Does anyone have any ideas or suggestions on where to find the guidelines for staffing ratios or how to have them changed? I have called the Renal Network for my area & was told to check with the board of nursing. I had no luck there either, I have looked for info from CMS and can't find the regulations. We currently work a 4:1 PCT / pt ratio, with one RN. It is horrific. A neighboring state less than 5 miles away has a mandatory 3:1 ratio. Both of the clinics are owned & run by FMC and we do share staff. The problem is that no one wants to work in the 4:1 ratio clinic when they can work a 3:1 ratio for the same amount of pay. We have tried to talk to our regional manager (who has no medical background) about this issue & it got us absolutely nowhere. Now, to make matters worse, techs are working off the clock in the morning to get their assignments ready because the regional mgr told them they aren't allowed to clock in earlier than 6am. The first patients come into the unit at 6:45am, it is not enough time unless we start to cut corners & not follow policy. I know that this is not legal for FMC to do this, but this is a big company with lots of $$$$$$. Please any suggestions would be helpful, everyday feels like we are hanging on by a thread & the patients are the ones who are paying the price. HELP!!!!!