tammerrin

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
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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."
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Jasonvisa

One DUI 19 years ago will not be a problem as long as there are no other
problems.

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