California relaxes limits on nurse to patient ratios

"We need to temporarily — very short-term, temporarily — look a little bit differently in terms of our staffing needs," said Gov. Gavin Newsom, after he quietly allowed hospitals to adjust their nurse-to-patient ratios on Dec. 11

Since then, 170 hospitals, mainly in Southern California, have been operating under the new pandemic ratios: They can require ICU nurses to care for three patients instead of two. Emergency room and telemetry nurses may now be asked to care for six patients instead of four. Medical-surgical nurses are looking after seven patients instead of five.

"What we're seeing in these hospitals is their just-in-time response to a pandemic that they never prepared for: just-in-time staffing, just-in-time resources, not staffing up, calling nurses in on a shift at the very last minute — to boost profits," says Stephanie Roberson, the government relations director for the California Nurses Association.

The state has asked the federal government for staff, including 200 medical personnel from the U.S. Department of Defense, and it's tried to reactivate the California Health Corps, an initiative to recruit retired health workers to come back to work, but that has yielded few people with the qualifications needed to care for hospitalized COVID-19 patients.

Joanne Spetz is an economics professor who studies health care workforce issues at the University of California, San Francisco. She says hospitals should have started training nurses for team care over the summer, in anticipation of a winter surge, but they didn't, either because of costs — hospitals lost a lot of revenue from canceled elective surgeries that could have paid for that training — or because of excessive optimism.

The California Nurses Association has good reason to be defensive when it comes to the integrity of the patient ratio law, Spetz says. It took 10 years of lobbying and activism before the bill passed the state legislature in 1999, then several more years to overcome multiple court challenges, including one from then-Gov. Arnold Schwarzenegger.