Originally posted by Desert Rat
Sounds good on paper, but I agree with rebel..so you are covering for LVN/SNT etc, what is your ratio then? Are they really going to cut out other staff to keep the licensed ratio?
Simple answer is NO!
Complex answer is that the RNs, other hospital staff, and the public (patients & visitors) will have to help enforce the ratios. U dom't expect most facilities to comply unless forced by their staff or the DHS. Who would stay at a poorly staffed hospital when a safely staffed one is nearby?
For answers to many questions soch as why laying off other workers will not be acceptable click the PDF files on the links:
http://www.calnurse.org/
http://www.calnurse.org/cna/press/7103.html
California Nurses Assn. Applauds Final RN Ratios Plan
Hospital Industry Proposals to Erode Ratios Rejected by State
The California Nurses Association today welcomed the release of the final regulations to establish new
minimum registered nurse staffing ratios that all hospitals must meet by January 1, 2004 as a
significant step towards improving patient care conditions in California hospitals and protecting patient
safety.
"A new era is dawning in which all California families should expect safer standards in California
hospitals," said Kay McVay, RN, president of the 50,000-member CNA which sponsored the Safe
Staffing Law and worked for 10 years to enact it. "The finish line is finally near. Every patient should be
able to demand and count on receiving the registered nursing care they need, when they need it."
In the package approved by Gov. Gray Davis and the Department of Health Services, state officials
made critical decisions on some hotly contested issues regarding implementation of the
CNA-sponsored law, the first such law in the nation which has been a model for RNs and legislators in
other states. Among key decisions in the plan:
Proposals by the hospital industry to erode the ratios in Emergency Rooms, Post-Surgical
Recovery units, and for evening, night, and weekend shifts, were all rejected. State officials also
rebuffed hospital efforts for further delays in implementation.
Phased-in, improved ratios (fewer patients to nurses) in three hospital areas. As of 2008, ratios
will be lowered in Step Down units, typically housing patients just transferred from critical or
intensive care, Telemetry, where patients are on monitors, and other specialty care units, such
as Oncology and Rehab. CNA was the only organization to present scientific data - based on
22 million patient discharge records, the DRG designations and patient acuity - along with
thousands of RN testimonials to make the case for these reductions.
Assurances that hospitals must adhere to scope of practice laws to protect patient safety. No
RN may be assigned, or be responsible for more patients than the specified ratios. The
regulations clarify the respective roles of RNs and LVNs, make it apparent that RNs and LVNs
are not inter-changeable, and require that additional nurses must be assigned, as needed, by
severity of patient illness.
Hospitals are required to document staffing assignments, including the licensure of the direct
caregiver for every patient for every unit for every shift, and keep the records for one year, steps
that will help the state monitor and assure compliance with the law.
McVay noted that many CNA-represented hospitals have already hired hundreds of additional RNs in
preparation for implementing the law, and as a result of unprecedented CNA gains in compensation,
retirement security, and workplace improvements intended to enhance retention of current experienced
RNs and recruitment of new RNs.
CNA, which has campaigned since 1992 to enact safe RN staffing ratios, will work with RNs across
the state to monitor enforcement of the law and encourage hospital compliance. CNA has also
sponsored a new bill, AB 253, to help assure compliance.
Introduced by Assembly introduced by Assembly member Darrell Steinberg (D-Sacramento), the bill
authorizes state health officials to conduct unannounced inspections, and provides for fines of up to
$5,000 a day, on hospitals that continue to maintain unsafe RN staffing after final implementation of
the ratio law.
For the specific ratios by hospital unit Click here.
For the specific ratios by hospital unit and more background on the law, Click Here
Fact Sheet on RN Staffing Ratio Law
California is the first state in the U.S. to establish minimum RN-to-patient ratios for hospitals. The
ratios are based on AB 394, sponsored by the California Nurses Association and signed by Gov. Gray
Davis in October, 1999.
Today's announcement of the final regulations to implement AB 394 culminates a 10-year campaign
by CNA to improve RN staffing in California hospitals to protect patient safety, and reverse the effects
of a decade of hospital restructuring that eroded patient care conditions and produced a hospital
nursing shortage.
