed a complaint with the California Board of Registered Nursing. 

“We fear an attempt to replace RNs with LVNs,” said Vicki Bermudez, a regulatory specialist with CNA. “This is not an effective care model.” 

CNA organizers cite research recently released by the Institute of Medicine of the National Academy of Science that conclusively links RN staff levels to positive patient outcomes and hospital safety. Hiring more LVNs they say, is just a way to meet the quotas without providing the best possible care. 

“Does the public realize what this means?” asked an Alta Bates nurse who wished to remain anonymous for fear of reprisal. “They are going to be expecting a certain level of care and they’re not going to get it.” 

Legally, LVNs can comprise up to half of the nurses assigned to patient care on any unit minus those requiring RNs only. 

According to Vicki Ardito, chief nursing officer at Alta Bates, her hospital and Summit plan to hire a total of 200 new nurses to meet the ratios. She expects that number will include a ratio of 80 percent RNs to 20 percent LVNs.  

The new jobs, she said, will be added to the already existing 1400 at the two hospitals and will come at a cost of $18 million. 

“No matter how you slice it, it’s more licensed people,” said Ardito. 

CNA charges that the decision to hire LVNs—who require less training and receive lower salaries—proves the decision is market-driven. 

They say both Alta Bates and Summit have been evasive and unwilling to schedule a meeting as the first step in the establishment of a system to monitor the hospital’s move towards meeting the quotas. 

In the meantime, CNA organizers say RNs already face the dilemma of scheduling assessments of LVN patients. During the meeting, they advised RNs to cite safety concerns, refuse increased workloads, and form a committee as a way to insure better outcomes. 

“Remember, the public is on our side,” said Donna Carter, an RN at Alta Bates. “People are concerned about the care they are going to get.”