Does 'licensed' in 2004 law mean only RNs? (article)
From 11/20/02 San Francisco Chronicle
http://www.sfgate.com/cgi-bin/articl...20/BA31607.DTL Does 'licensed' in 2004 law mean only RNs? Unions debate nurse-patient ratios ahead Sabin Russell, Chronicle Medical Writer Wednesday, November 20, 2002 ------------------------------------------------------------------------------- As California prepares to carry out its first-in-the-nation law telling hospitals how many nurses they must have on hand for patients, a bitter dispute has broken out between rival unions over exactly who should count as a nurse. In the alphabet soup of the medical professions, it's RNs vs. LVNs. No one doubts that the law will require hospitals to hire more nurses, who are already in short supply. At issue is whether the state will allow hospitals to meet their quotas by hiring licensed vocational nurses -- or LVNs -- in lieu of more highly trained and paid registered nurses, or RNs. "It's for RNs only," said Hedy Dumpel, director of nursing practice for the California Nurses Association, which wrote the bill that required the state to come up with nurse-to-patient ratios. Gov. Gray Davis signed the bill in October 1999. "It's rewriting history, to say this is for registered nurses only," said Beth Capell, a lobbyist for the Service Employees International Union. The law, as written, specifies "licensed" nurses, and both RNs and LVNs are licensed by state boards. As the state prepares regulations to put the nurse-to-patient ratios into effect as of January 2004, the issue has deepened the divide between the rival labor groups. It pits the independent and combative CNA -- a group of 45,000 registered nurses -- against the powerful SEIU, which includes 30,000 California RNs and 5,000 LVNs as well as hospital orderlies. On Tuesday, the issues were aired at a public hearing before the state Department of Health Services in San Francisco. Dozens of nurses from the opposing camps staked out opposite sides of the granite steps in front of the Edmund G. Brown State Office Building and presented dueling news conferences before the hearing. The CNA nurses were decked out in red surgical smocks, and waved red and white posters mounted on sticks: "RN Ratios Save Lives." The rival SEIU nurses wore purple and yellow, and brought their own lectern, their own microphone and their own brightly colored placards: "Safe Ratios Save Lives." The CNA supports the state health department's proposal for a ratio of one nurse for every six patients on the "medical/surgical" floor, where most hospitalized patients are treated. But it strongly denounces a clause in the plan that would allow up to 50 percent of the nurses to be LVNs. The SEIU insists that the proposed state ratio is far too weak. Members want a medical-surgical ratio of 1 to 4 -- the same ratio that Kaiser Permanente agreed to in an accord with the SEIU and its allied unions, which represent Kaiser nurses in Southern California. "This kind of thing happens only once every 25 years or so," Capell said. "We want to get it right. The CNA endorsed 1 to 6. That's just not good enough. " But CNA executive director Rose Ann Demoro contends that if half the nurses are LVNs, a 1-to-4 ratio really translates into a 1-to-8 ratio for registered nurses. "This is Kaiser's agenda," she said. "If it is 50/50 with LVNs, we might as well have not done the bill at all." Kaiser spokesman Terry Lightfoot acknowledges a cooperative relationship with SEIU, but says there's no conspiracy against registered nurses. "There's no intention to change the mix of RNs and LVNs at this point," he said. Although the rules, as proposed, would require a 1-to-6 nurse-to-patient ratio, Kaiser is planning to hire enough nurses to reach the SEIU's goal of 1 to 4. Currently, only about 18 percent of licensed nurses in California hospitals are LVNs. Rules limit what LVNs can do in a hospital -- they cannot, for instance, administer intravenous drugs -- but they are also paid about one- third less. CNA spokesman Chuck Idelson said that LVNs are attempting to broaden their "scope of practice" with rule changes that would allow them to give IV drugs. Meanwhile, the rest of the state's hospitals remain opposed to the law that mandated nurse-to-patient ratios in the first place. Having lost that fight in the Legislature, they pushed at Tuesday's hearing for a more flexible approach to final rule making. Jan Emerson, spokeswoman for the California Healthcare Association, noted that only a handful of hospitals in the state, such as UC Davis Medical Center, have an all-RN staff. Meanwhile, economists project a shortage of 109,000 nurses in the state by 2010. "What we need is flexibility," she said. Hospitals should not be required to meet the ratios when nurses are on break, or during quieter times such as night shifts. Martha Kuhl, a CNA nurse at Children's Hospital Oakland, said the law's required staffing levels will eliminate the nursing shortage. "There is no shortage of RNs," she said. "There's just a shortage of RNs willing to do direct, bedside patient care under current conditions." ------------------------------------------------------------------------------- |
Re: Does 'licensed' in 2004 law mean only RNs? (article)
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