By Deia de Brito and Bobby Caina Calvan
Sacramento Bee
June 11, 2010

Dozens of nurses walked picket lines outside the UC Davis Medical Center on Thursday, joining scores of other registered nurses across the state to protest what they decry as chronic violations of the state law requiring minimum staffing levels.

University officials, however, insist they are in full compliance with the minimum nurse-to-patient ratios mandated by the 1999 state law at the core of the dispute.

Ultimately, the fundamental disagreement between the California Nurses Association and the University of California over how the law should be interpreted and applied may be resolved during contract talks.

Staffing issues have long been a contentious issue in negotiations.

Thursday's rallies in California – at six university-run hospitals – drew scores of nurses.

But the gatherings paled in comparison to those in Minnesota, where 12,000 registered nurses held a one-day strike over the same issue.
On Tuesday, a San Francisco judge granted a temporary restraining order prohibiting the CNA from striking, so the union held informational rallies instead. Both sides will return to court June 18.

According to state law, hospitals must provide at least one nurse for every five patients. In some critical areas, such as the intensive-care unit, there must be at least one nurse for every two patients.

While staffing ratios might appear black and white, they delve into gray areas when involving patients whose medical conditions require varying degrees of nursing care.

Both sides acknowledge the complexity of measuring a patient's medical acuity – or the severity of illness. Computer software is used to help determine staffing levels.

"The state law doesn't require the hospitals to staff for acuity minute for minute," Carol Robinson, chief nursing officer for UCD Medical Center, said Thursday as a line of pickets marched in the distance. She said shift changes and breaks momentarily cause staffing to dip, but patients are never in danger.

"We meet the minimum ratios all the time. In fact, most of the time, we're overstaffed" when it comes to state-mandated minimum ratios, she said.
But the nurses union said otherwise.

Beth Kean, the union's chief negotiator for the UC labor contract, said the medical center has a history of understaffing that's gotten worse since budget cuts swept the UC system.

Kean provided hospital staffing documents that she said were evidence of understaffing.

A staffing report from March 2009, for example, showed that a UC Davis medical unit was understaffed by 26 nursing hours during one work shift.
A memo from October showed the unit went without a monitor technician during six different shifts. Another document showed the required ratio of nurses to patients had been violated on 12 occasions in October.

Kean said these numbers don't include break times, making the understaffing more severe if a nurse takes a lunch or bathroom break.

"The motive for understaffing is profit. The top people get bonuses if they come in under budget," Kean said. "As a result, most nurses don't get their breaks or they eat lunch on the run."

It's a problem caused largely by the "no-float" system UC Davis implemented a few years ago, said Kean. Floating allows nurses to fill in where there's demand in other departments.

"Nurses hate to float because you're going to work in a place you're not familiar with," said Kean. But, she added, it helps provide support where there's not enough staff.

The California Department of Public Health has enforcement authority over the staffing law, but hospitals aren't required to submit staffing reports to the agency – unless asked to do so.

In November, the nurses union filed a complaint with the state over alleged staffing violations. But state health officials have not yet investigated the complaint.

ONLINE See more photos of a demonstration by nurses protesting what they say is hospital understaffing. sacbee.com/photos"The motive for understaffing is profit. … As a result, most nurses don't get their breaks or they eat lunch on the run." BETH KEAN, chief union negotiator for the UC contract.