CA staffing ratios evoke anger 'tween RNs & LVNs - page 9
Big news on the California nursing ratios front. As California prepares to carry out its first-in-the-nation law telling hospitals how many nurses they must have on hand for patients, a bitter... Read More
Nov 26, '02Originally posted by -jt
No...... LPNs will be restricted to just 4.Originally posted by -jt So what the heck are they doing fighting for RNs to be required to be responsible for at least 8?
Nov 26, '02I'm really glad for this thread, despite the peevishness.
Other states are going to try passing similar laws, as I already mentioned my state has a similar bill already introduced. Maybe other states can avoid these pitfalls by learning from the California bill.
Nov 26, '02Originally posted by rebelwaclause
Karen...Shut it down. This is leading nowhere.
Instead of shutting down a good thread that is actually mirroring the debates in California, where we can all learn from it, and see the issues and strong emotions involved . . . maybe you two could just sit back for awhile and listen to what others have to say? I'm sending you both for a time-out! :kissLast edit by Youda on Nov 26, '02
Nov 26, '02Originally posted by -jt
After reading about your own excellent staffing ratios & your confession that you have never even worked with unsafe staffing numbers, I see how it might be difficult for you to visualize what its like for the rest of us & why this is a topic that is being debated. Its impossible.Originally posted by -jet Imagine being the lone RN on a busy urban med surg unit with just 3 LPNs & 36 pts or even be one of the LPNs in that situation. Its shouldnt be too hard to see what the RN is talking about when she expresses strong concern over not being able to safely manage her own pts PLUS "cover" for all the LPNs pts and still adhere to the professional standards her license requires of her & holds her accountable for.Originally posted by -jt I would be terrified to be that RN - and not because I didnt trust the LPN. How can it be so difficult for LPNs to see this? I would also be terrified of the LPN (and RN) who didnt recognize the problem with this kind of staffing.
How many times can I agree with you? You aren't satisfied with this and nothing will do.Last edit by rebelwaclause on Nov 26, '02
Nov 26, '02Originally posted by Youda
Rebel and -jt, I'm sending you both for a time-out! :kiss
Dec 10, '02From the California DHS web site. The CNA originally recommended 1:3. With LVNs that would have been excellent staffing, might even get me to work full time!
Of course the CNA used data from the hospitals that probably included all RNs whether actually caring for patients or not.
WARNING! This is very long. For policy wonks (is that the correct expression?)
INITIAL STATEMENT OF REASONS
Description of the public problem, administrative requirement, or other conditions or circumstances the amended regulations are intended to address
In October, 1999 the California State Legislature passed AB394 (Kuehl, Chapter 945, Statutes of 1999) adding section 1276.4 to the Health and Safety Code (HSC). This section was later amended by AB 1760 (Kuehl, Chapter 148, Statutes of 2000). The section requires the California Department of Health Services (Department/CDHS) to develop minimum, specific, numerical licensed nurse-to-patient ratios for specified units of general acute care hospitals. CDHS determined that the requirements listed in this section are the minimum necessary to protect the public health and safety. CDHS's policy decisions were found to remediate the hospitals with the leanest staffing, effectively raising the bar for the standard of acceptable staffing.
In their preamble to the legislation, the Legislature "found and declared all of the following:
a) Health care services are becoming complex and it is increasingly difficult for patients to access integrated services.
b) Quality of patient care is jeopardized because of staffing changes implemented in response to managed care.
c) To ensure the adequate protection of patients in acute care settings, it is essential that qualified registered nurses and other licensed nurses be accessible and available to meet the needs of patients.
d) The basic principles of staffing in the acute care setting should be based on the patients' care needs, the severity of condition, services needed, and the complexity surrounding those services."
