Lpn's in Calif.

What is the status of Lpn's in calif? Is this a reality?

Plenty of work?

-R

depends on where you are in cali. if you are in the bigger cities/urban areas there are urgent cares clinics, large hospitals, rehab centers, and the usual nursing home/doctor's office stuff. a lot of california is rural. folks don't think so from watching tv, but it is true. there are plenty of rural areas in northern california that need LVNs (what LPNs are called in texas and california). most of the work will be snf/nursing home.

the state is currently trying to work out the rnurse-patient ratios in hospitals. they way it stands now, most aren't hiring many new LVNs. depends on how many sub-acute beds, etc. there was a law passed and ruled on by a court that only RNs could be used in figuring the ratio in acute care. so hospitals are desperate for RNs.

i'm a bettin' man. there is no way health care will be affordable with 5:1 ratios that only count RNs, else there will be no health care. things will shift soon...either law will be revoked/changed...or more sub-acute/rehab type centers will be used.

depends on whether you want to work on school to be n RN...work in geriatrics, etc.

good luck

The Nursing Practice Act (Title 16 of the Business and Professions Code and Title 22, which licenses the hospitals require this of RNs:

TITLE 22. Social Security

Division 5. Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies

Chapter 1. General Acute Care Hospitals

Article 3. Basic Services

70215. Planning and Implementing Patient Care

(a) A registered nurse shall directly provide:

(1) Ongoing patient assessments as defined in the Business and Professions Code, Section 2725(d). Such assessments shall be performed, and the findings documented in the patient's medical record, for each shift, and upon receipt of the patient when he/she is transferred to another patient care area.

(2) The planning, supervision, implementation, and evaluation of the nursing care provided to each patient. The implementation of nursing care may be delegated by the registered nurse responsible for the patient to other licensed nursing staff, or may be assigned to unlicensed staff, subject to any limitations of their licensure, certification, level of validated competency, and/or regulation.

(3) The assessment, planning, implementation, and evaluation of patient education, including ongoing discharge teaching of each patient. Any assignment of specific patient education tasks to patient care personnel shall be made by the registered nurse responsible for the patient.

(b) The planning and delivery of patient care shall reflect all elements of the nursing process: assessment, nursing diagnosis, planning, intervention, evaluation and, as circumstances require, patient advocacy, and shall be initiated by a registered nurse at the time of admission.

© The nursing plan for the patient's care shall be discussed with and developed as a result of coordination with the patient, the patient's family, or other representatives, when appropriate, and staff of other disciplines involved in the care of the patient.

(d) Information related to the patient's initial assessment and reassessments, nursing diagnosis, plan, intervention, evaluation, and patient advocacy shall be permanently recorded in the patient's medical record.

So if based on the assessment made by the registered nurse who has assessed and charted said assessment the needs of the patients require 1:5, 1:4 or even 1:1 staffing that needs to be provided. At my hospital a patient may need constant attendance by nursing personnel, a sitter, CNA, LVN, or RN can often keep an agitated confused patient safe. This is much better than restraints.

Orthopedic patients and others often need medication, dressing changes, and other procedures. Adding an LVN to assist one or more RNs can allow each RN to be assigned the maximum the ratio allows. Alternately an extra RN may need to be scheduled.If in the professional opinion the needs of each individual patient are such that one RN can safely assume responsible for the nursing care of ten patients shared with an LVN that is acceptable.

I'd be interested in where you read that LVN's are not counted in ratios. Because we count them and I have read the information that they do count. I'm thinking because of the ratios being hard to meet, LVN's would be very valuable and needed.

Russell - there are lots of opportunities for LVN's in California. Especially rural.

steph

I dont think so.... My facility laid all of our LVN's off when ratios went into effect and there planning on doing away with CNA's for the most part too. All to pave the way for the "Mighty All Accountable" R.N.'s whom they are hiring from India and all other parts off the world just to satisfy the "ratios". Congrats CNA ( The RN UNION) you did your members well, its just everyone else involved in patient care that got screwed out of a job by the "ratio law". Really hows that gonna increase "patient safety" taking another set of eyes off your patients? Good luck is all I can say! You will no doubt have your hands full with 5 primary and no one else to cover you.

The actual wording of the current title 22 section:

70217. Nursing Service Staff.

(a) 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 licensed 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.

No hospital shall assign a licensed nurse to a nursing unit or clinical area unless that hospital determines that the licensed nurse has demonstrated current competence in providing care in that area, and has also received orientation to that hospital's clinical area sufficient to provide competent care to patients in that area. The policies and procedures of the hospital shall contain the hospital's criteria for making this determination.

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.

