California Is Overriding Its Limits On Nurse Workloads As COVID-19 Surges

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Specializes in Mental health, substance abuse, geriatrics, PCU.

I realize we live in unprecedented times. But time and time again hospital executives have proven they do not care about nurses and will kick us in the teeth every chance they get. I don't blame the nurses in California for protesting because I'm sure when it's all said and done, hospitals WILL fight to keep the mandated ratios from returning.

California Is Overriding Its Limits On Nurse Workloads As COVID-19 Surges

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Specializes in ER.

Unprecedented? Have you studied history?

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Specializes in Mental health, substance abuse, geriatrics, PCU.
4 minutes ago, Emergent said:

Unprecedented? Have you studied history?

 

Obviously I'm talking about modern times.

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Specializes in Tele, ICU, Staff Development.

The California Dept of Public Health issued a 90 day waiver to increase nurse-pt ratios. ICU goes from 1:2 to 1:3, Tele goes from 1:4 to 1:6, MedSurg 1:5 to 1:7

It doesn't change the law (Title 22).

 

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Specializes in Critical Care.

California's staffing ratio law is very loosely referred to as a "law" since there are no consequences or punishment that result from violating it.  I've known a number of nurses who worked in California and only one worked at a facility that followed the law.  There have been Bill's proposed to add a punishment for breaking the ratio law, as far as I know none have passed.

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Specializes in Tele, ICU, Staff Development.
14 hours ago, MunoRN said:

California's staffing ratio law is very loosely referred to as a "law" since there are no consequences or punishment that result from violating it.  I've known a number of nurses who worked in California and only one worked at a facility that followed the law.  There have been Bill's proposed to add a punishment for breaking the ratio law, as far as I know none have passed.

I know what I say may not change your mind, but I hope you'll consider your information may be incorrect. It really saddens me to think people may believe your understanding.

I've worked my entire career in California acute care, both before and after nurse:patient ratios. Since ratios were implemented, I've never seen the ICU ratio of 1:2 exceeded until last Tuesday, when we went into disaster mode. Likewise, the last time I know of MedSurg nurses having 7 patients was before ratios, in 2004.

Here's my lived experience- CA hospitals take ratios extremely seriously. 

Are there some who don't follow the ratios? Probably. There's also facilities that don't report Stage 3 pressure injuries, or have otherwise disreputable practices.

 

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Specializes in Critical care, tele, Medical-Surgical.

Thank you Nurse Beth!

From 1992 to 2004 WE worked to achieve safe staffing ratios:http://www.healthwatchusa.org/conference2007/downloads/Availability of Nursing Workforce in California.pdf  

Here is the statute AKA law, also known as the enabling legislation for the regulations: http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=199920000AB394

In 2004 these ratios went into effect:  https://govt.westlaw.com/calregs/Document/I8612C410941F11E29091E6B951DDF6CE?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)

Our safe staffing ratios save lives:  Hospital nurse staffing ratios mandated in California are associated with lower mortality and nurse outcomes predictive of better nurse retention in California and in other states where they occur: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1475-6773.2010.01114.x

 Direct care RN and coworkers enforce the law. California registered nurses have an obligation to advocate in the best interest of our patients:  https://govt.westlaw.com/calregs/Document/IFD69DB90621311E2998CBB33624929B8?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)&bhcp=1

Advocacy today:  https://www.nationalnursesunited.org/press/arcadia-nurses-hospital-industry-attack-safe-staffing-puts-lives-at-risk

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Specializes in Mental health, substance abuse, geriatrics, PCU.

I just hope Cali nurses fight like hell to keep this from being permanent practice. Nurses across the country look at the example of California's mandated ratios as proof that it can be done despite what hospitals want us to believe.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
On 12/31/2020 at 11:02 AM, Nurse Beth said:

I know what I say may not change your mind, but I hope you'll consider your information may be incorrect. It really saddens me to think people may believe your understanding.

I've worked my entire career in California acute care, both before and after nurse:patient ratios. Since ratios were implemented, I've never seen the ICU ratio of 1:2 exceeded until last Tuesday, when we went into disaster mode. Likewise, the last time I know of MedSurg nurses having 7 patients was before ratios, in 2004.

Here's my lived experience- CA hospitals take ratios extremely seriously. 

Are there some who don't follow the ratios? Probably. There's also facilities that don't report Stage 3 pressure injuries, or have otherwise disreputable practices.

 

Agreed.  California is a mish mash of different types of hospitals...there are some bad players for sure but I've never encountered a pattern of ratio violations in the 11 years I've worked here in 5 different institutions with diverse ownership...a nationally known academic medical center,  a nationally known integrated health care corporation and health plan leader, a locally established private non profit corporation, a religious-owned corporation, and a struggling smaller religious organization.  Even the latter followed ratios.  I'm in NorCal and so far our hospital is still in compliance but we're certainly at a tipping point.

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Specializes in NICU, PICU, Transport, L&D, Hospice.

Minimal nursing staff is a decades old health business model in the USA. 

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Specializes in ICU, trauma, neuro.

There is only one effective solution. If you are a nurse in California resign, take mental health leave, resist with the aid of your union or move to a state where they won't abuse you in such a manner. If they lost even 10% of their RN's their "crisis" mode would become completely untenable.   RN's should not be required to put their licenses in jeopardy and risk their patient's lives (due to unsafe ratios) because of government mandates.  Will the states be granting "waivers" to the RN's who stay on the job and fail to perform at the mandated standard?  Will the BON come to their defense when mistakes ensue and licenses are suspended?  California has one of the strongest nursing unions in the nation if there was ever a time for them to stand up for their nurses it is now. I don't think that a strike is acceptable during a public health crisis, but certainly peaceable protests around hospitals that highlight the danger that this change creates for the public might help.

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Specializes in Critical care, tele, Medical-Surgical.

California is rolling back protections for frontline workers. This is wrong and dangerous: By Zenei Cortez RN Dec. 28, 2020

As California struggles with record infections, hospitalizations and deaths, it’s hard to imagine that hospital industry executives, with the cooperation of state regulators, would come up with a plan to make conditions worse. Sadly, they have.

Pushed by the California Hospital Association, California’s Department of Public Health has granted hospitals the ability to obtain blanket, expedited waivers, granted presumptively, that force nurses to care for more patients in hospital emergency rooms, intensive care units and on several other floors...

...   Instead, we’ve seen hospitals close units, furlough and permanently lay off staff, cancel nurse shifts, not fill vacancies, push buyouts, and make workplace conditions so dangerous that scores of nurses have left...

The hospitals, which have pressed for two decades to overturn the state’s safe staffing law and are exploiting the pandemic in hopes of a permanent suspension, need to focus first on safer facilities, bring back all the experienced staff that are available to work, and stop all the management practices that are driving nurses out of the workplace.

This is not a moment to roll back protections Californians need and count on. Nurses will not stop advocating the safety of our patients, and ourselves.

Zenei Cortez is a Bay Area registered nurse and president of the California Nurses Association and National Nurses United.

https://www.sfchronicle.com/opinion/openforum/article/California-is-rolling-back-protections-for-15830464.php

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