Healthcare Standards

California ends fast-tracked hospital staffing ratio waivers

The California Department of Public Health on Monday imposed stricter requirements on its staffing waiver requirements.

Effective Feb. 1, the state’s public health department stopped accepting expedited requests for staffing waivers, instead requiring hospitals to follow the standard waiver process. All existing staffing waivers will expire Feb. 8, unless the public health department deems there is an “unprecedented circumstance” for that hospital, according to a letter sent to general acute care hospitals.

The state had allowed temporary waivers in December—its second time during the COVID-19 pandemic—to help hospitals respond to the surge in COVID-19 cases and hospitalizations that threatened to overwhelm Southern California hospitals but have since started to decline. California law typically requires hospitals to have one nurse available to care for every two intensive care patient and one nurse for every four emergency room patients.

The California Public Health Department said it will investigate any hospitals that have not “maintained efforts to increase staffing” and many do unannounced audits of those hospitals.

The California Nurses Association characterized the decision to end expedited staffing waivers “a victory.”

“This is an incredible victory for patients and nurses because we know that safe staffing saves lives,” Zenei Triunfo-Cortez, a nurse and a president of the California Nurses Association and its national organization, National Nurses United, said in a prepared statement. “But we must continue to stay united and vigilant in protecting and enforcing the safe staffing standards we need to provide the kind of nursing care we know our patients deserve.”

California Hospital Association President and CEO Carmela Coyle said the association is working with the state “to ensure this policy will not put patients at risk.”

“While COVID-19 cases and hospitalizations have been tapering, the current level is still more than double that of the summer surge, and the need for specialized nurses in certain regions has been beyond what we are able to secure,” Coyle said in a prepared statement. “Staffing ratio waivers have been a critical part of a strategy, along with the use of travel nurses and team nursing, to care for as many Californians as possible during this pandemic. As surges wax and wane, and new strains of the virus threaten more and faster outbreaks, we’ll need to continue to evaluate the best mix of approaches with the goal of saving as many lives as possible.”

The debate over staffing ratios is one that workers and administators are having across the country, as the pandemic exacerbates existing staff shortages. Nurses associations say patient safety is affected when ratios are too high but systems say they are unable to find workers to handle the COVID-19-induced demand.

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