All hospitals must be staffing with the minimum ratios as of January 1, 2004. Many CNA represented
hospitals have already hired hundreds of additional RNs in preparation for implementing the law, and
as a result of unprecedented CNA gains in compensation, retirement security, and workplace
improvements intended to enhance retention of current experienced RNs and recruitment of new RNs.
What the Law Does
AB 394 establishes specific numerical nurse-to-patient ratios for acute care, acute psychiatric and
specialty hospitals in California. The ratios are the maximum number of patients that may be assigned
to an RN during one shift. The law requires additional RNs be assigned based on a documented
patient classification system that measures patient needs and nursing care, including severity of
illness and complexity of clinical judgment.
AB 394 also restricts the unsafe assignment of unlicensed staff and the unsafe assignment of nursing
staff to hospital clinical areas where they do not have demonstrated competency, training, and
orientation.
The specific ratios:
AB 394 required the state Department of Health Services to establish the specific ratios for specific
hospital units. In 2002, the DHS issued the proposed regulation to implement AB 394, including the
specific ratios for every hospital unit, and held public hearings.
On July 1, 2003, Gov. Davis and the DHS issued the final regulations incorporating extensive
testimony presented during the hearings and public comment, including from 500 CNA RNs who
testified in the hearings, and nearly 25,000 RNs whose letters were submitted by CNA to the DHS.
Why the Law was needed
The purpose of the law was to address the growing crisis in patient care in California hospitals caused
by managed care and market based decisions on hospital care that resulted in California having
among the worst RN staffing in the nation and a growing exodus of RNs out of hospitals creating a
serious nursing shortage.
CNA campaigned for 10 years to get the law enacted, including the largest gatherings of RNs in
California history, major rallies drawing thousands of RNs to the Capitol.
California's law was the first (and still only) ratio law in the nation. It is the single most effective
response to protecting patient safety in hospitals and reducing the nursing shortage. The California law
is considered a national, even international model, and has generated extensive attention from the
national media and RN organizations around the world.
How the ratios will protect patients
Safe RN staffing is the single most essential element to safe patient care in hospitals. In the last year
alone:
JCAHO, the Joint Commission on Accreditation of Hospital Organizations, announced that
inadequate staffing precipitated one-fourth of all sentinel events - unexpected occurrences that
led to patient deaths, injuries, or permanent loss of function - reported to JCAHO the past five
years
A New England Journal of Medicine study documented that improved RN-to-patient ratios
reduces rates of pneumonia, urinary infections, shock, cardiac arrest, gastrointestinal bleeding,
and other adverse outcomes. No similar links were found for LVNs or other nursing staff.
Research in the Journal of the American Medical Association found that up to 20,000 patient
deaths each year can be linked to preventable patient deaths. For each additional patient
assigned to an RN the likelihood of death within 30 days increased by 7 percent. Four
additional patients increased the risk of death by 31%. No similar findings were associated with
improved ratios for LVNs or other staff.
Where will the RNs come from to meet the ratios?
DHS has projected that California will need 5,000 RNs to meet the ratios that go into effect in
January. That is the same number of RNs who graduate every year from California's 72 schools
of nursing.
The approach of the ratios is already having an effect on overcoming the nursing shortage. In
the past fiscal year, the number of RNs increased by 4% -- the largest increase since 1989,
reports the Board of Registered Nurses. The number of exam applicants increased by 18% and
the ratio of RNs entering and exiting the state continues to make a dramatic change with 1,664
more RNs coming into the state than leaving.
In the three years since the law was signed, according to BRN data, applications for RN
licenses from new graduates and from RNs outside California, has grown from 22,372
applications in fiscal year 1999-2000 to 27,551 in fiscal year 2000-2001 to 32,368 in fiscal year
2001-2002.
In Victoria, Australia, ratios were enacted in 2001. By February 2002, the full-time RN
workforce had increased by 16.5 percent.
The real key to meeting the ratios is for hospitals to hang on to the RNs they already have.
Many CNA-represented hospitals have taken big strides by enacting significant improvements,
though collective bargaining with CNA, in retirement security, compensation, and improved
patient care conditions.
More background information is available at
www.calnurse.org
July 1, 2003
Would you like to comment?