The Legislature clearly believed that the quality of patient care was related to the number of licensed nurses at the bedside, and wished to ensure a minimum, adequate number. When Governor Davis signed the bill on October 10, 1999, he accompanied the measure with a "sign message" which read, in part, "Registered nurses are a critical component in guaranteeing patient safety and the highest quality health care. Over the past several years many hospitals, in response to managed care reimbursement contracts, have cut costs by reducing their licensed nursing staff. In some cases, the ratio of licensed nurses to patients has resulted in an erosion in the quality of patient care." (Exhibit A)
California's hospitals are currently required (22 CCR, 70053.2 and 70217) to use a PCS for determining the staffing needs of individual units. PCS are defined as systems that include:
(1) A method to predict nursing care requirements of individual patients.
(2) An established method by which the amount of nursing care needed for each category of patient is validated for each unit and for each shift.
(3) An established method to discern trends and patterns of nursing care delivery by each unit, each shift, and each level of licensed and unlicensed staff.
(4) A mechanism by which the accuracy of the nursing care validation method described in (2) above can be tested. This method will address the amount of nursing care needed by patient category and pattern of care delivery on an annual basis, or more frequently, if warranted by the changes in patient populations, skill mix of the staff, or patient care delivery model.
(5) A method to determine staff resource allocations based on nursing care requirements for each shift and each unit.
(6) A method by which the hospital validates the reliability of the patient classification system for each unit and for each shift.
(7) A written staffing plan must be developed by the administrator of nursing service or a designee, based on patient care needs determined by the patient classification system. The staffing plan must be developed and implemented for each patient care unit and must specify patient care requirements and the staffing levels for registered nurses and other licensed and unlicensed personnel.
(8) The plan must include the following:
(a) Staffing requirements as determined by the patient classification system described above for each unit, documented on a day-to-day, shift-by-shift basis.
(b) The actual staff and staff mix provided, documented on a day-to-day, shift-by-shift basis.
(c) The variance between required and actual staffing patterns, documented on a day-to-day, shift-by-shift basis.
(d) The staffing plan must be retained for the time period between licensing surveys, which includes the Consolidated Accreditation and Licensing Survey (CALS) Process.
(8) The reliability of the patient classification system for validating staffing requirements must be reviewed at least annually by a committee appointed by the nursing administrator to determine whether or not the system accurately measures patient care needs.
(9) At least half of the members of the review committee must be registered nurses who provide direct patient care.
(10) If the review reveals that adjustments are necessary in the patient classification system in order to assure accuracy in measuring patient care needs, such adjustments must be implemented within thirty (30) days of that determination.
(11) Hospitals must develop and document a process by which all interested staff may provide input about the patient classification system, the system's required revisions, and the overall staffing plan.
These PCS requirements will not change with the addition of the minimum nurse-to-patient ratios required by HSC 1276.4.
The CNA proposed the adoption of the following ratios:
Critical Care Unit/ICU 1:2
Burn Unit 1:2
Neonatal ICU 1:2
Labor and Delivery 1:1
Well Baby Nursery 1:5
Postanesthesia Service 1:2
Emergency Department 1:3
Operating Room 1:1
Pediatric Unit 1:3
Stepdown Care Unit 1:3
Specialty Care Unit 1:3
Telemetry Unit 1:3
General Medical/Surgical Unit 1:3
Subacute/Transitional Care 1:4
Behavioral/Psychiatric Unit 1:4
The SEIU proposed the adoption of the following ratios:
Critical care Unit/ICU 1:2 (+1RT^:4 Vents#)
Burn Unit 1:2 (+1RT^:4 Vents#)
Neonatal ICU 1:2 (+1RT^:2 Vents#)
Labor and Delivery 1:2
Postpartum 1:3 couplets
Well Baby Nursery 1:6
Postanesthesia Service 1:2 Adults; 1:1 Peds
Emergency Department (ED) 1:3
ED-Critical Care 1:2
Operating Room 1:1RN+1LVN/1Tech
Pediatric Unit 1:3
Stepdown Care Unit 1:3
Telemetry Unit 1:3
General Medical/Surgical Unit 1:4
Subacute/Transitional Care 1:5
Behavioral/Psychiatric Unit 1:2/1:3/1:5 (by acuity)
^RT= Respiratory Therapist
#Vents= Ventilator-Dependent Patients
The CHA proposed the adoption of the following ratios:
Critical Care Unit/ICU 1:2
Burn Unit 1:2
Neonatal ICU 1:2
Labor and Delivery 1:3
Postpartum 1:4 couplets
Well Baby Nursery 1:8
Postanesthia Service 1:3
Emergency Department 1:6
Operating Room 1:1
Pediatric Unit 1:6
Stepdown Care Unit 1:6
Telemetry Unit 1:10
Oncology Unit 1:10
General Medical/Surgical Unit 1:10
Subacute/Transitional Care 1:12
Behavioral/Psychiatric Unit 1:12
CHA, together with the Association of California Nurse Leaders, convened a statewide taskforce to identify what they believed were clinically appropriate staffing ratios for all major patient care units.
