California staffing ratio's for PCU?

Nurses General Nursing

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Specializes in Cardiovascular.

Are there staffing ratio's that will be set in California (when the new ratio requirements take effect) for step down, telemetry or PCU area's specifically. I know there are for critical care and med surg...

Our CNO recently used this as an excuse to staff our PCU with 6 patients per nurse, stating that is what California will be using as a ratio. My understanding is though that that is for Med/Surg. How can they include PCU in that? I live in Texas by the way, and apparently, where I work is looking at that - what will happen in California. We have gone from 4:1, now to 5 and it seems like they are trying for 6! Way too many patients... 5 is crazy enough with the high acuity these patients have.

I don't know much about the new law that will go in effect in California and hope my question isn't way off!

Thanks!! Anne

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http://www.calnurse.org/finalrat/ratiobox.html

http://www.applications.dhs.ca.gov/regulations/search.asp?REGID=R-37-01&advanced=yes&c2=@filewrite&o2=%3E&q1=&EMERGENCY=&submit1=Begin+Search

From the Law:

"(7)The licensed nurse-to-patient ratio in a postanesthesia recovery unit of the anesthesia service shall be 1:2 or fewer at any time all times, regardless of the type of anesthesia the patient received. "

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From the Statement of Reasons:

"Under description of section 70217(a)(7), add to paragraph 1 on page 25 of the Initial Statement of Reasons, add the following :

The nurse-to-patient ratio in a postanesthesia recovery unit (PACUs) of the anesthesia service is proposed to be 1:2 or fewer at any time. Compared with the CDHS on-site study, 25% of hospital shifts in California staff PACUs at 1:1.8; the leanest 10% staff PACUs at 1:2.5, so the ratio of 1:2 would increase staffing at the leanest 10-25% of hospitals statewide. This 1:2 ratio is consistent with the staffing requirements for critical care units in the hospital. Multiple physiological systems, notably the neurological and pulmonary systems, are compromised with the administration of anesthesia and remain unstable until the patient is recovered successfully. CDHS concurs with the California Society of Anesthesiologists which wrote as Commenter #1633, "The CSA supports the proposed DHS nurse-to-patient ratio of 1:2 or fewer for patients in the postanesthesia recovery unit. The most critical phase for a patient recovering from anesthesia whether it is general, regional, or intravenous, is the immediate period following surgery and anesthesia, before they are transitioned to an inpatient setting or discharged to a lower level of care." The American Society of PeriAnesthesia Nurses, representing the nurses in that specialty, has set standards of practice which require a minimum of one nurse for every two patients during the immediate postanesthesia period, defined as the time from the patient's admission to the PACU until they are transitioned to an inpatient setting or discharged to a lower level of care (Exhibit FF). In addition, the PeriAnesthesia Nurses Association of California concurs that 1:2 is the appropriate ratio (Exhibit GG), as does the California Society of Anesthesiologists, representing the specialty's physicians (Exhibit HH). The Department relied upon these documents in developing the proposed regulations. This sentence was added to the proposed regulations for clarity and in response to the requests of many public comments."

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Many states are following the fine example of CA in introducing legislation to guarantee minimum safe nurse-patient ratios.

The one I like the best is the state of Nevada, with specfic numbers for all areas, documentation requirements of shift-by shift assignments and hefty fines for failure of management to comply. Check them out on the internet.

Edward, IL

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Your CNO is mistaken. Minimum ratio for telemetry would be 1:5 to start, with the goal being 1:4 by 2008 thru successful recruitment efforts.

Step down units would start with 1:4 and have a goal of 1:3 by 2008.

Since she has indicated a willingness to follow the CA ratio proposals as a guideline for one unit, print out the whole thing for her & tell her youll expect & accept the CA ratios for all the other units as well.

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Specializes in Cardiovascular.

Thank you all for the great information.... I followed one of those links to http://www.calnurse.org/finalrat/finratrn7103.pdf and I printed out much of the information given and will take it to work.

Our PCU (Progressive Care Unit) or "Telemetry" unit's tele tech also has the function of acting as unit secretary. Needless to say this is very unsafe and much gets missed. We have many cardiologists who have voiced their dissatisfaction with this set up. I notice that the link I listed above specifically mentions the monitoring person doing ONLY monitoring. What a concept!!

Wish I knew what to do to get a law like this in Texas. I LOVE being a nurse, but HATE the staffing.

Thanks again! Anne

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Specializes in Cardiovascular.

Thank you all for the great information.... I followed one of those links to http://www.calnurse.org/finalrat/finratrn7103.pdf and I printed out much of the information given and will take it to work.

Our PCU (Progressive Care Unit) or "Telemetry" unit's tele tech also has the function of acting as unit secretary. Needless to say this is very unsafe and much gets missed. We have many cardiologists who have voiced their dissatisfaction with this set up. I notice that the link I listed above specifically mentions the monitoring person doing ONLY monitoring. What a concept!!

Wish I knew what to do to get a law like this in Texas. I LOVE being a nurse, but HATE the staffing.

Thanks again! Anne

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