California patient Ratio

U.S.A. California

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I posted this thread at the other forum but not many people responded. I have questions about Cailfornia's patient's ratio law on the telemetry-med surg unit. Hopefully somebody will answer me. I just transferred from stepdown unit to tele med surg. I have 5 patients on my own, covering 3 LVN patients and 1 or 2 primary care patients, Team nursing is NOT implemented in my new unit and the LVN did absolutely NOTHING for my own 5 patients, but if something happened to those 3 LVN patients, I have to call the MD for them, if there is an admission, I need to get a report for them. Also I need to carry their orders and check their orders for them. I don't mind giving their IV med. I feel so overwhelmed and frustrated at work. In my opinion, it seems out of the ratio. What do you guys think about it? And what can I do about it aside from complaining to my manager? He (my manager) claims he cannot change anything, I can't quit right now because I have a year contract (3 months). I will be out but in the meantime, I want to make sure I am working in a safe place. Can anybody tell me which hospitals in the LA area strictly enforce the ratio law and not burn the nurses out every shift?

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hello!

I just read your thread and i know it's been awhile. I wonder if you still are working in the Telemetry unit? I was hired to work in the Telemetry Unit in San Diego. I know nothing about Telemetry. But they said they will train me. Please give me some unput regarding work there, specifically in that unit. I'm worried now that you state there is no team support . Please reply as soon as you can.

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I understand exactly where you are coming from, but other than that, I'm not sure what else you can do besides working ur chain of command!

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Please clarify your patient load: first you say in your post you have 3 LVN's patients and 1 or two primary care of your own, then you say you have five of your own? Do you mean you are responsible for up to ten patients? I am confused by your post. Are you able to ask the LVN to help you with turning/changing pt.s, covering your lights, etc? It would seem fair to get a little trade-off for doing the IV meds. (Thats how we do it where I work)

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I have 5 patients on my own and 2 out that five patients are primary care means no CNA help me. I also need to cover 3 LVN patients (IV meds, orders, called the MD for them) The LVN do NOTHING for my own set of patients because my manager do not want TEAM NURSING.

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Not sure if you ever got your answer, but calnurses.org is a GREAT site for California Nurses. Check this link for specific ratios http://www.calnurses.org/assets/pdf/ratios/ratios_basics_unit_0704.pdf and check the rest of the site for more info.

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I have 5 patients on my own and 2 out that five patients are primary care means no CNA help me. I also need to cover 3 LVN patients (IV meds, orders, called the MD for them) The LVN do NOTHING for my own set of patients because my manager do not want TEAM NURSING.

This is how hospitals in CA are getting around the nurse/patient-ratio law, they assign the RN 6 patients with a LVN taking one of those, but the RN is still totally responsible for that patient and must do the plan of care/assessment/treatment/evaluation that an LVN is not licensed to do.

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This is how hospitals in CA are getting around the nurse/patient-ratio law, they assign the RN 6 patients with a LVN taking one of those, but the RN is still totally responsible for that patient and must do the plan of care/assessment/treatment/evaluation that an LVN is not licensed to do.

The regulations state, "The licensed nurse-to-patient ratio in a telemetry unit shall be 1:5 or fewer at all times."

If you are responsible for a patient shared with an LVN you have more than five. That is NOT legal.

Your posts proves you know your hospital is flaunting the law.

Also, Section 70217 of Title 22 states, "The 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."

and

"Additional staff in excess of these prescribed ratios, including non-licensed staff, shall be assigned in accordance with the hospital's documented patient classification system".

This would mean adding an LVN to assist in order to provide safe care.

When the DHS came up with the ratios they based them on the skill mix in place in 2002. For telemetry units that was 17% LVN. Even the DHS knows the safe minimum ratio is 1:4. That is why in 2008 the minimum ratio for telemetry will be four or fewer patients assigned each nurse.

http://www.dhs.ca.gov/lnc/pubnotice/NTPR/R-37-01_Regulation_Text.pdf

http://www.dhs.ca.gov/lnc/NTP/default.htm

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I have 5 patients on my own and 2 out that five patients are primary care means no CNA help me. I also need to cover 3 LVN patients (IV meds, orders, called the MD for them) The LVN do NOTHING for my own set of patients because my manager do not want TEAM NURSING.

If they tell you you have five patients and "cover"3 patients of the LVN you have EIGHT patients. Three more than allowed!

http://www.calnurses.org/nursing-practice/ratios/ratios_index.html?print=t

http://www.dhs.ca.gov/lnc/pubnotice/...ation_Text.pdf

http://www.dhs.ca.gov/lnc/NTP/default.htm

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The regulations state, "The licensed nurse-to-patient ratio in a telemetry unit shall be 1:5 or fewer at all times."

If you are responsible for a patient shared with an LVN you have more than five. That is NOT legal.

Your posts proves you know your hospital is flaunting the law.

Also, Section 70217 of Title 22 states, "The 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."

and

"Additional staff in excess of these prescribed ratios, including non-licensed staff, shall be assigned in accordance with the hospital's documented patient classification system".

This would mean adding an LVN to assist in order to provide safe care.

When the DHS came up with the ratios they based them on the skill mix in place in 2002. For telemetry units that was 17% LVN. Even the DHS knows the safe minimum ratio is 1:4. That is why in 2008 the minimum ratio for telemetry will be four or fewer patients assigned each nurse.

http://www.dhs.ca.gov/lnc/pubnotice/NTPR/R-37-01_Regulation_Text.pdf

http://www.dhs.ca.gov/lnc/NTP/default.htm

Medical/Surgical units it is only suppose to be 1:5 too, but they get around that with the word LICENSED.

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They do try but they are wrong. AB 394 the enabling legislation for the ratios says, "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."

From TITLE 22.70215. "Planning and Implementing Patient Care

(a) A registered nurse shall directly provide:

(1) Ongoing patient assessments as defined in the Business and Professions Code, Section 2725(d). Such assessments shall be performed, and the findings documented in the patient's medical record, for each shift, and upon receipt of the patient when he/she is transferred to another patient care area.

(2) The planning, supervision, implementation, and evaluation of the nursing care provided to each patient. The implementation of nursing care may be delegated by the registered nurse responsible for the patient to other licensed nursing staff, or may be assigned to unlicensed staff, subject to any limitations of their licensure, certification, level of validated competency, and/or regulation.

(3) The assessment, planning, implementation, and evaluation of patient education, including ongoing discharge teaching of each patient. Any assignment of specific patient education tasks to patient care personnel shall be made by the registered nurse responsible for the patient.

(b) The planning and delivery of patient care shall reflect all elements of the nursing process: assessment, nursing diagnosis, planning, intervention, evaluation and, as circumstances require, patient advocacy, and shall be initiated by a registered nurse at the time of admission.

© The nursing plan for the patient's care shall be discussed with and developed as a result of coordination with the patient, the patient's family, or other representatives, when appropriate, and staff of other disciplines involved in the care of the patient.

(d) Information related to the patient's initial assessment and reassessments, nursing diagnosis, plan, intervention, evaluation, and patient advocacy shall be permanently recorded in the patient's medical record."

In acute care each patient must be assigned a registered nurse. No nurse may be assigned more that the maximum number of patients so no nurse in med/surg or tele may be assigned more than five patients. There is no such term in the law a "covering" for another nurse.

Also staffing must meet the needs of each patient as assessed by a registered nurse. As we learned in nursing school "not charted=not done"

They are simply wrong.

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