The phrase, "In addition to the requirements of subdivision (a)" was added here to make clear the Department's intent that the ratios are minimums only, and will co-exist with PCS, which will dictate increased staffing when patients' needs warrant it, based on assessments on each shift.
The statement, "In no case shall the staffing level for licensed nurses fall below the requirements of subsection (a)" was added to require that the staffing plan that is developed and implemented for each unit be based first on the PCS, using the ratios only to designate the minimum safe staffing level.
This provision was added to clarify that the Department expects hospitals to plan for routine fluctuations in patient census. This planning should include, but not be limited to, an evaluation of the number of patients in other areas of the hospital waiting for an inpatient bed, consideration of how many patients are customarily admitted to individual units, etc., on a day-to-day, shift-by-shift basis. 22 CCR currently requires that each patient's nursing care needs must be determined by the PCS, and documented on a day-to-day, shift-by-shift basis. This clarifies that the hospital must also track the number of patients needing care in every unit on each shift.
In the event of a change in patient census that could not reasonably have been foreseen by the hospital, this states the Department's intent to give the hospital needed flexibility while the hospital makes prompt, diligent efforts to return each unit to the minimum required staffing ratios. The requirement cannot be more specific because the broad range of circumstances that could befall a hospital are beyond the Department's ability to anticipate. The timing and the appropriateness of the response may vary according to the circumstances and the nature of the unanticipated changes. These changes could include such diverse events as earthquakes and other natural disasters, and instances of bioterrorism.
Dec 10, '02Directly copied from the CA DHS site:
(1) Amend Section 70217 to read:
Section 70217. Nursing Service Staff.
(a) Hospitals shall provide staffing by licensed nurses, which includes registered nurses and licensed vocational nurses within the scope of their licensure, in accordance with the following nurse-to-patient ratios. Staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system. Nurse-to-patient ratios represent the maximum number of patients that shall be assigned to one nurse during one shift. Only nurses providing direct patient care shall be included in the ratios. Nurse Administrators, Nurse Supervisors, and Charge Nurses, and other licensed nurses not having a specific patient care assignment, shall not be included in the calculation of the nurse-to-patient ratio.
Licensed vocational nurses may constitute up to 50 percent of the licensed nurses assigned to patient care on any unit, except for Intensive Care Newborn Nursery Service Units, which specifically requires one registered nurse to two or fewer intensive care infants, or where registered nurses are required pursuant to the patient classification system.
Nothing in this section prohibits a licensed nurse from providing care within the scope of his or her practice to a patient assigned to another nurse.
(1) The licensed nurse-to-patient ratio in a critical care unit shall be 1:2 or fewer at any time. "Critical care unit" means a nursing unit of a general acute care hospital which provides one of the following services: an intensive care service, a burn center, a coronary care service, or an acute respiratory service. In the intensive care newborn nursery service, the ratio shall be 1 registered nurse: 2 or fewer patients at any time.
