Losing momentum?

barton · Apr 28, 1999

PLEASE- PLEASE- PLEASE!

LISTEN TO JOE!

Look at all the good work we've all done here---- and in such a SHORT time!

As I see it, we went from complaints/reports to each other, to sending questions/reports to legislators, 20/20, ANA and so on.

NOW we have the opportunity to take our collective efforts one GIANT LEAP forward in the NEW COLUMN!

When was the last time any of us saw nurses FROM AROUND THE COUNTRY rally together for ANYTHING? Yet here we are having professional and productive communications about the most important part of nursing: PATIENTS! AND---people at BOTH wwnurse AND hospitalhub have noticed, commented positively, and encouraged us! WHY ON EARTH WOULD WE STOP NOW??

If some of you are nervous, let me say that sometimes I am too---but if all we print is the truth, and if all concerned remain anonymous, then in my opinion, we are doing the right thing-- we are not breaking confidentiality, and we are acting in our role as patient advocates. If we DON'T report unsafe conditions, then I believe we are FAILING in that role.

We must let the nation know what perils we are facing!

We must work toward enpowering nurses by gaining the autonomy we need to DECIDE FOR OURSELVES how to protect our patients and ourselves.

Let's TAKE nursing BACK from business!!

BethanyJ · Apr 29, 1999

Amen to barton!!

Ahn · Apr 30, 1999

OK - Let's Go!

Sophie · May 1, 1999

Hello! Barton, Bethany, and others. Although it's been a while since I have posted, I have been busy with letters to my state assembly and senate reps, re: current legislation relative to nursing issues. As I have mentioned before, there is a Calif. State Assembly bill - AB 394- that is specically written to make firm LAWS about safe staffing ratios. Much like the ones that already exist (in Calif,) for ratios in critical care, this law would be for the regular floors where we know the staffing is dangerous and work can be miserable. Please support this by writing to the bill author-

Sheila Kuehl, State Capitol, PO Box 942849, Room 3013, Sacramento, Cal. 94249-0001, or call at 916-310-2041. Suggest this legislation to you own state reps if you are outside Cal., it could be used as a guideline. This is a positive and constructive means to get something done about the dangerous staffing issue. If each one of you asked one person to write and support this bill, and those people asked even one other person, the support would be tremendous. We need to realize that nurses are 'do-ers' and although letter writing may seem a passive thing, it is a very action involved step. Remember that when something is written it carries a lot more weight than just a phone call or a comment. A letter is tangible and can be counted. As for our other endeavors, how's the 20/20 situation coming?? Keep sending Sylvia Johnson your examples of mistakes, violations etc. that are occuring due to the nursing shortage and dangerous staffing. Sophie (sorry this was so long-winded)

[This message has been edited by Sophie (edited May 01, 1999).]

barton · May 1, 1999

Sophie,

Thanks for your post. I would like to review this bill you mentioned re: staffing LAWS---it sounds like just what we need in EVERY state, and I WOULD like to write my reps. re: using this as a guideline.

Where can we find it on line?

Thanks!

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Joe,RN · May 3, 1999

Yes thanks for the posts, everyone! Has anybody else sent an article to [email protected]? I do not work in a hospital any more so I do not have any recent stories to relate. Please send some info this way. I will help you compose an article, if you feel you need the help. And Hey! That's a great idea regarding, the Calif. state bill on staffing ratios. Can we get a copy of that bill somehow? Also there are some nurses in Maryland meeting on 6/16/99 to discuss their concerns and talk aboutthe forming of a union. I don't know any more about this, as I am in Georgia. You can visit the web site at nsweb.nursingspectrum.com/NurseToNurse/ and view the message boards!

Joe,RN · May 3, 1999

Correction, sorry for the typo, I get in a hurry sometimes, the correct address to send articles for publication is: [email protected]!

Sophie · May 4, 1999

Hi Joe and barton, You can get a copy of the proposed bill AB394, by entering:

www.sen.ca.gov,

Calif. State Senate,

legislation,

(bill #) AB394,

click on 'current' or 'intro.'

This should do it. Sophie

barton · May 4, 1999

Ooooooh Sophie!!

I think that God wrote this bill in answer to our prayers! Thanks for giving us the info, and I'm going to write my rep and ask him to read this and to SERIOUSLY AND IMMEDIATELY CONSIDER IT FOR FLORIDA!

EVERYONE------PLEASE------Read this bill, write to the appropriate people in your state, and ask them to read and consider it!

barton

SOPHIE--by the way, I have asked that the "director" for our column be someone at that site, and that the rest of us submit---just wrote today and will let all know response!

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[This message has been edited by barton (edited May 04, 1999).]

barton · May 5, 1999

Sophie,

I e-mailed a copy of the bill to six people Tuesday. Plan to send to my state reps today! Thanks again!!

(By the way, this bill seems to be moving quickly through "the process" and I can't wait to hear the results---hope it passes there and in ALL STATES SOON!)

barton

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barton · May 5, 1999

Hey All!!

