California health officials have delayed new emergency staffing rules for acute psychiatric hospitals, pushing the start date from Jan. 31 to June 1 of this year.
The proposed regulations, required under Assembly Bill 116, would establish minimum staffing ratios for acute psychiatric facilities. Hospitals would be required to staff at least one nurse for every six adult or five pediatric patients. Facilities that fail to comply could face daily fines of up to $30,000.
The rules were prompted by a San Francisco Chronicle investigation that tied patient harm to low staffing and exposed a regulatory loophole at psychiatric hospitals.
Registered nurses rallied outside the California Department of Public Health offices in Sacramento last month, arguing the state’s proposal falls short of existing staffing standards at acute care hospitals, where the ratio is one nurse to five adult patients and four pediatric patients.
“I have worked without ratios and with the ratios. I've been a nurse long enough to have experienced both. And having the ratios makes a difference,” said Brandy Welch, a registered nurse with 28 years of experience.
“It makes a difference in the safety of our patients, as well as our own safety, but also the amount of care that we can give them,” she said.
The California Nurses Association also said the state’s proposal is less protective because it allows licensed vocational nurses and psychiatric technicians to count toward staffing ratios. Union leaders argue that approach weakens the standard of care.
“I believe that registered nurses should be counted only towards the ratios, because we are the ones that have the scope for the care of the psychiatric patient,” Welch said.
Behavioral health hospitals said their concerns are not about the concept of staffing ratios, but about how quickly the state is attempting to implement them.
“We support adjustments that are going to help people thrive, but we don't support them under extreme time pressure. That doesn't allow us to put the needed people in place,” said Le Ondra Clark Harvey, chief executive officer of the California Behavioral Health Association.
Harvey said the emergency rules do not reflect longstanding workforce shortages in behavioral health care.
“We cannot staff units with professionals that just don't exist yet, have not come through the pipeline,” she said.
Local hospitals have warned that even with the delay, hiring takes time. At Sharp Mesa Vista Hospital in San Diego County, it took an average of 67 days last year to hire a registered nurse from job posting to the employee’s first day, the hospital said in a letter to the state.
Harvey said staffing challenges could further reduce access to inpatient psychiatric care in a state that already lacks sufficient beds.
“In California, we have about 17 to 20 beds per 100,000 people. That's our current state. Ideally, we should have about 50 beds,” she said.
She warned that moving too quickly could force facilities to reduce capacity or shut down entirely.
“Folks are at risk … flooding the E.R. departments, streets, and service systems that are not adequately prepared to take care of the needs that they have,” Harvey said.
Several psychiatric facilities in San Diego County submitted letters to the state requesting more time to meet the staffing requirements. State health officials say the emergency regulations are now expected to take effect June 1.
