Being out of ratio. Is it legal in California?

  1. Hello,

    I work as an RN on a Stroke Unit at a fairly large hospital in Southern California. I have been a nurse for 8 years and this is my first year at this particular hospital. I've noticed they will work us out of ratio with 5:1 tele patients and they will say they have "exhausted" their resources and "no other nurse wants to come in including regular staff and/or registry." The higher ups have said the BRN will allow for this out of ratio staffing since it is considered an "emergency." I find this shady, as other hospitals I've worked at will always call in a registry nurse with no problems. We feel they are doing this to save the hospital money, but at our expense. A lot of us on my unit are wondering is this legal??? Especially with California ratio laws??? They are always pulling the same excuse "sorry no extra nurse is available" and we often work out of ratio at least once a month. We feel as though we can't complain due to fear of retaliation or termination. Is there anything we can do? Our manager does not support us, and she is the one who often approves us being out of ratio.
    Last edit by tnbutterfly on Aug 21
  2. Visit abnormal_saline profile page

    About abnormal_saline

    Joined: Feb '15; Posts: 10; Likes: 2

    10 Comments

  3. by   MunoRN
    It should first be noted that while California has legally mandated ratios, practically speaking it's not illegal to be out of compliance since there is no punishment for being out of compliance except for having to submit a plan to resolve the deficiencies, although the hospital is not legally required to follow that plan. There is currently a bill in process that would impose fines for violating the law, but currently there are no fines or other consequences for failing to abide by the staffing ratio law.

    That being said, your hospital isn't correctly interpreting the "emergency" exception of the law, and doesn't allow inadequate staffing availability to be an exception to the requirements.
  4. by   ICUman
    Quote from MunoRN
    There is currently a bill in process that would impose fines for violating the law, but currently there are no fines or other consequences for failing to abide by the staffing ratio law.
    Hey Muno would you mind posting a link or a source for the current bill that you are referencing? I want to read more about it.

    OP, I wonder what would happen if this was reported to the proper authorities who handle these situations.
  5. by   MunoRN
    Quote from ICUman
    Hey Muno would you mind posting a link or a source for the current bill that you are referencing? I want to read more about it.

    OP, I wonder what would happen if this was reported to the proper authorities who handle these situations.
    Our “Stop Repeat Offender Hospitals” bill — stay updated on its progress!
  6. by   ICUman
    That bill sounds completely amazing. I read through the bill tracker updates. I hope that it passes! Looks like it's doing well so far.
  7. by   abnormal_saline
    Wow. Very useful info. Thank you so much MunoRN! And thanks for that link too! Until that Bill passes, it seems like we are powerless in refusing out of ratio assignments. It just feels so unsafe at times. Not sure I will be staying at this hospital for much longer.
  8. by   Sour Lemon
    I've only had two employers in Southern California, but they both seem(ed) "terrified " of being out or ratio. You might have better luck elsewhere.
  9. by   iluvivt
    I work on Ca too for many many years.We do not go out of ratio unless it's a true emergency or disaster.We use our float poool and registry. Managers also will help cover for break relief if needed.I am aware there is no current legal punishment but I would report bc them and keep it myself because I think they are pulling a fast one on the nurses and the patients.
  10. by   weluvoands
    I wish we had mandated ratios. I'm in NY (upstate not city) and work on a stroke/tele floor also and sometimes have up to 8 patients a night. It is insane and so very unsafe.
  11. by   rnprincesstlo
    We used to sign an "Assignment Despite Objection" form to protect us in case an incident occurred while working with more patients than we should be assigned since there was not that additional help available.
  12. by   HomeBound
    Quote from Sour Lemon
    I've only had two employers in Southern California, but they both seem(ed) "terrified " of being out or ratio. You might have better luck elsewhere.
    They're not "terrified" of the ratio law.

