DAVID GREENE, HOST:
Here in California, there is a battle going on between hospitals and the state's powerful nurses union. Because of a surge in hospitalizations, the state is asking nurses to take care of more patients than they normally would. That waters down a nurse-to-patient ratio law that so far exists only in California. From member station KQED, April Dembosky reports.
APRIL DEMBOSKY, BYLINE: Normally, telemetry nurses take care of four patients at once. But since the governor relaxed the state's ratio law in mid-December, Nerissa Black has to keep track of six.
NERISSA BLACK: We are given 50% more patients, and we're expected to do 50% more things with the same amount of time.
DEMBOSKY: Her patients are sick. Many of them are in the hospital for a stroke or heart attack, and they have COVID. Black is terrified of missing something or making a mistake.
BLACK: You know, I go home and I feel like I could have done more. Oh, I could have done this for them; I could have done that for them. But there just wasn't enough time.
DEMBOSKY: In recent weeks, the state has excused 170 hospitals from the normal ratio rules, and nurses have taken to the streets in socially distanced protests, like this one in San Bernardino.
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DEMBOSKY: They accuse hospitals of putting profits over preparing for a surge - of laying nurses off over the summer, then not hiring enough for winter.
BLACK: It seems that the hospitals have been more reactive than proactive in their staffing.
DEMBOSKY: In California's current surge, four times as many people are testing positive for the virus compared to the summer. Up to 7,000 new patients could be coming to California hospitals every day. That's according to Carmela Coyle, the head of the state's hospital association. She says there's no way around the math.
CARMELA COYLE: We are simply out of nurses, out of doctors, out of respiratory therapists.
DEMBOSKY: Coyle says hospitals have tried to hire contract nurses.
COYLE: But because California surged early during the summer and other parts of the United States then surged afterwards, those travel nurses are taken.
DEMBOSKY: Coyle says hospitals' next step is to try team nursing - pulling nurses from the operating room, for example, to help with COVID patients. Economist Joanne Spetz studies the health care workforce at UC San Francisco. She says hospitals should have started training for this over the summer, but they didn't - either because of costs or excessive optimism.
JOANNA SPETZ: California was doing so well in that we kind of got it under control, and I think there was a lot of belief that we would be able to maintain that.
DEMBOSKY: Spetz says the nurses union has reason to be defensive of the law that limits the number of patients nurses have to care for at one time. It took 10 years before it passed the Legislature in 1999, then several more to clear the court challenges, including one from then-Governor Arnold Schwarzenegger.
SPETZ: At some rally where they were protesting, he made some offhand comment about kicking the nurses' butts...
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ARNOLD SCHWARZENEGGER: Because I'm always kicking their butt. That's why they don't like me (laughter).
SPETZ: ...Which really hardened the opposition to him.
DEMBOSKY: Nurses prevailed - in the court of public opinion and law. But the battle has made them fiercely protective of patient ratios. They've even accused hospitals of using the pandemic to try to roll them back for good. Hospitals deny this, and Spetz says it's unlikely.
SPETZ: To go in and say, oh, you clearly did so well without ratios when we let you waive them, so let's just eliminate them entirely, I think would be just adding insult to moral injury to nurses.
DEMBOSKY: The public can see that nurses are overworked and burned out by the pandemic. Spetz says hospitals probably wouldn't want to pick a fight with them over job protections once it's over.
For NPR News, I'm April Dembosky in Oakland.
GREENE: April's story is part of a partnership with NPR, Kaiser Health News and KQED.
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