The California Department of Public Health announced this week that with the end of COVID emergency orders, it will return to enforcing nursing ratios at hospitals.

Senate Bill 227 mandates that general acute care hospitals maintain a certain number of nurses for each patient.

The law went into effect Jan. 1, 2020. By March, when the COVID-19 emergency was declared, CDPH shifted its focus from enforcement to pandemic response, according to a CDPH statement.

“Since the public health emergency is no longer in effect and the Department has returned to performing routine workload, the Department wanted to remind facilities of the requirements for compliance with staffing ratios and the penalties that are associated with noncompliance,” a CDPH spokesperson said.

SEIU Praises Announcement

The law breaks down necessary nurse ratios by department.

Critical care departments must have one nurse for every two patients, emergency departments must have one nurse for every four patients, and surgery centers must have one nurse for every six patients.

The law allows unannounced inspections to enforce those ratios. Hospitals would be fined $15,000 for the first violation and $30,000 for the second.

The union representing hospital workers, Service Employees International Union, praised the announcement.

“Patients in California are safer today because nurses and health care workers demanded that hospitals be held accountable for violating safe-staffing laws,” said Leo Pérez, RN and president of SEIU 121RN.

“The COVID-19 pandemic taught us that our state’s health depends on supporting and listening to those who are on the front lines of patient care – a lesson we should never forget. Today’s action is the result of SEIU’s relentless vigilance. We applaud the step CDPH has taken to enforce laws that keep patients safe.”

Costa Introduces Bill to Address Nursing Shortages

The announcement comes as politicians and health care experts say the industry has a nursing shortage.

In June, Rep. Jim Costa (D-Fresno) announced legislation to look into methods to address what he says was a coming shortage.

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By 2030, experts expect a shortage of between 6,000 and 9,000 nurses in the San Joaquin Valley, Costa said.

Sources at multiple Valley hospitals and the California Hospital Association were unaware of the CDPH announcement restating the law.

But they say they have been keeping up with mandated ratios.

Keri Noeske, chief nursing officer with Kaweah Health, said these rules are not new. Since the law has been in effect, CDPH has not been randomly inspecting hospitals.

Kaweah Health has maintained the required nursing ratios, Noeske said.

Inspections came if complaints were made or if another visit was scheduled, Noeske said.

“My guess is they want to demonstrate clearly that they are going to be surveying this and expecting accountability to this expectation in response to likely nursing group demands that hospitals are held accountable to staffing ratios,” Noeske said.

‘Unpredictability’ Makes Staffing Hard

Hospitals have been facing shortages regularly.

“Like so many hospitals across the country, Community Medical Centers has experienced unpredictable and uncontrollable situations over the last few years affecting staffing levels,” said Daniel Davis, RN and Senior VP, Chief Nursing Officer with Community Health System. “We monitor the flow of patients through our facilities closely to maintain appropriate nurse-to-patient ratios.”

At Kaweah Health, they have 120 to 140 nurses on any given shift, said Noeske. The problem comes with callouts. Ten or twelve people calling out can be difficult to backfill.

The law creates exemptions for hospitals that can show they don’t have control of the staffing shortage.

Hospitals would have to show that they exhausted their on-call list of nurses, according to CDPH.

Tulare County Nursing Students Are Up 50%

Across the five programs in Tulare County, the number of nursing students has increased by 50%, adding 202 students, according to Noeske.

Porterville College, San Joaquin Valley College, and College of the Sequoias all have nursing programs. Private university Unitek offers courses at Kaweah Health and at Sierra View Medical Center.

Unitek also recently began offering courses at Community Medical Center. In Fresno County, there are nearly 600 qualified applicants who are unable to secure a spot in a local nursing program, according to a news release from Community Health.

Noeske said not all those will graduate and not all those will stay in Tulare County, but the number is encouraging.

“A couple of years ago, it was about 400 a year who graduated, but they weren’t necessarily all local,” Noeske said. “Now it will be over 600 a year that graduate and that will help with the shortage.”