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She said that this bill would limit her flexibility to take care of her patients. “Things come up that you don’t prepare for, and having a ratio would put a rigid structure on our workflow,” Gonzales said. She said if a patient needed to come in earlier, they might not be able to. Too many patients at once, she said, could put nurses in the uncomfortable situation of either seeing a patient or breaking the law. According to data collected by the Centers for Medicare and Medicaid Services, 69 percent of dialysis patients in California give their clinic a ranking of nine or 10 out of 10, and only 10 percent of patients rated their clinic at a six or below. Opponents argue, then, that clinics are already operating better than other states with similar ratio structures. A Californian Health Care Foundation study in 2009 found that “ratios have had no clear impact on the quality measures that are associated with nursing care,” though it gave no specific data on dialysis nurses. Dr. Bryan Wong, who has worked in dialysis for about 30 years, says the bill will create unintended consequences for his patients. “The bill as it exists does not have enough safeguards that will allow treatment of patients being paramount,” Wong said. He said that because the new law requires that chairs be vacant for 45 minutes, all shifts would be pushed up, and patients who usually come in at night could no longer be treated.
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