Former California Registered Nurse Says Vote No on Question 1

Kendra Zuffoletti, RN, lived and worked in California for five years as a registered nurse in the emergency department when the nurse-patient staffing ratio ballot was implemented. She has first-hand experience of the devastation she witnessed in hospitals because of the government-mandated ratios.

Kendra worked in a community hospital where the negative impact of the nurse-staffing ratios was greatest. With budgets that are always razor-thin, the hospital had no choice but to close beds in order to meet the cost of additional mandated nurses. Because beds were closed, wait times in the emergency department became much longer. Adhering to the mandated nurse-staffing ratios, Emergency Medical Service personnel (EMS) that arrived with patients by ambulance were held up in the emergency department for up to 36 hours to oversee their patients in the hallway until a nurse was allowed to care for them. This doubly impacted the communities they served by their absence in their role servicing the emergency medical needs of residents outside the hospital. Internally, support staff, including secretaries, IV and respiratory staff, were cut. Patient experience scores went down and quality of care did not improve.

Here are Kendra’s thoughts…

Over the five years I worked in California under the nurse-patient staffing ratio mandate, I watched our hospital struggle- Floors closed, services cut, patients were held in the ER for up to 36 hours waiting for a bed, ER wait times sky rocketed, hospitals all around us closed, EMS were stuck holding the wall waiting for a nurse…. as I was getting ready to move here, my hospital was anxiously waiting to hear if a larger company or healthcare system would come in and buy them or else they would be forced to close their birthing center (which was really an exemplary service). I lived in the community this hospital served- it was awful.

I know from personal experience how this ballot would severely affect the way nurses care for patients. The lack of flexibility in an “at all times” nurse staffing ratio hurts patient care; it doesn’t improve it. Nurses want to use their professional judgment when caring for patients based upon acuity, or how sick a patient is. This is thrown out the window with ratios. I know… I dealt with it. So whereas now, if I have a patient coding, I can focus on that patient one-on-one and have additional staff care for my other patients whose acuity is much less. In California, I had a 4:1 patient ratio regardless of acuity.  I could have 3 highly acute patients and then be in charge of a code with no one to help watch over my other patients.

Don’t be fooled into thinking that this ballot protects other staff besides nurses. If you’re referring to this: “including the facility obligation that implementation of limits shall not result in reduction in the staffing level of the health care workforce assigned to such patients,” this mandates that hospitals stick with the NURSE to patient ratios. So hospitals can’t reduce the number of nurses. By law, they can’t reduce the number of NURSES, but they can reduce the number of beds, which ultimately impacts the nurses.  So when the hospital is struggling to absorb the additional cost, who do you think will be affected… one way or the other, respiratory therapists, phlebotomists, CNAs, secretaries, techs, transport…. that’s how the hospital stays afloat. You may say they can’t; but don’t believe it. Hospitals would be forced to cut non-nursing staff and increase nursing responsibilities. Bedside nurses would be expected to do more as support staff is whittled down to the bare minimum. It may not happen right away, but it WILL happen. It happened in California, while I was nursing there-and it was scary for the patients and definitely less safe.

I work at Milford Regional in the emergency department. I encourage all of you to really research the state of healthcare in California before you do this to our sweet little community hospital. We serve a wonderful community of patients who will be forced to go elsewhere once Milford Regional can no longer handle the financial burden brought on by this terrible ballot.

I love my hospital and want to see it continue to thrive. I am fortunate enough to work with a wonderful group of teammates I can count on to pitch in, help out and have my back. I am lucky to be employed in a hospital where I feel I have a voice. I can only speak from what I saw my hospital, my community, my peers go through in California. There are big differences in the state of our healthcare versus California. For me, how nurses are able to use their professional judgement here in delivering care to patients is far better than the mandated ratio approach seen in California that strips nurses from using the autonomy and judgment they worked so hard to achieve.

We are all in this profession because we are dedicated to give our patients the absolute best care possible. We ALL want patient safety; we all want to be the best that we can possibly be. For me, that means voting “no” on Question 1.