Nurse Administrators, Nurse Supervisors, Nurse Managers, and Charge Nurses, and other licensed nurses shall be included in the calculation of the licensed nurse-to-patient ratio only when those licensed nurses are engaged in providing direct patient care. When a Nurse Administrator, Nurse Supervisor, Nurse Manager, Charge Nurse or other licensed nurse is engaged in activities other than direct patient care, that nurse shall not be included in the ratio. Nurse Administrators, Nurse Supervisors, Nurse Managers, and Charge Nurses who have demonstrated current competence to the hospital in providing care on a particular unit may relieve licensed nurses during breaks, meals, and other routine, expected absences from the unit.

Licensed vocational nurses may constitute up to 50 percent of the licensed nurses assigned to patient care on any unit, except where registered nurses are required pursuant to the patient classification system or this section. Only registered nurses shall be assigned to Intensive Care Newborn Nursery Service Units, which specifically require one registered nurse to two or fewer infants. In the Emergency Department, only registered nurses shall be assigned to triage patients and only registered nurses shall be assigned to critical trauma patients.

Nothing in this section shall prohibit a licensed nurse from assisting with specific tasks within the scope of his or her practice for a patient assigned to another nurse. "Assist" means that licensed nurses may provide patient care beyond their patient assignments if the tasks performed are specific and time-limited.

(1) The licensed nurse-to-patient ratio in a critical care unit shall be 1:2 or fewer at all times. "Critical care unit" means a nursing unit of a general acute care hospital which provides one of the following services: an intensive care service, a burn center, a coronary care service, an acute respiratory service, or an intensive care newborn nursery service. In the intensive care newborn nursery service, the ratio shall be 1 registered nurse: 2 or fewer patients at all times.

(2) The surgical service operating room shall have at least one registered nurse assigned to the duties of the circulating nurse and a minimum of one additional person serving as scrub assistant for each patient-occupied operating room. The scrub assistant may be a licensed nurse, an operating room technician, or other person who has demonstrated current competence to the hospital as a scrub assistant, but shall not be a physician or other licensed health professional who is assisting in the performance of surgery.

(3) The licensed nurse-to-patient ratio in a labor and delivery suite of the perinatal service shall be 1:2 or fewer active labor patients at all times. When a licensed nurse is caring for antepartum patients who are not in active labor, the licensed nurse-to-patient ratio shall be 1:4 or fewer at all times.

(4) The licensed nurse-to-patient ratio in a postpartum area of the perinatal service shall be 1:4 mother-baby couplets or fewer at all times. In the event of multiple births, the total number of mothers plus infants assigned to a single licensed nurse shall never exceed eight. For postpartum areas in which the licensed nurse's assignment consists of mothers only, the licensed nurse-to-patient ratio shall be 1:6 or fewer at all times.

(5) The licensed nurse-to-patient ratio in a combined Labor/Delivery/Postpartum area of the perinatal service shall be 1:3 or fewer at all times the licensed nurse is caring for a patient combination of one woman in active labor and a postpartum mother and infant The licensed nurse-to-patient ratio for nurses caring for women in active labor only, antepartum patients who are not in active labor only, postpartum women only, or mother-baby couplets only, shall be the same ratios as stated in subsections (3) and (4) above for those categories of patients.

(6) The licensed nurse-to-patient ratio in a pediatric service unit shall be 1:4 or fewer at all times.

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

(8) In a hospital providing basic emergency medical services or comprehensive emergency medical services, the licensed nurse-to-patient ratio in an emergency department shall be 1:4 or fewer at all times that patients are receiving treatment. There shall be no fewer than two licensed nurses physically present in the emergency department when a patient is present.

At least one of the licensed nurses shall be a registered nurse assigned to triage patients. The registered nurse assigned to triage patients shall be immediately available at all times to triage patients when they arrive in the emergency department. When there are no patients needing triage, the registered nurse may assist by performing other nursing tasks. The registered nurse assigned to triage patients shall not be counted in the licensed nurse-to-patient ratio.

http://ccr.oal.ca.gov/cgi-bin/om_is...Section&record={605BF}&softpage=Browse_Frame_Pg42

TITLE 22. Social Security

Division 5. Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies

Chapter 1. General Acute Care Hospitals

Article 3. Basic Services

70217. Nursing Service Staff.

Hospitals designated by the Local Emergency Medical Services (LEMS) Agency as a "base hospital", as defined in section 1797.58 of the Health and Safety Code, shall have either a licensed physician or a registered nurse on duty to respond to the base radio 24 hours each day. When the duty of base radio responder is assigned to a registered nurse, that registered nurse may assist by performing other nursing tasks when not responding to radio calls, but shall be immediately available to respond to requests for medical direction on the base radio. The registered nurse assigned as base radio responder shall not be counted in the licensed nurse-to-patient ratios.

