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HELP. Is it legal for hospitals to put us out of ratio due to the pandemic?

Hi everyone,

I am a new graduate nurse on a telemetry floor, and recently, because of the surge in COVID (+) patients, management is giving us 5 tele patients with no CNAs on the floor (we're really understaffed).  This is concerning because being out of ratio (the hospital is in California) & doing CNA duties compromises the patient's safety.  The nurses on our unit have brought this to our management's attention but they're saying that due to the pandemic they cannot get in trouble by the CDC or Public Health.  I have been doing research and have not found anything that says it is okay to be out of ratio.  Does anyone know if this is in fact true?  Also, we're still reusing N95 for weeks straight...is this still the norm? 

Thank you for your help 🙂 

Nurse SMS specializes in Critical Care; Cardiac; Professional Development.

Reusing N95s is definitely still the norm and probably will be from here on out. 

Have you contacted your union regarding being out of sync with lawful staffing? I suspect the answer is that yes, they definitely CAN do this, but check with your union to be sure. Then look at what your Safe Harbor laws are.

NRSKarenRN specializes in Vents, Telemetry, Home Care, Home infusion.

3 hours ago, Nurse SMS said:

Reusing N95s is definitely still the norm and probably will be from here on out. 

Have you contacted your union regarding being out of sync with lawful staffing? I suspect the answer is that yes, they definitely CAN do this, but check with your union to be sure. Then look at what your Safe Harbor laws are. 

CNA duties ARE part of nursing that can be delegated when staffing matrixes include the CNA/patient technician role.   Some hospitals are all RN staffed in ICU/Telemetry units.  In a Pandemic like the US is seeing in many areas, staffing is stretched thin  (staff out due to COVID exposure, illness/surgery, FMLA, quitting due to fear COVID exposure, etc) and ratio's/ staffing matrix exceeded.

Only Texas and New Mexico have Safe Harbor laws.   Many facilities especially union ones, utilize "Assignment Despite Objection" form to document unsafe staffing.  University of Michigan Nurses Assoc has details on how and when to use this form: http://www.umpnc.org/assignment-despite-objection.html   Check to see if your facility utilizes this to document staffing concerns.  Staff need to band together to push for additional help -- documenting increased staff needed due to patient acuity, time taking in doffing/donning PPE and # patients in isolation, etc.

N95 masks remain in short supply throughout the US despite manufacturers ramping up production.  WIth 22 states now having an increase in covid hospitalizations, lack adequate PPE will remain an issue for foreseeable future.

Consider filing OSHA complaint:  You have the right to file a confidential safety and health complaint and request an OSHA inspection of your workplace if you believe there is a serious hazard or if you think your employer is not following OSHA standards.  https://www.osha.gov/workers/file_complaint.html

Early in my career, I worked 14 bed telemetry unit-- when unit got up to 6 vented patients + 8 Cardiac/ Respiratory patients we 3 RN's staffing 12hr shift were swamped, emotionally drained and begged for an aide, so understand your concern.  

As a new nurse, all these challenges adding stressors to introduction into the nursing profession.   Decompress on your days off, do not accept overtime. Find  a mentor/colleague/friend that you can hash over the most stressful shifts.  Keep a journal.  Take care of YOU. 

Wishing better days ahead.

Serhilda specializes in Cardiac Telemetry, ICU.

Reusing N95's is unfortunately still occurring around the country although from what I've heard, using them for multiple weeks at a time is less common now. I haven't heard of units staffing tele floors quite that poorly but likely, California (like Massachusetts, where I am currently) passed a law to exempt employers from abiding by staffing laws due to the pandemic. Can't say for sure. My non-union hospital has been upstaffing due to the pandemic actually. Given all the nurses that have been laid off/furloughed, there's no excuse for not cross-training them to adequately staff other floors. Just my two cents.

herring_RN specializes in Critical care, tele, Medical-Surgical.

13 hours ago, Tvu1109 said:

Hi everyone,

I am a new graduate nurse on a telemetry floor, and recently, because of the surge in COVID (+) patients, management is giving us 5 tele patients with no CNAs on the floor (we're really understaffed).  This is concerning because being out of ratio (the hospital is in California) & doing CNA duties compromises the patient's safety.  The nurses on our unit have brought this to our management's attention but they're saying that due to the pandemic they cannot get in trouble by the CDC or Public Health.  I have been doing research and have not found anything that says it is okay to be out of ratio.  Does anyone know if this is in fact true?  Also, we're still reusing N95 for weeks straight...is this still the norm? 

Thank you for your help 🙂 

Welcome to nursing in California! I'm a retired California hospital nurse. Feel free to ask any questions and I will do my best to answer. 

Each hospital must plan for providing sufficient staff at all times. See the bolded paragraph at the bottom of the selected section.

Here are the regulations all acute care hospitals in California must obey. (Il legalese "shall" = "Must". 

Quote

CALIFORNIA CODE OF REGULATIONS - Nursing Service Staff: 

Hospitals shall provide staffing by licensed nurses, within the scope of their licensure in accordance with the following nurse-to-patient ratios. Licensed nurse means a registered nurse, licensed vocational nurse and, in psychiatric units only, a psychiatric technician. Staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system. 

 Licensed nurse-to-patient ratios represent the maximum number of patients that shall be assigned to one licensed nurse at any one time. “Assigned” means the licensed nurse has responsibility for the provision of care to a particular patient within his/her scope of practice. There shall be no averaging of the number of patients and the total number of licensed nurses on the unit during any one shift nor over any period of time. Only licensed nurses providing direct patient care shall be included in the ratios...

...   Commencing January 1, 2008, the licensed nurse-to-patient ratio in a telemetry unit shall be 1:4 or fewer at all times. “Telemetry unit” is defined as a unit organized, operated, and maintained to provide care for and continuous cardiac monitoring of patients in a stable condition, having or suspected of having a cardiac condition or a disease requiring the electronic monitoring, recording, retrieval, and display of cardiac electrical signals....

In addition to the requirements of subsection (a), 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 as specified at subsection 70215(a)(1), of patient requirements and provides for shift-by-shift staffing based on those requirements...    ...   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 for determining nursing care requirements, considering factors that include the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan, the ability for self-care...

...    The hospital shall plan for routine fluctuations in patient census. If a healthcare emergency causes a change in the number of patients on a unit, the hospital must demonstrate that prompt efforts were made to maintain required staffing levels. A healthcare emergency is defined for this purpose as an unpredictable or unavoidable occurrence at unscheduled or unpredictable intervals relating to healthcare delivery requiring immediate medical interventions and care...

https://govt.westlaw.com/calregs/Document/I8612C410941F11E29091E6B951DDF6CE?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)

You will want to read this one page outline of the responsibilities of hospital RNs in California :   https://govt.westlaw.com/calregs/Document/IFD69DB90621311E2998CBB33624929B8?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)

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