Sophie told us about this! Isn't this what we ALL WANT??! WILL YOU SEND IT TO YOUR STATE LEGISLATORS??!!

---PLEASE READ THIS----AND LEAP FOR JOY!!!---

~Current Session Legislation~

AB 394 Health facilities: nursing staff.

BILL NUMBER: AB 394 INTRODUCED 02/11/99

INTRODUCED BY Assembly Members Kuehl (Coauthors: Assembly Members Dutra, Gallegos, and Villaraigosa) (Coauthors: Senators Burton and Escutia)

FEBRUARY 11, 1999

An act to add Section 2725.3 to the Business and Professions Code, and to add Section 1276.4 to the Health and Safety Code, relating to health care.

LEGISLATIVE COUNSEL'S DIGEST

AB 394, as introduced, Kuehl. Health facilities: nursing staff.

Existing law provides for the licensing, registration, and regulation of nurses, and sets forth the scope of practice.

This bill would prohibit a general acute care hospital, an acute psychiatric hospital, and a special hospital, as defined, from assigning an unlicensed person to perform nursing functions in lieu of a registered nurse, or from allowing unlicensed personnel under the direct clinical supervision of a registered nurse to perform certain functions.

Existing law prohibits operation of a health facility, as defined, without a license issued by the State Department of Health Services and provides for the issuance of licenses and for the regulation of health facilities and sets forth the services to be provided therein. Willful or repeated violation of these provisions is a crime.

This bill would require general acute care hospitals, acute psychiatric hospitals, and special hospitals to provide certain minimum nurse-to-patient ratios, and to adopt written policies and procedures for training and orientation of nursing staff.

By changing the definition of an existing crime this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

SECTION 1. The Legislature finds and declares 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.

© 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 patient's care needs, the severity of condition, services needed, and the complexity surrounding those services.

SEC. 2. Section 2725.3 is added to the Business and Professions Code, to read:

2725.3. (a) A health facility licensed pursuant to subdivision (a), (b), or (f), of Section 1250 of the Health and Safety Code shall not assign unlicensed personnel to perform nursing functions in lieu of a registered nurse and may not allow unlicensed personnel to perform functions under the direct clinical supervision of a registered nurse that require a substantial amount of scientific knowledge and technical skills, including, but not limited to, any of the following:

(1) Administration of medication.

(2) Venipuncture or intravenous therapy.

(3) Parenteral or tube feedings.

(4) Invasive procedures including inserting nasogastric tubes, inserting catheters, or tracheal suctioning.

(5) Assessment of patient condition.

(6) Educating patients and their families concerning the patient's health care problems, including postdischarge care.

(7) Moderate complexity laboratory tests.

(b) This section shall not preclude any person from performing any act or function that he or she is authorized to perform pursuant to Division 2 (commencing with Section 500).

SEC. 3. Section 1276.4 is added to the Health and Safety Code, to read:

1276.4. (a) A health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250 shall allocate sufficient numbers of registered nurses so as to provide a nurse-to-patient ratio as follows:

(1) One registered nurse to two patients to staff critical care units, burn units, labor and delivery, postanesthesia units, and critical patients in emergency departments requiring care in an intensive care or critical care setting. The ratio of one registered nurse to two critical care patients temporarily held in the emergency departments shall be in addition to the regularly scheduled emergency room staff.

(2) There shall be sufficient nursing personnel so that one registered nurse is not serving as circulating assistant for more than one operating room.

(3) One licensed nurse to three patients to staff pediatric and step-down/intermediate care units.

(4) One licensed nurse to four patients to staff specialty care and telemetry.

(5) One licensed nurse to six patients to staff general medical care units that include subacute care and transitional inpatient care units.

(b) These ratios shall constitute the minimum number of registered and licensed nurses that shall be allocated. Additional staff shall be assigned in accordance with a documented patient classification system for determining nursing care requirements, including the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan and the ability for self-care, and the licensure of the personnel required for care.

© "Critical care unit" as used in this section means a unit that is established to safeguard and protect patients whose severity of medical conditions requires continuous monitoring and complex intervention by licensed registered nurses.

(d) All health facilities licensed under subdivision (a), (b), or (f) or Section 1250 shall adopt written policies and procedures for training and orientation of nursing staff.

(e) No registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has first received orientation in that clinical area sufficient to provide competent care to patients in that area, and has demonstrated current competence in providing care in that area.

(f) The written policies and procedures for orientation of nursing staff shall require that all temporary personnel shall receive the same amount and type of orientation as is required for permanent staff.

(g) Requests for waivers to this section that do not jeopardize the health, safety, and well-being of patients affected and that are needed for increased operational efficiency may be granted by the department to rural general acute care hospitals meeting the criteria set forth in paragraph (2) of subdivision (a) of Section 1250.

(h) In case of conflict between this section and any provision or regulation defining the scope of nursing practice, the scope of practice provisions shall control.

SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.

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