7/1/03 UPDATE: Calif Nurse Ratios info here - page 3
Forwarded by PSNA.org: The California Department of Health Services (DHS) announced this week that its revised nurse-to-patient staffing regulations will be published on June 30 or July 1. The... Read More
Jul 16, '03http://www.pe.com/localnews/opinion/...sed.a244e.html
More nurses; better care
California is the first state to order nurse-to-patient ratios for hospitals. Health officials estimate the new ratios will cost hospitals more than $950 million by 2008, when the ratios are fully in place.
With the first phase of ratios taking effect in January, some hospital officials predict the ratios will cause cuts in medical services and the closing of facilities.
These administrators suggest hospitals will be unable to find enough nurses because of the nationwide nursing shortage and, because of that, hospitals could be faced with running afoul of the regulations.
The nurse shortage is acute. California needs an additional 30,000 nurses over the next few years; by 2010, demand will be for another 100,000. Over the longer run, though, the lower nurse-patient ratios should promote nursing as a profession and cut into the shortage.
Nurses pushed for the ratios, saying many of their colleagues have fled nursing because of poor working conditions. Some complained they cared for 10 patients at a time. Under the new rules, hospital burn units, post-anesthesia care and labor and delivery units will have to staff one nurse for every two patients. For pediatrics, ER and step-down wards, the ratio will be 1-to-4.
Hospitals throughout the state have labored themselves under cost-controls of managed care. Some medical facilities will be tempted to adjust prices for additional nurses or even shutter units. They should be circumspect.
Arguably, these lower nurse-patient ratios were something hospitals should have been working toward anyway. Nurse morale in hospitals is a key issue. It is in the interest of hospitals to increase the number of nurses.
In the shorter term, however, state health officials will have to use common sense in enforcing these ratios in light of nurse availability. When, the dust settles, the health care profession should find common ground in the intent of lower ratios: better patient care.
Jul 27, '03Does the amended statement really state Registered nurse or does it still say licensed. This is a fine point, in CA both RN's and LVN's are considered licensed nurses. I know of one facility that has increased the number of LVN's dramatically and has RN's covering the LVN and her own patients as well. This is exactly what I predicted would happen when the initial bill was passed stating licensed even though CNA kept telling all the nurses it meant RN's. Would like some clarification, I am no longer a member of the group of nurses who "slave" daily to make sure their patients are well cared for. However I am still working as a nurse in private industry.
Jul 28, '03Yes, it is licensed. RNs will have to document that an LVN cannot be assigned to patients. They must be assistive to the RN.
In hospitals and units with a strong assertive staff the requirement for the ratios to be the 'floor' and staffing must increase according to the needs of individual patients the 'staffing up' may be with LVNs. The committee at my hospital has kept all the schedules for each unit. We will not agree to ingreasing the percentage of LVN to RN as they decrease the numbers of patients to licensed nurse.
For instance on the oncology unit patients receiving chemotherapy were staffed at 1:3. All others were 1:6 on days and 1:8 on nights. NO LVNs.
Already the night shift takes only 6 patients. As a specialty unit there will be only 5 per nurse by 1/1/2004.
Telemetry now has similar. Ventilator patients are 1:3 while the others are 1:6. There is one LVN on days, two on nights. When full 11 or 12 total licensed nurses work so that less than 10% are LVN. The increase in staffing when the acuity of 1 or more patients need more care MAY be an LVN or an RN depending on the needs of the patients. Our committee is 50% of the acuity committee and presents the facts in a way that on most units the manager agrees.
A couple units are weaker and unless they participate may end up responsible for the patients "assigned" to an LVN instead of working as a team with all nursing staff as is already the case on strong units.