Reprieve gives Barton time to find more nurses |

Reprieve gives Barton time to find more nurses

Susan Wood
Jim Grant/Tahoe Daily Tribune Barton registered nurse and instructor Claudine Katz, right, supervises student nurse Carmen Lawrence as she practices an IV set-up in the RN skills lab at the hospital.

The state under Gov. Arnold Schwarzenegger’s orders will give Barton Memorial Hospital a three-year reprieve from accelerated nurse-to-patient regulations.

As of last January, the state Department of Health Services required hospitals have licensed nurses care for no more than six patients in medical-surgical units – Barton’s busiest department.

By next January, the ratio would have been set where only five patients could be cared for by one nurse. The mandate gives hospitals until 2008 to implement the new ratios. The orders have been identified as leading to the closure of 11 hospitals around the state, the Association of California Nurse Leaders has reported.

In emergency rooms, the level of care is four patients for one nurse.

Hospital administrations have breathed a sigh of relief over the delay, while nursing advocates denounce relaxed rules after the state took four years to study sufficient levels.

The mandate was signed into law by then Gov. Gray Davis in 1999.

To implement the new rules, Barton was forced to shut down the intensive care unit for an unprecedented 60 days this year because it failed to have adequate staffing. Before the mandate, the closure would be considered rare, Barton Director of Hospital Operations Kathy Cocking said.

“When you’re the only game in town, patients have to wait until there’s a bed available,” she said, citing a growing number of transfers from Barton.

For that, Barton looks east not west. California hospitals are already saddled with implementing their own ratios. In Nevada, Barton has sent a steady number of patients to Carson Tahoe Hospital, Washoe Medical Center and St. Mary’s – depending on insurance provided.

And in the history of the hospital, administration has never called on so many traveling fill-in nurses to help with the demand.

Barton may save about $400,000 from the three-year delay.

Barton has scrambled to hire enough nurses to handle the demand and rules, with the South Shore facility teaming up with Lake Tahoe Community College and Sierra College to run a Web-based pilot program that trains future RNs.

Amid a severe nursing shortage, Nevada has the worst nurse-to-patient ratio, with 520 practitioners treating 100,000 patients. California comes in second.

Barton is flanked by both states, expecting many of its nurses to retire in the next five to 10 years. The average age among Barton RNs is 48.

The Federal Health Resources and Services Agency has projected by 2010 that California will need more than 42,000 additional nurses to meet the demand.

Cocking, a registered nurse herself, said she’s split on her opinion of the rules.

“I agree with fewer patients per nurse. I think the theory is a good one. But the timing is ridiculous. It’s so silly to have this mandate when we have a nursing shortage,” she said.

But there’s no time like the present when it comes to patient health, the California Nurses Association contends in condemning the governor’s decision last week.

“We don’t advocate traveling nurses as the preferred alternative, but they’re better than no nurses,” CNA spokesman Charles Idelson said, adding national studies have shown safe RN staffing saves lives. “A lot of hard work went into these requirements.”

CNA President Deborah Burger said suspending the major provisions “puts tens of thousands of Californians at risk.”

Emergency rooms in particular are expected to be undermined by the delay, CNA states. The association predicts patients will have longer waits.

CNA plans to stage a protest at the Capitol on Dec. 1.

– Susan Wood can be reached at (530) 542-8009 or via e-mail at

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