    They're afraid of two things:

    1. The CNA. The RNs and others covered by them grieve the most minute infraction, and drag management into quagmires. FOR NOW, the CNA is powerful and can get things done. Management is afraid of the union, not the ratio laws.

    Before you get all flamey-pants, I am PRO UNION. I am PRO RATIO. You asked a question, and I am answering.

    2. The income/salary disparity in California from SoCa to NorCa is breathtaking. Higher COL in SoCal, but they make almost half of what a NorCal RN makes. It's obscene. And the RNs know it. The NorCal RNs turn a blind eye, and even encourage the retaliation against RNs who won't "go along to get along" with the "hush money" being paid to the Central/North areas.

    They routinely remind the RNs of their precarious place if they complain, in the SoCa area. These RNs have families and homes and careers---and where will they go? NorCal is the hardest market to break into---as the NorCal RNs keep it "all in the family". I worked at a place that hired husbands and wives ON THE SAME UNIT. Only friends and "trusted circle" are hired. They will get second and third PRN jobs, keeping other RNs from out of the area---out of the area.

    SoCal is different---they offer crap wages, with a "union" to give lip service---and dare the RNs to either rock the boat or walk away. Either one, they won't work in Ca again. It's a "who you know" racket.

    About the CNA being powerful. FOR NOW, I said....because the Janus decision will cut the union off at the knees, and I give it maybe 2 years before they are rendered toothless.

    The decision made union dues OPTIONAL....but the union MUST continue to protect the RN. They are members...for free.

    The union reps go around and flog it that the union dues are "tax deductible". Does that pay the electric bill or the kids' orthodontics bill? Nope. So people will get it into their heads that the union dues are OPTIONAL and the union is still forced to protect them.

    The union is strong because of one thing. Money. Take away the funding, and the union goes to crap. Look up the history of union busting, if you don't like what you are reading. It's factual, not opinion.

    The arrogance and entitlement of the CA nurses is pretty astounding as well. They do believe that because they are paid more and have union representation, that this makes them better nurses. Nothing is further from the truth.

    The CNA will be out of the picture soon enough---and the management of these wonderful "uber nurses" facilities that pay "stupid money" will be on those stupid money salaries like flies on crap.

    The ratios are a good idea, and I am all for them---when they are utilized intelligently. But for the most part, they aren't. They are a vehicle for cliquey Charge RNs to assign highly acute patients to the "non favored" and light assignments to their friends.

    If a facility breaks these ratio rules, you have to consider your options carefully in CA. You rock that boat, be prepared for the end of your career in that state, without recommendation. In fact, I've watched some of them maliciously go after RNs who rocked the boat and left, calling other hospitals in the area to prevent the RN from getting hired.

    Figure out if you want to win the battle, or the war. Ratios in CA are not there because of concern for patient safety. Every "good thing" that is given, usually has a root to it. Hospitals retaliate where they can.

    Short staffing, "emergency" clause like OP was talking about, mysterious "call outs" at the last minute. I've watched senior staff nurses come in, get an assignment, and a half hour later, some other RN get approached with "you are taking so and so's patients, bc she has to do education". The senior RNs, the "in crowd" sit in the locked management offices and watch the board explode.

    Then...the surveillance nurses, who are paid to do nothing but spy live time on your charting, write you up for the inevitable mistakes you make---because you are overwhelmed, no help and rushed. The ones they like, they allow to get away with anything. They select for the ones that will not rat the hospital out.

    So. You make up your own mind. Wanna die on that hill for an imaginary "high salary" (CA taxes knock you down to median average anyway?

    My advice? Stay away from CA and their "high salaries". With the crap living conditions, the meth/drug/crime problems and the taxes....you will most likely spend that "high salary" to get the hell away from the area every chance you get. Better to stay in a solid job, work your way up and get off the floor. Enough RNs get smart and get off the floor....the more hospitals have to pay overtime and for travelers, the more likely it will be that these facilities will start voluntarily easing up on the 8 patients per RN on a step down unit.

close