(2) The surgical service operating room shall have at least one registered nurse assigned to the duties of the circulating assistant and a minimum of one additional person serving as scrub assistant for each patient-occupied operating room.
(3) The nurse-to-patient ratio in a labor and delivery suite of the perinatal service shall be 1:2 or fewer at any time.
(4) The nurse-to-patient ratio in a postpartum area of the perinatal service shall be 1:4 mother-baby couplets or fewer at any time. In the event of multiple births, the total number of mothers plus infants assigned to a single licensed nurse shall never exceed eight. For postpartum areas in which the licensed nurses' assignment consists of mothers only, the nurse-to-patient ratio shall be 1:6 or fewer at any time.
(5) The nurse-to-patient ratio in a combined Labor/Delivery/Postpartum area of the perinatal service shall be 1:3 or fewer at any time the nurse is caring for a combination of one laboring woman and a postpartum mother and infant. When a nurse is caring for laboring women only, the ratio shall be 1:2 or fewer at any time. When the nurse is caring for postpartum women only, the ratios shall be 1:6 or fewer at any time. When the nurse is caring for mother-baby couplets, the ratio shall be 1:4 couplets or fewer at any time. At no time shall the total of mothers plus infants assigned to an individual nurse exceed eight.
(6) The nurse-to-patient ratio in a pediatric service shall be 1:4 or fewer at any time.
(7) The nurse-to-patient ratio in a postanesthesia recovery unit of the anesthesia service shall be 1:2 or fewer at any time.
(8) In a hospital providing basic emergency medical services or comprehensive emergency medical services, the nurse-to-patient ratio in an emergency department shall be 1:4 or fewer at any time patients are receiving treatment. There shall be no fewer than two licensed nurses physically present in the emergency department when a patient is present.
At least one of the licensed nurses shall be a registered nurse assigned to triage patients. The nurse assigned to triage patients shall not have a patient assignment, shall not be assigned responsibility for the base radio, and shall not be counted in the licensed nurse-to-patient ratio.
Hospitals designated by the Emergency Medical Services (EMS) Agency as a "base hospital", as defined in section 1797.58 of the Health and Safety Code, shall have a registered nurse on duty to respond to the base radio 24 hours each day. The registered nurse assigned to the base radio shall not have a patient assignment, shall not be counted in the nurse-to-patient ratio, and shall not be assigned to triage patients.
When licensed nursing staff are attending critical care patients in the emergency department, the nurse-to-patient ratio shall be 1:2 or fewer at any time. When licensed nursing staff in the emergency department are attending trauma patients, as defined in section 1798.160 of the Health and Safety Code, the nurse-to-patient ratio shall be a minimum of 1:1 at any time.
(9) The nurse-to-patient ratio in a step-down unit shall be 1:4 or fewer at any time. A "step down unit" is defined as a unit which is organized, operated, and maintained to provide for the monitoring and care of patients with moderate or potentially severe physiologic instability requiring technical support but not necessarily artificial life support. "Artificial life support" is defined as a system that uses medical technology to aid, support, or replace a vital function of the body that has been seriously damaged. "Technical support" is defined as specialized equipment and/or personnel providing for invasive monitoring, telemetry, and mechanical ventilation, for the immediate amelioration or remediation of severe pathology for those patients requiring less care than intensive care, but more than that which is available from medical/surgical care
(10) The nurse-to-patient ratio in a telemetry unit shall be 1:5 or fewer at any time. "Telemetry unit" is defined as a unit designated for the electronic monitoring, recording, retrieval, and display of cardiac electrical signals.
For every 10 or fewer telemetry patients, there shall be a minimum of one additional person who is legally authorized to perform the function of monitoring the telemetry screens. The person monitoring the telemetry screens shall not have any additional assignment.
