California Senate Bill 349

Chisca, RN · May 15, 2017

If Kent Thiry is against it I am for it.

reatta89 · May 15, 2017

Yes of course davita is running the opposition. If you are in California contact me and I'll put you in touch with Someone. Nurses n tech's are joining the unio faster than rabbits

TAKOO01, BSN · May 27, 2017

Can someone help me to understand why the safe staffing ratio bills appear to be confined to California? Is it because of progressive politicians or just super active nurses? What can I do to help to get these bills started in my state?

reatta89 · May 27, 2017

Thank you for your question. In fact, there are states that have staffing ratios...for dialysis clinics. The SEIU-UHW Service Employees International Union - United Healthcare Workers (dialysis RNs and techs) have requested ratios, along with increased staffing eg ratios.. The industry now has fought this to the end. You would think that they would support this long overdue change but it will cut into their profits if they hire more staff.. They claim increasing transition time between patients, to ensure stability with patients, will make them close units.. that is garbage we know different... If you are in California, please contact me directly.. [email protected] SB 349 passed the appropriations committee this past week and this coming week will go before the California Senate. If all goes well, we move on to the Assembly... I don't understand why Davita/FMC are spending so much money on attempting to stop this when, in fact, this money could go into additional staff to ensure patients get safe care.. Anyone can take a look at the inspection reports done by the state and see mistakes that are made and can attribute this to not enough time between patients and not enough staff. As a retired RN I fully support this bill and testified before the CA Senate Health Committee and verbally supported the bill at the Judiciary Committee...

SmilingBluEyes · May 28, 2017

Such a complicated issue. It (legislation) may not close the units, but it does bring about the concern about staff having to work longer hours and units having to operate nearly or at 24 hour basis. Many PCT/RNs get into dialysis to get away from 12 hours (and NOC) shifts, which this may well bring back some dialysis units where shifts are 8, 9 or 10 hours.

Also, not only is more staff needed, so are more chairs. There are many patients waiting out there for outpatient spots, where there are none, in certificate-of-need states. These states control how many chairs each unit can operate, and some have much more capacity, but no approval or the staff to run them. In addition there is a movement to bring acute renal failure pts into the outpatient setting, which right now, I am unclear how that could happen----when the units don't have enough room for the ESRD/chronics already waiting. Anyhow I digress, I am sorry.

More chairs, lower ratios, more people needed. Some units are having job fairs etc, to try and get people to work in them, and having a tough time recruiting enough staff right now. This change could make it worse before it gets better; but I agree change is needed.

Of course, of perpetual concern, is actual acuity. Often safe staffing bills forget/neglect to sufficiently address that. Some patients take a lot more time or are sicker ( and increasingly so) and ARF patients will certainly require a whole different level of monitoring and management, not seen currently in the outpatient setting. Numbers are not the only consideration.

Also there are units poised to open more chairs, but no staff or approval to open them. Many units cannot get staff except on traveler/float basis as it is, to cover the shifts/patients they have currently.

I also think to attract quality staff, particularly, PCTs, the pay/compensation needs to be much improved. These folks have an awful lot of responsibility on their hands for making so little. I am sure ratios will be used as an excuse to suppress pay/benefits increases; it may even affect the benefits that are already being considered for decrease. This exacerbates the staffing issue even more....what a vicious cycle.

I am not sticking up for multi-billion dollar industries here, believe me, just presenting some more concerns that go along with any legislation to improve staffing ratios. There are no easy answers. I hope this moves things in the right direction but there is a long way to go just yet.

So sorry to have digressed. I guess I am just thinking too much and wordy.

Chisca, RN · May 30, 2017

The opposition to this bill boils down to if we eliminate slavery who will pick our cotton.

five10fevr, ASN, RN · Jun 11, 2017

I agree with the staffing ratio's for patient safety. I don't agree with a lot of the other proposed issues.

Do you realize that Access rated death are not even in the top 3 of dialysis rated deaths. So making sure that the chair is empty for 45 minutes in between last patient off until next patient on. What is this going to solve. It will spread out the shifts where you would have to cut out the 4th shift. If not when will you have time to regenerate your R/O system. Or who is willing to get off dialysis at midnight. Not the patients in my unit.

Smaller units will have to close. If you add an extra 2 RN with a salary of almost $100,000 a year with taxes, insurance ect..., then you add additional 2 PCT at $40,000 a year. The unit is looking at almost additional $300,000 when they are barely breaking even because of the high rate patient with Medi-Cal here in the state of California. We all know if the patient primary insurance is Medi-Cal we don't even break even for the treatment.

At this point we can not even get DHS to do recertification's every 6 years. How will we get them to our units every year?

Staffing is hard enough. If I recall the staff can only work 8 hours a day. So the employee will have to pick what unit they will be working at, as most have two jobs. Where will the units get qualified staff to cover the shifts for the employees they lost, plus the additional staff they have to employee to meet ratio's. I have heard most RN's will go back to the hospital so they can work two jobs to support their families.

What about the patients. If the unit cuts out 4th shift. Where do all the 4th shift patients go? Many units cant expand due to staffing or space limitations. These patients will eventually find a new dialysis unit, but some have gone to their unit for 5 maybe 10 years why force them to leave.

What happens when a RN calls out sick and a CC or FA can not be considered part of the RN:Patient ratio. We all know how hard it is to find last minute coverage and the CC or FA works the floor. Now we are triaging the patients to see who needs to go to the hospital for dialysis or who can wait for the next dialysis treatment. If we run their treatment out of ratio the facility will be fined.

Yes, on paper it looks great, but in reality it is a lot to consider. I vote NO. I don't work for either of the big two and maybe they need to consider better staffing ratio's instead of spending so much money on opposing SB349.