Nurses to voice concerns over PVH staffing

Presentation planned at Nov. 3 health care board meeting

October 26, 2005

By DAN JOHNSON
ARGUS-COURIER STAFF

The California Nurses Assoc-iation, representing registered nurses at Petaluma Valley Hospital, plans to make a presentation to the Petaluma Health Care District Board of Directors Nov. 3 emphasizing the need to include only registered nurses -- not licensed vocational nurses -- in meeting mandatory California nurse-to-patient ratios.

The presentation is scheduled for a public meeting that will focus on recent surveys of community leaders and the general public regarding whether or not PVH should continue its lease with the St. Joseph Health System. In 1997, SJHS signed a 20-year contract with PHCD to operate PVH, but a clause in the contract allows the health care district to sever ties in 2007 if it wants.

Nurse-to-patient ratios are also among the main points of contention during ongoing contract discussions between the CNA and PVH administrators. The current contract theoretically expires on Oct. 31, but would remain in place after that until a new one is agreed upon as an arbitrator attempts to resolve disputes.

"RNs are the primary caregivers in the hospital, and the board needs to hear their major concerns before making a decision about the lease," said Bill Urman, the CNA labor union representative for PVH nurses. "We've had a running battle with the hospital regarding the application of the California nurse staffing law."

In an effort to address a serious nursing shortage, California became the first state in the country to establish minimum RN-to-patient ratios for hospitals. The nurse staffing law, based on Assembly Bill 394, mandates that all staffing must be within minimum specific numerical nurse-to-patient ratios for acute care, acute psychiatric and specialty hospitals.

The ratios are the maximum number of patients that may be allocated to a nurse during a shift. The law requires patients to be assigned based on a documented classification system that measures patient needs and nursing care, including severity of illness and complexity of clinical judgment.

Assembly Bill 394 states, "This bill would prohibit a general acute care hospital, an acute psychiatric hospital, and a special hospital, as defined, from assigning an unlicensed person to perform nursing functions in lieu of a registered nurse, or from allowing unlicensed personnel under the direct clinical supervision of a registered nurse to perform certain functions."

The bill was passed in 1999, final implementation regulations were issued in the summer of 2003 and hospitals were required to meet staffing ratios by Jan. 1, 2004. But controversies over interpretation have popped up throughout the state.

CNA's point of contention with PVH concerns the use of LVNs to meet the required ratios.

PVH currently has 156 RNs and only eight LVNs on staff, but utilizes some of the 55 LVNs at Santa Rosa Memorial Hospital, said Kevin Andrus, media relations specialist for SJHS of Sonoma County.

"LVNs must work directly under either an RN or a physician," Urman said. "They can't exercise independent judgment in regard to medical care. RNs, on the other hand, are accountable for the care they provide, and have legal responsibility. Although the nurse ratio law doesn't exclude LVNs, it says that each hospital must respond within its own scope of practice.

"When we've discussed the nurse ratio law with other hospital systems, most of them have understood the need to include only RNs, and as a result, we haven't had too many fights. At this point, PVH administrators are arguing not to do this, but we still have a ways to go in our negotiations."

"The language in the nurse ratio law says 'licensed nurses,' but CNA would like to change this language," said Jan Kiely, director of nursing services at PVH. "For us at PVH, it's a matter of exercising flexibility to meet the hospital's needs."

PVH Director of Operations Wayne Fairchild acknowledges that nursing staff ratio is a major point of contention.

"It's been a big agenda issue to the CNA statewide. We've been discussing it during negotiations, and we will continue to staff nurses pursuant to the law," he said.

Urman says that statewide, attempts to clarify or change the nurse ratio law have faced an uphill battle.

"Part of the problem is that the government in this state has gone through the courts to do away with the ratio," he said. "Since the administration has taken that position, whenever the Department of Health Systems has tried to investigate a problem, it hasn't seen much of an opportunity to launch any big fights.

"But statutes have been on the books for a long term specifying that a LVN is not an RN."

Urman says that CNA hasn't taken a position on the lease agreement with SJHS.

"At some point, we will, though. I don't know where the PHCD board stands on the lease," he said.

Kiely feels that the tie-up between PVH and SJHS has helped to boost nursing and other services.

"The hospital has very much benefited from it. St. Joseph has provided equipment, technology and other resources, and enabled us to offer generous benefits and wage packages," she said.

PVH nurses have other concerns besides the nurse ratio law, including economic compensation.

"Actually, CNA isn't too unhappy with the compensation," Kiely said. "We have an excellent benefit program, we've been able to select our retirement program and our wages track pretty closely with hospitals in Santa Rosa. CNA wants to be sure that compensation is kept at the same levels as hospitals around us, because this is important for the retention and recruitment of nurses."

Kiely reports substantial progress in negotiations on the new contract with PVH.

"Overall, we're making good progress," she said. "We've had some constructive collegial dialogue, and have managed to maintain humor at times during the process. So far, we've agreed on several issues, but others still are on the table. I'm very hopeful we will continue to progress as well as we have to this point."

Kiely applauds the new contract's stipulation that monthly meetings will take place between PVH and nursing services administrative leaders.

"Strong communication is one of the most important things to us, and certainly, it has been improving," she said.

Fairchild has been stressing the need to improve communications throughout the hospital since he came aboard this year.

"We want to better meet the needs of the community, and this can be done partially through better communications," he said. "So, I'm trying to get everyone at the hospital involved in working toward this goal.

"We need to deliver -- not merely talk about it. So, I'm on the floor five days a week, and sometimes on weekends. I don't want to just sit behind a desk and fiddle with paper."

Fairchild feels that contract negotiations have gone extremely well.

"In negotiations such as this, people begin by asking for the moon," he said. "The nurses won't get the moon, but we are on the same page in wanting to offer quality care and successfully address the needs of our nurses."

"I'm optimistic that we can wrap up negotiations fairly quickly. Actually, this has been the easiest round of negotiations I've ever had."

(Contact Dan Johnson at djohnson@arguscourier.com)