(11) The nurse-to-patient ratio in medical/surgical care units shall be 1:6 or fewer at any time. Commencing January 1, 2005, the nurse-to-patient ratio in medical/surgical care units shall be 1:5 or fewer at any time. A medical/surgical unit is a unit with beds classified as medical/surgical in which patients, who require less care than that which is available in intensive care units or step-down units, receive 24 hour inpatient general medical services, post-surgical services, or both general medical and post-surgical services. These units may include mixed patient populations of diverse diagnoses and diverse age groups.
(12) The nurse-to-patient ratio in a specialty care unit shall be 1:5 or fewer at any time. A specialty care unit is a unit which is organized, operated, and maintained to provide care for a specific medical condition or a specific patient population, is more comprehensive for the specific condition or disease process than that which is available on medical/surgical units, and is not otherwise covered by subdivision (a).
(13) The nurse-to-patient ratio in a psychiatric unit shall be 1:6 or fewer at any time. For purposes of this subsection only, "licensed nurses" also includes licensed psychiatric technicians. Licensed vocational nurses, licensed psychiatric technicians, or a combination of both, shall not exceed 50 percent of the licensed nurses on the unit.
(14) Identifying a unit by a name or term other than those used in this subsection does not affect the requirement to staff at the ratios identified for the level or type of care described in this subsection.
(a)(b) In addition to the requirements of subsection (a), Tthe hospital shall implement a patient classification system as defined in section 70053.2 above for determining nursing care needs of individual patients that reflects the assessment, made by a registered nurse as specified at subsection 70215(a)(1), of patient requirements and provides for shift-by-shift staffing based on those requirements. The system developed by the hospital shall include, but not be limited to, the following elements:
(1) Individual patient care requirements.
(2) The patient care delivery system.
(3) Generally accepted standards of nursing practice, as well as elements reflective of the unique nature of the hospital's patient population.
(b)(c) A written staffing plan shall be developed by the administrator of nursing service or a designee, based on patient care needs determined by the patient classification system. The staffing plan shall be developed and implemented for each patient care unit and shall specify patient care requirements and the staffing levels for registered nurses and other licensed and unlicensed personnel. In no case shall the staffing level for licensed nurses fall below the requirements of subsection (a). The plan shall include the following:
(1) Staffing requirements as determined by the patient classification system for each unit, documented on a day-to-day, shift-by-shift basis.
(2) The actual staff and staff mix provided, documented on a day-to-day, shift-by-shift basis.
(3) The variance between required and actual staffing patterns, documented on a day-to-day, shift-by-shift basis.
(4) The staffing plan shall be retained for the time period between licensing surveys, which includes the Consolidated Accreditation and Licensing Survey process.
(c)(d) The reliability of the patient classification system for validating staffing requirements shall be reviewed at least annually by a committee appointed by the nursing administrator to determine whether or not the system accurately measures patient care needs.
(d)(e) At least half of the members of the review committee shall be registered nurses who provide direct patient care.
(e)(f) If the review reveals that adjustments are necessary in the patient classification system in order to assure accuracy in measuring patient care needs, such adjustments must be implemented within thirty (30) days of that determination.
(f)(g) Hospitals shall develop and document a process by which all interested staff may provide input about the patient classification system, the system's required revisions, and the overall staffing plan.
(g)(h) The administrator of nursing services shall not be designated to serve as a charge nurse or to have direct patient care responsibility.
(h)(i) Registered nursing personnel shall:
(1) Assist the administrator of nursing service so that supervision of nursing care occurs on a 24-hour basis.
(2) Provide direct patient care.
(3) Provide clinical supervision and coordination of the care given by licensed vocational nurses and unlicensed nursing personnel.
(i)(j) Each patient care unit shall have a registered nurse assigned, present and responsible for the patient care in the unit on each shift.
(j)(k) A rural General Acute Care Hospital as defined in Health and Safety Code Section 1250(a), may apply for and be granted program flexibility for the requirements of subsection 70217(g)(h) and for the personnel requirements of subsection (h)(i)(1) above.
