SACRAMENTO - California nurses grabbed yet another opportunity to put their stamp on an event featuring Gov. Arnold Schwarzenegger. Shortly before the governor arrived at the Sheraton Hotel in downtown Sacramento Thursday to keynote a conference on legislative reform, dozens of vociferous nurses picketed the venue and chanted for the governor to restore legislatively mandated nurse-to-patient ratios.
Last week, the nurses staged a loud protest next door to the theatre where Schwarzenegger was attending a film screening. Prior to that, nurses disrupted his speech at a conference on women in Southern California. At that event, the governor fueled the nurses’ ire by calling them “special interests.”
At Thursday’s event, some members of the group managed to slip into an invitation-only luncheon after picketing in the street. The handful of protestors quietly stood surrounded by white table clothes and conference attendees as Schwarzenegger spoke about reforming the redistricting process. After unrolling banners that read “Stop the power grab,” they were peacefully escorted from the room by the governor’s security officers. Schwarzenegger ignored the brief interruption and continued his pitch for reform without missing a beat.
The nurses’ protest is aimed at pressuring the administration to move forward with a staffing plan as outline in a 1999 bill, sign by then-Gov. Gray Davis. That legislation, AB-394, sponsored by the California Nurses Association, set the maximum number of patients that could be assigned to a nurse in various settings. In emergency rooms the ratio was set at four patients to one nurse and six to one in general medical units. This year, the medical unit ratio was scheduled to drop to one nurse to every five patients.
According to the Nurses Association, those limits were determined through studies of patient mortality as related to nurse staffing. Deborah Burger, R.N., and president of the 58,000-member CNA, says one too many patients lessens the quality of care. “Nurses are given assignments and then they have to prioritize.” Patients with minimal care needs may be ignored so that nurses can attend to those with more acute needs, Burger added.
Last November Schwarzenegger issued an executive order that froze the planned transition to lower ratios in 2005. The action was taken in response to a plea from hospitals in the state which would have been forced to hire at least 2,300 new registered nurses to comply with lowered ratios. According to the California Hospital Association, the costs associated with increased staffing would have hit hospitals in California with an additional $200 million in payroll and benefits costs. And, although many hospitals in California are logging profits, there have also been many closures – particularly of emergency rooms – throughout the state in the past five years.
Members of CNA who are active in the anti-Schwarzenegger blitz say the governor issued the executive order because he was indebted to the hospital association and large HMOs that spent more than $3 million lobbying in 2004. One source at the CNA called the governor’s move a “quid pro quo” and charged him with endangering lives.
While being highly critical of the governor’s fund raising tactics, the CNA has amassed it’s own war chest to fight a high profile battle with the governor. And, according to Jan Emerson, spokesperson for the hospital association, the CNA has plans that go beyond California’s borders and the staffing issue.
“They have an agenda that has zero to do with patients,” Emerson said. “They are trying to establish a national labor union.” The CNA Web site (www.calnurse.org) solicits nurses to “Join with CNA to help build a national movement for RN’s.”
“They are going into other states and trying to convince nurses to disaffiliate with state associations and join the national association,” Emerson said. “They stand to get many more millions in dues than they already get. They have a $24 million operating budget and the hospital association’s is $10 million.They have more than twice the resources than we do.”
CNA executives do not deny the organization aspires to a national presence. It’s needed, they say, because the American Nurses Association has failed to represent its members.
The hospitals’ association has a different perspective. They see CNA’s campaign as an opportunistic power grab – using California’s staffing issue as a convenient vehicle. Indeed, the eyes of nurses throughout the country are on California – the only state with nurse-to-patient ratio legislation.
“One of their [CNA’s] top issues is California’s landmark ratio law,” Emerson said. “They are using the ratio law as a marketing tool.”
According to a recent article in the Stockton Record, CNA is using its financial resources in much the same manner as its rival did last year – lobbying, making $375,000 in campaign contributions to Democratic candidates and investing in a major media campaign to ding the governor.
CNA’s president says the group’s actions are not politically motivated. The association is focused on providing care that does not gamble with patient’s lives, according to an editorial written by Burger. But, much of the CNA’s message focuses on the governor. “Gov. Arnold Schwarzenegger has compromised public safety standards to please the corporate special interests he told Californians he was sent to Sacramento fight,” Burger wrote.
Emerson said the governor’s order does not “rollback” staffing ratios but, rather, continues the ratio in place last year. “In the ER the ratio is one to four, he didn’t change that,” she said. What did change was a hospital’s ability to pull additional nurses from other assignments in the event of a catastrophe – such as a train wreck, Emerson said. After the emergency is over, normal ratios would be restored.
In addition, the November order loosened the requirement that hospitals be in total compliance every hour of every day. According to Emerson, if a nurse stepped away to use the phone or the rest room, his or her patients needed to be reassigned. That requirement was suspended. “That they [the nurses] are fighting here are really some very minor changes,” Emerson said, adding that the state does not have enough nurses to staff medical units in one to five ratios.
“The plan was based on assumptions made in the Davis administration that we would have more nurses,” she said. “But we have done nothing to get more nurses.” State and nationwide nursing shortages are well documented.
But, the bottom line for the hospital association is the perception that CNA is motivated more by ambition than altruism. The nurses need to win the fight in California. “If the CNA has a setback here, that compromises their efforts in other states,” said Emerson, adding that the association represents about 60,000 of the state’s 300,000 nurses. “They present themselves like they are the voice of all nurses,” Emerson added. “But they are not. Most of the protestors are union organizers. They are not front line nurses.”
But, Burger insists that nurses have one driving concern, “patients, not profits.”
“I think that people who have not been in the hospital don’t get our fight,” she said at Thursday’s rally. “When your family member or loved one is in the hospital and that nurse is busy with someone else – well, that’s the issue we are trying to convey.” Burger says that hospital corporations – and by extension the California Hospital Association – are concerned about profits, not health. “With the election of Schwarzenegger, the industry anticipated that it had a governor who would champion corporate interests over public safety,” Burger wrote.