California issuing waivers to bypass strict nurse-to-patient ratio rules amid COVID surge

Facing a massive surge in coronavirus cases, California has been issuing waivers allowing hospitals to temporarily bypass the nation's only strict nurse-to-patient ratios.

About 250 of some 400 hospitals across the state have been granted 60-day waivers, which allows ICU nurses to care for three instead of two people at a time and emergency room nurses to oversee six patients instead of three.

California is the only state in the U.S. to require specific nurse-to-patient ratios. The waivers will only temporarily bypass that law but nurses say the change is already starting to affect care.

The waivers only apply to intensive care, observation units, cardiac monitoring, emergency and surgical care units.

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California Hospital Association spokeswoman Jan Emerson-Shea said hospitals are applying for the waivers only after they have no other choice left to care for the patients they have.

"We are literally in the worst crisis of this pandemic so far and are seeing caseloads that we have not seen to date," Emerson-Shea said, adding that hospitals are just trying to get through the crisis. "No one wants to have our staff emotionally and physically exhausted. But we have no choice. People need care."

California hospitals typically turn to staffing agencies and travel nurses during the winter season, when hospitalizations surge and medical staff get sick because of the flu. But California is now among states nationwide vying for medical personnel, particularly trained ICU nurses.

Nerissa Black was already having a hard time tending to four COVID-19 patients who need constant heart monitoring. But because of staffing shortages affecting hospitals throughout California, her workload recently increased to six people infected with the coronavirus.

Black, a registered nurse at the telemetry cardiac unit of the Henry Mayo Hospital in Valencia, barely has time to take a break or eat a meal. But what really worries her is not having enough time to spend with each of her patients.

Black said she rarely has time to help patients brush their teeth or go to the bathroom because she must prioritize making sure they get the medicine they need and don't develop bedsores.

"We have had more patients falling (in December) compared to last year because we don't have enough staff to take care of everybody," Black said.

The Associated Press contributed to this report.
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