Health care jobs are reported to be among both the largest- and fastest-growing occupations in the United States, according to Bureau of Labor Statistics projections for 2002-2012. These occupations include registered nurses, medical assistants, physician assistants, home health aides, medical records and health information technicians, and physical therapist aides and assistants. This indicates a future influx of health care workers, but also the likelihood of legislative changes for the workplace. Some of these changes are already under way.
In a May 26 ruling, for example, a California Superior Court judge in Sacramento County upheld the state's nurse staffing law, which says that hospitals must maintain the law's nurse-to-patient ratios at all times. The ruling was in response to a challenge by the California Healthcare Association (CHA) in a lawsuit filed last December against the state Department of Health Services. The judge ruled "the hospital must reassign the nurse's patients to another nurse and the reassigned patients must not cause the relieving nurse's patients to exceed the applicable ratios set forth in the regulation." The statement of the Department of Health Services was being challenged in reference to the law requiring hospitals "to reassign patients to another nurse when that nurse is on a break, transporting a patient, or otherwise temporarily unavailable." The California Nurses Association called the ruling "a huge victory for RNs and patients," while the CHA stated that "the judge's ruling essentially handcuffs a hospital's ability to guarantee access to timely health care services for every patient who needs our care." Based on 4 months of survey data it gathered, the CHA reported "85 percent of hospitals throughout California are unable to comply with the nurse-to-patient ratio regulations."
If patients cannot be readily assigned to other nurses, delays may occur in transporting patients and impact schedules of other departments. In some instances, staffing would need to be increased in departments that depended on nurses to transport patients. Although this might not impact larger hospitals, it could have a major impact on smaller hospitals where there is a large amount of multitasking.
California has taken the lead in establishing nurse-to-patient ratios, but other states are in various stages of multidisciplinary health care legislative activity. In Montana, for example, a proposed administrative rule for medical assistants gave the Board of Medical Examiners the authority to establish a law allowing physicians and podiatrists to delegate clinical and administrative tasks to medical assistants "in their office," which was defined as any place where patients are seen, including hospitals and nursing homes.1 This proposed rule was withdrawn by the Board of Medical Examiners because of the volume of opposing comments and testimonies.
Because of the projected increased job opportunity in health care, a strong case can be made for supporting the proposal for strengthening ties between Nursing Administration Research and Health Services Research. These ties would enable Nursing Administration Research and Health Services Research to tackle problems that exceed the ability of either field alone. A specific example refers to staffing and structural measures that were omitted from the National Health Care Quality Report.2
To improve patient services and safety, a critical look at the many changes affecting the health care workplace is needed. Such examination will strengthen research efforts that have the potential to provide innovative approaches to the issues.
SueEllen Pinkerton, RN, PhD, FAAN
Editor-in-Chief
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