[danvet]

I am concerned and unclear about the new minimum staffing law in California. I work in the NICU and of course, we are taking, routinely 1:3. Our intermediate nursery is seperately licensed and upstairs and consists of "growers and feeders" and can go to 1:4.

I have questions regarding the breaks:

First of all, what are we supposed to do if we are not relieved for breaks? The continuing practice since Jan. 1 has been to have the other nurses (with full assignments) cover your assignment. No effort has been made in getting another body in to relieve us. We are a large hospital in a metropolitan area with a population of >200,000 people. Does that qualify them for "flex"?

If we go ahead and take our breaks leaving the other nurses in the room with full assignments to watch our patients, are we in violation of the law? Can we be disciplined by the BRN?

I want my breaks, but I also want to keep my license. I am concerned that this issue has not been openly addressed.

Please advise on what we should or should not be doing.

Thanks!!!!!!

[pickledpepperRN]

Well, the ratio law has been in effect in NICU for many years. Without a program flexibility each RN must be assigned to 2 or fewer infants at all times.

I think you should tell your management in writing (signed by all who agree) that "covering" for others babies is neither safe nor legal. Go up the chain of command, inform your manager and medical director.

If there is a program flexibility it must be posted with the hospitals license. The criteria will be clearly listed.

I truly believe the BRN will not discipline staff nurses for the failure of the administration to provide break relief.

If you are reported your copy of your informing your management should put the onus on the facility NOT you.
If in your professional opinion as the RN who assessed the babies it is not safe to leave for a meal or rest break start telling all who can either provide the relief (if competent) and keep a record. One nurse friend is keeping copies of the e- mails to the managers, supervisors, and CEO of her hospital so they cannot say they were not told.

I filled out an incident report saying that I was so fatigued from 14 hpurs of hectic life threatening events that i may have missed something and my charting was probably incomplete.
Usually we do get our breaks. I could have called in my manager and the night supervisor could have too.

The last couple nights I worked we had an extra nurse who could relieve for breaks in the ICU, CCU, or telemetry unit. That is in addition to the charge having no assigned patients.

[pickledpepperRN]

BE CAREFUL!

I just found out a nurse manager discovered it was a bit slow. She ordered food and invited the nursing staff to all come into the lounge.
When most were there eating she told them, "I know it is OK to all go to lunch together. Why not?"
Then all were encouraged to call the state to complain that the safe staffing law is unfair to nurses!
She said, "From now on the charge nurse will take an assignment so that way you can choose when you go to lunch."

Anyone think LESS STAFF is better?

YOU are responsible for whatever happens to your patient from pain to a code. If you did not give report and endorse your patient to a competent registered nurse whatever happens to your patient during your absence is your responsibility.

I believe the situation is reversed if there is no provision for relieving nurses for meal and rest breaks. Then document and keep a record.

NO GOOD to allow others to take more patients than is safe. The DHS has written the regulations regarding what is the largest number of patients that may be assigned to a nurse.

PLEASE do not go along with a gamble with your patients safety and quality nursing care!

[cheerfuldoer]

IMHPO........nurses on any unit should NOT have more than 4 patients per nurse PERIOD!

1:1 or max 1:2 in ICU

3:1 in Stepdown

4:1 in Med/Surg or any other mass patient unit

That would be my limit for nurses who work in the hospital I hope to run one day.

[Mimi2RN]

I thought it was supposed to be 1:1 or 2 in NICU, 1:4 in level 2 that does just feeder/growers?

Depending on our patients and available staff, we are usually 1:2 or 3. We are level 2, but also catch babies (high risk & C/S) Our leads cover peds as well as us, and often have patients, too. They do not go to deliveries.

Breaks are something else. At the present time, we do not have extra staff to cover our patients when we leave for a delivery or lunch break. It sounds like there are no plans to implement this.

I suppose we wait for a disaster.......hope I'm not working that night!

[prmenrs]

I am working in a small Level II--when the census is low, I have to float to Mother-baby Unit, where I only take care of babies. (Thank God) What is the ratio in that case?

[pickledpepperRN]

Originally posted by prmenrs
I am working in a small Level II--when the census is low, I have to float to Mother-baby Unit, where I only take care of babies. (Thank God) What is the ratio in that case?

A maximum of 1:8 HEALTHY babies only per licensed nurse. Must be at least 50% RN.

For 'transition' and sick babies the minimum is the ACOG guidelines as has been in the regulations for years 4:1 or fewer.

The patient classification system (PCS) = acuity must allow for more staff based on the assessment of the registered nurse who has assessed the baby (and charted that assessment).
An LVN may be the second nurse if the RN determines it is safe.

I know nurses who are glad to work with their LVN friends whose competency they are familiar with. They will not work with registry or float LVNs.

[sharann]

Danvet,
You are NOT responsible for upholding the ratios, your management is! If you are not being given the appropriate staffing (which in your unit should be 1:1 or 1:2, depending on acuity) then you have 3 options:
1) Report them to the DHS
2) Take breaks as normally, and let the managers explain themselves when audited
or
3) Resign

The BRN is not involved. Your license shouldn't be at stake. You must give report to a qualified nurse who can watch your patients until you return.
What else is there?
Actually, you have one other option: Don't take any breaks or lunches, then charge the hospital for a "missed meal break" EACH and EVERY day. Encourage others to do this.

[pickledpepperRN]

Originally posted by cheerfuldoer
IMHPO........nurses on any unit should NOT have more than 4 patients per nurse PERIOD!

1:1 or max 1:2 in ICU

3:1 in Stepdown

4:1 in Med/Surg or any other mass patient unit

That would be my limit for nurses who work in the hospital I hope to run one day.

Please hire me!