California's Nurse-to-patient Ratio Law -- Update - page 5

As predicted by many, California's nurse-to-patient ratio law (also known as AB394) may not go into effect after all. Bowing to the serve nursing shortage in the State and at the suggestion of both... Read More

  1. by   pickledpepperRN
    Originally posted by Gomer
    Spacenurse, I predict that beds/units/maybe hospitals will close if this bill passes. I may be wrong, but we shall see in a few months how this economical effects Calif. healthcare.
    That is what the Healthcare Association and Organization of Nurse Leaders say. They are the union for the hospital industry.
    California Healthcare Association
    January 22, 2002

    California Hospitals Remain Committed to Providing Appropriate Nurse Staffing to Meet
    Needs of Patients

    Proposed Nurse Ratios Add Focus to Nursing Shortage,
    Financial Pressures on Hospitals

    C. Duane Dauner
    California Healthcare Association

    Governor Gray Davis today released a set of proposed nurse staffing ratios, as required by state law (AB 394, 1999). The
    proposed ratios are the first-ever attempt by any state in the nation to establish a predetermined ratio of nurses to patients in
    the various services of acute-care hospitals. These proposed ratios will be subject to the normal state regulatory process.
    This process will involve numerous opportunities for public input.

    The Governor's announcement represents more than two years' of work by the state Department of Health Services (DHS),
    which was charged with developing the proposed ratios. DHS' efforts were far from easy, since research on staffing ratios is

    California's hospitals already do whatever is necessary to provide adequate nurse staffing to meet the needs of their
    patients. This includes staffing based on the acuity of the patients' condition, innovative recruitment and retention efforts, and
    the use of nurse registries and traveling RNs. Whatever staffing standards are ultimately adopted following the regulatory
    process, California's hospitals will comply with the new law.

    However, because we face the most serious nursing shortage in the nation, some hospitals may have to shut down some
    services or significantly reduce the capacity of their services in order to comply with the law. Statewide, California hospitals
    currently are operating with a more than 15 percent RN vacancy rate - meaning that more than one out of every 6 nursing
    positions in hospitals is not filled with regular hospital employees. Nurse registry and traveling nurses are used to fill the

    California hospitals are under severe financial stress. Nearly two out of every three hospitals lose money on operations.
    Manufacturing money to pay for more nurses is not possible, and the continual ratcheting down of payments to hospitals by
    government agencies and private payors is making the situation even worse. Several California schools of nursing have
    closed or cut back their enrollment, thereby reducing the number of nurses who are available. With an average age of 47
    years, the California RN workforce is headed for disaster.

    Once the proposed staffing ratios are in effect, the nursing shortage may become even more acute and access to patient
    care services may be jeopardized. For example, if a hospital has 10 treatment bays in its Emergency Department (ED) but
    only has enough nurses to staff five of those beds and be in compliance with the law, half of the hospital's ED capacity may
    have to be taken out of service. The net result would be less access to emergency care services in a local community.

    The California Healthcare Association (CHA) has consistently maintained that it is in the best interest of patients to base
    staffing decisions on the actual needs of patients at any given time. Patients' conditions often change by the hour, and
    hospitals face a continual turnover of patients with diverse medical needs, all of which impact staffing requirements.
    Hospitals have deployed nurses on this basis for more than a decade.

    CHA will analyze the proposed nurse staffing ratios released today and will comment and provide input to DHS officials
    throughout the regulatory process. Contact: Jan Emerson, (916) 552-7516.

    Home | Nurse Staffing Ratios | Cost to Hospitals

    Copyright California Healthcare Association 2001. A
    Last edit by pickledpepperRN on Jun 3, '03
  2. by   pickledpepperRN
    The letter that lead to the lawsuit that lead to this thread, ( that died in the house that greed built).
    August 2, 2000

    Brenda Klutz
    Deputy Director
    California Department of Health Services
    Post Office Box 942732
    1800 - 3rd Street, Suite 210
    Sacramento, California 94234-7320

    Dear Brenda:

    As the California Healthcare Association (CHA) and Association of California Nurse Leaders (ACNL) attempt to provide recommendations regarding the implementation of AB 394 and nurse staffing ratios, we continue to have significant concerns about the lack of statistically significant data on which to base our recommendations. To date, there are no studies that define or suggest appropriate ratios.

    The California Nursing Outcomes Coalition (CalNOC) is currently engaged in a process that correlates patient falls, skin ulcers and satisfaction with skill mix and hours per patient day (HPPD). CalNOC has the largest database and is the only real-time project of this kind. In the near future, it will have the ability to scientifically determine if HPPD and skill mix actually affect outcomes. Considering the enormous implications nurse-to-patient ratios will have on hospitals, the workforce, and the health care provided to the citizens of California it would be our suggestion that the department delay implementation of AB 394 until CalNOC can provide evidence based on data relative to nurse/patient ratios. Recognizing that AB 394 demands implementation by 1/1/01, which will most likely be changed to 1/1/02, we suggest a process that would provide for additional decisions to be made once the data is available. This will allow staffing to be based on factual information.

    Enclosed, please find recommended standardized definitions, minimal ratios and related information. We look forward to discussing our proposal with the Department.

    Thank you for your consideration of our proposal.


    C. Duane Dauner Patricia McFarland, MS, RN
    President Executive Director
    California Healthcare Association Association of California Nurse Leaders


    cc: The Honorable Sheila Kuehl
    Susan Kennedy
    Diana M. Bont, R.N., Dr.PH
    Gina Henning
  3. by   pickledpepperRN
    Ventilator related death or permanent brain and/or kidney damage is reportable to the JCAHO.
    It is one "Failure to Rescue" attributed to competence and staffing. Below is part of their report:

    Preventing ventilator-related deaths and injuries
    As of January 2002, the Joint Commission has reviewed 23 reports of deaths or injuries related to long term ventilation--19 events resulted in death and four in coma. Of the 23 cases, 65 percent were related to the malfunction or misuse of an alarm or an inadequate alarm; 52 percent were related to a tubing disconnect; and 26 percent were related to dislodged airway tube. A small percentage of the cases were related to an incorrect tubing connection or wrong ventilator setting. None of the cases were related to ventilator malfunctions. As the percentages indicate, ventilator-related deaths and injuries are often related to multiple failures that lead to negative outcomes. The majority of the cases occurred in hospital Intensive Care Units (ICUs), followed by long term care facilities and hospital chronic ventilator units.
    Root causes
    Root cause analysis of the 23 cases reveals the following contributing factors:
    Inadequate orientation/training process 87 percent
    Insufficient staffing levels 35 percent
    Communication breakdown
    Among staff members 70 percent
    With patient/family 9 percent
    Incomplete patient assessment
    Room design limits observation 30 percent
    Delayed or no response to alarm 22 percent
    Monitor change not recognized 13 percent
    Alarm off or set incorrectly 22 percent
    No alarm for certain disconnects 22 percent
    Alarm no audible in all areas 22 percent
    No testing of alarms 13 percent
    Restraint failure (escape) 13 percent
    Distraction (environmental noise) 22 percent
    Cultural (hierarchy/intimidation) 13 percent