As state health officials prepare to set the first comprehensive nurse-to-patient hospital staffing ratios in the country, the California Nurses Association has embarked on a statewide publicity blitz.

The CNA, which represents 32,000 registered nurses, is holding a series of town hall meetings up and down the state, with the avowed intent of gaining widespread media coverage and ratcheting up political pressure.

The union is upset over proposed staffing ratios that the California Healthcare Association, the hospital industry trade group, has submitted to the state. The nurses contend that if the Department of Health Services accepts the proposed ratios, it would lock in currently unacceptable conditions that the union blames on managed care, hospital mergers and the growth of corporate chains.

"Those ratios would drive even more nurses out of hospitals," said CNA spokesman Charles Idelson. "It's our contention that a major cause of the nursing shortage is the erosion of patient care caused by a decade of downsizing that has produced unsafe staffing levels and unmanageable work levels for nurses."

To make its point, the CNA, which has yet to release its own staffing proposals, has invited nurses, the public and the media to attend 21 meetings to be held at various locations stretching from San Diego to Sacramento. Three Los Angeles-area meetings are scheduled for next month.

During the meetings held thus far, nurses have spoken out about what they say are poor working conditions. Those statements have infuriated the hospital association.

"All they are trying to do is attack and get publicity. This is about a union trying to get publicity and members," said Jan Emerson, the CHA's vice president of external affairs. "They are not contributing to a constructive dialogue on this."

The CHA defends its proposed ratios as bare minimums that would likely be adjusted upward, depending on patient conditions.

The association's proposed ratios range from one nurse for every 12 patients in subacute/transitional care, to one nurse for every six patients in emergency rooms and one nurse for every two patients in burn units.

By comparison, the other major nursing union, the Service Employees International Union, which represents more medical personnel but fewer registered nurses, already submitted its proposal to the state calling for higher ratios.

It proposes one nurse to every six patients in subacute/transitional care and one nurse to every three patients in emergency rooms. Its burn-unit proposal is the same as the CHA's.

Emerson said she does not expect the state to accept any of the parties' proposals wholesale, with the final ratios likely emerging from a compromise.

Lea Brooks, chief spokeswoman for the state health department, said the agency is still studying the situation and recently signed an agreement with the University of California to research the matter.

"There is no requirement that hospital facilities provide this information (on their actual current staffing ratios), so we are gathering a lot of information," she said.

The state, which had asked the hospitals, nurses and other interested parties to submit their own proposals, now expects to issue preliminary mandatory minimum staffing ratios by September.

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