(k)(l) Unlicensed personnel may be utilized as needed to assist with simple nursing procedures, subject to the requirements of competency validation. Hospital policies and procedures shall describe the responsibilities of unlicensed personnel and limit their duties to tasks that do not require licensure as a registered or vocational nurse.
(l)(m) Nursing personnel from temporary nursing agencies shall not be responsible for a patient care unit without having demonstrated clinical and supervisory competence as defined by the hospital's standards of staff performance pursuant to the requirements of subsection 70213(c) above.
(m)(n) Hospitals which utilize temporary nursing agencies shall have and adhere to a written procedure to orient and evaluate personnel from these sources. Such procedures shall require that personnel from temporary nursing agencies be evaluated as often, or more often, than staff employed directly by the hospital.
(n)(o) All registered and licensed vocational nurses utilized in the hospital shall have current licenses. A method to document current licensure shall be established.
(p) The hospital shall plan for routine fluctuations in patient census. If an unanticipated occurrence causes a change in the number of patients on a unit, the hospital must demonstrate that prompt efforts were made to maintain required staffing levels.
NOTE: Authority cited: Sections 100275(a), and 1275, 1276.4 and 100275(a), Health and Safety Code.
Reference: Sections 1250(a), and 1276, 1276.4, 1797.58 and 1798.160, Health and Safety Code.
(2) Amend Section 70225 to read:
Section 70225. Surgical Service Staff.
(a) A physician shall have overall responsibility for the surgical service. This physician shall be certified or eligible for certification in surgery by the American Board of Surgery. If such a surgeon is not available, a physician, with additional training and experience in surgery shall be responsible for the service.
(b) One or more surgical teams consisting of physicians, registered nurses and other personnel shall be available at all times.
(c) A registered nurse with training and experience in operating room techniques shall be responsible for the nursing care and nursing management of operating room service.
(d). There shall be registered nurses, licensed vocational nurses and operating room technicians in the appropriate ratio to ensure that at all times a registered nurse is available to serve as the circulating assistant whenever a licensed vocational nurse or operating room technician is serving as scrubassistant.
(e) (d) There shall be sufficient nursing personnel so that one person is not serving as a circulating assistant for more than one operating room.
(f) (e) There shall be evidence of continuing education and training programs for the nursing staff.
Dec 30, '02Originally posted by RN2B2005
Hospitals want to call L.P.N.'s "nurses" because these "nurses" earn a fraction of what a graduate R.N.'s earn. L.P.N's DO have their place--to assist and carry out the directions of a physician or nurse under the immediate supervision of a graduate R.N. To the uninformed public, especially the older members of the population, any female in any kind of uniform in a hospital setting counts as a "nurse"; hospitals generally fail to educate patients in the roles of various staff. The inter-union bickering just serves the purpose of the hospital's bottom line.
Not to denigrate L.P.N.'s, but when push comes to shove, I want an R.N. at my bedside. When I was hospitalized after the birth of my son, my urinary catheter bag was changed by a well-meaning but none-too-bright L.P.N. who marked that the catheter had been REMOVED instead of CHANGED. Therefore, the catheter was left unattended for several hours (the bag hung on the side of the bed out of immediate view of hospital staff), backing up and causing a bladder infection. It was only after I brought it to the attention of an R.N. (after telling a C.N.A. and another L.P.N. that the catheter was still in place, and being ignored after they looked at the chart) that the catheter was removed.
The hospital avoided a lawsuit because a) I recovered without sequelae from the bladder infection and b) I'm not a litigious person. I wonder if other patients who suffer because inadequately trained staff make mistakes will be so forgiving.
If hospitals want to call L.P.N.'s "nurses", fine. Just let them hire TWO L.P.N.'s for every R.N.; after all, an L.P.N's training is one year, half the minimum for an R.N. This will turn the hospital's "cost-saving measures" on their head.
Jan 5, '03I go along with you,lol, as an LPN, I may also kill somebody who I am caring for. Give me a break!!! I went to school fulltime for 15 months and one of the reasons that I didn't go for RN is because alot of thefor rns closed, making it difficult to get in. I wanted to be a nurse and an LPN is a NURSE!!!!! For over 10 yrs, I was an OR tech before becoming a nurse. I have seen many nurses/doctors etc over the yrs and believe me, there are some rn's that I wouldn't let care for my worse enemy. I am in school right now(going for rn)and the only reason that I am is because there are more positions available. As for money, I make more than several of my friends who are rn's. Seems that hospitals here don't pay that well. Nursing isn't about money, or it shouldn't be. To be a wonderful nurse, you need to go into it because of the love for nursing, not the money. Anyways, I am sick of others dissing lpn's and then say, "nothing against lpns, they have their place" or "if I am in hosp, give me an rn"....It's ignorant to assume because one is an rn, that means that they will automatically get excellent care but if they get an lpn assigned to them they are in a dangerous situation............though this isn't the "main topic" here, I had to add my 2 cents in and say that I agree with you.
Originally posted by michelle95
Well, hopefully, you won't have to be taken care of by me...I would probably kill you or something since I am too stupid to know how to do my job being only an LPN...
I've known some pretty stupid RNs myself.
Truthfully, a lot of the RNs that I work with are pretty lazy and don't want to do their jobs properly. Would you like me to lump you in that category?
Don't generalize LPNs and we won't do that to you
Aug 21, '10again, where do they reference ancillary staff in all this. we have numbers similar to this--minus one RT for 4 vents! WOW-now THAT IS GRAVY. but again, our step-down provides TWO ancillary in addition to RN, and in our ccu/icu we have NONE with much heavier patients. you would have to wonder WHY would the hospital want to put more critical patients AND the nurses AND the hospital as far as lawsuits at risk? Why, indeed.
Aug 21, '10the ratios effective january 1, 2004 in california (http://www.cdph.ca.gov/services/dpopp/regs/pages/n2pregulations.aspx )
in the first paragraph the regulation states, "staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system."
page 20 of the "final statement of reasons states, "in order to clarify that a hospital cannot reduce overall staffing by assigning licensed nurses to duties customarily and appropriately performed by unlicensed staff, it is stated that staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system." (see above link)
because in california each patient must be assigned to a registered nurse when the rn has five patients and is teamed with an lvn with five patients the rn is responsible for ten patients.
due to the high acuity of hospitalized patients this is unsafe.
but all too many hospitals have unwisely deprived patients of care by not replacing lvns who leave, moving lvns to an outpatient setting, or laying off some of their finest nurses because they are lvns.
rns, lvns, and cnas on one surgical unit that cared for a variety of post operative patients worked together to keep their cnas and lvns. the rns stated that the patient's needs would require them to be assigned only three patients unless they had help.
all the staff attended the meeting with the don. that was a few years ago and they still have their mix nearly very shift.
if the cnas have 12 or 14 patients one shift management is notified in writing that this is unsafe so the hospital, not the nursing staff is responsible for any adverse effect on patient care or for poor patient satisfaction.
there is insufficient enforcement so unless the nurses on a unit are united and assertive the hospital will staff the maximum number of patients allowed to each rn.
for example on one telemetry unit (1:4 ratio) the rns whose patients need more sophisticated care have an lvn assigned. the lvn can suction, insert foley catheters and ng tubes, perform dressing changes, give tube feedings, administer medications, start ivs, do accuchecks, and other tasks the certified nursing assistants (cnas) may not do.
the nursing staff has worked with their manager and the vp of nursing so that when an lvn is not available an additional rn is the replacement.
the rns with lower acuity patients will be assigned to work with a cna.
please read the section requiring additional staff according to the needs of each patient.
there are two federal staffing bills being discussd on allnurses.com now:
Registered Nurse Safe Staffing Act (THIS ONE IS IMPORTANT!)
Would you support this federal staffing bill?