When licensed nursing staff are attending critical care patients in the emergency department, the licensed nurse-to-patient ratio shall be 1:2 or fewer critical care patients at all times. A patient in the emergency department shall be considered a critical care patient when the patient meets the criteria for admission to a critical care service area within the hospital.

Only registered nurses shall be assigned to critical trauma patients in the emergency department, and a minimum registered nurse-to-critical trauma patient ratio of 1:1 shall be maintained at all times. A critical trauma patient is a patient who has injuries to an anatomic area that : (1) require life saving interventions, or (2) in conjunction with unstable vital signs, pose an immediate threat to life or limb.

(9) The licensed nurse-to-patient ratio in a step-down unit shall be 1:4 or fewer at all times. Commencing January 1, 2008, the licensed nurse-to-patient ratio in a step-down unit shall be 1:3 or fewer at all times. A "step down unit" is defined as a unit which is organized, operated, and maintained to provide for the monitoring and care of patients with moderate or potentially severe physiologic instability requiring technical support but not necessarily artificial life support. Step-down patients are those patients who require less care than intensive care, but more than that which is available from medical/surgical care. "Artificial life support" is defined as a system that uses medical technology to aid, support, or replace a vital function of the body that has been seriously damaged. "Technical support" is defined as specialized equipment and/or personnel providing for invasive monitoring, telemetry, or mechanical ventilation, for the immediate amelioration or remediation of severe pathology.

(10) The licensed nurse-to-patient ratio in a telemetry unit shall be 1:5 or fewer at all times. 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. "Telemetry unit" as defined in these regulations does not include fetal monitoring nor fetal surveillance.

(11) The licensed nurse-to-patient ratio in medical/surgical care units shall be 1:6 or fewer at all times. Commencing January 1, 2005, the licensed nurse-to-patient ratio in medical/surgical care units shall be 1:5 or fewer at all times. A medical/surgical unit is a unit with beds classified as medical/surgical in which patients, who require less care than that which is available in intensive care units, step-down units, or specialty care units receive 24 hour inpatient general medical services, post-surgical services, or both general medical and post-surgical services. These units may include mixed patient populations of diverse diagnoses and diverse age groups who require care appropriate to a medical/surgical unit.

(12) The licensed nurse-to-patient ratio in a specialty care unit shall be 1:5 or fewer at all times. Commencing January 1, 2008, the licensed nurse-to-patient ratio in a specialty care unit shall be 1:4 or fewer at all times. A specialty care unit is defined as a unit which is organized, operated, and maintained to provide care for a specific medical condition or a specific patient population. Services provided in these units are more specialized to meet the needs of patients with the specific condition or disease process than that which is required on medical/surgical units, and is not otherwise covered by subdivision (a).

(13) The licensed nurse-to-patient ratio in a psychiatric unit shall be 1:6 or fewer at all times. For purposes of psychiatric units only, "licensed nurses" also includes licensed psychiatric technicians in addition to licensed vocational nurses and registered nurses. Licensed vocational nurses, licensed psychiatric technicians, or a combination of both, shall not exceed 50 percent of the licensed nurses on the unit.

(14) Identifying a unit by a name or term other than those used in this subsection does not affect the requirement to staff at the ratios identified for the level or type of care described in this subsection.

(b) 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. The ratios specified in subsection (a) shall constitute the minimum number of registered nurses, licensed vocational nurses, and in the case of psychiatric units, licensed psychiatric technicians, who shall be assigned to direct patient care. 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, and the licensure of the personnel required for care. The system developed by the hospital shall include, but not be limited to, the following elements:

(1) Individual patient care requirements.

(2) The patient care delivery system.

(3) Generally accepted standards of nursing practice, as well as elements reflective of the unique nature of the hospital's patient population.

© A written staffing plan shall be developed by the administrator of nursing service or a designee, based on patient care needs determined by the patient classification system. The staffing plan shall be developed and implemented for each patient care unit and shall specify patient care requirements and the staffing levels for registered nurses and other licensed and unlicensed personnel. In no case shall the staffing level for licensed nurses fall below the requirements of subsection (a). The plan shall include the following:

(1) Staffing requirements as determined by the patient classification system for each unit, documented on a day-to-day, shift-by-shift basis.

(2) The actual staff and staff mix provided, documented on a day-to-day, shift-by-shift basis.

(3) The variance between required and actual staffing patterns, documented on a day-to-day, shift-by-shift basis.

(d) In addition to the documentation required in subsections ©(1) through (3) above, the hospital shall keep a record of the actual registered nurse, licensed vocational nurse and licensed psychiatric technician assignments to individual patients by licensure category, documented on a day-to-day, shift-by-shift basis. The hospital shall retain:

(1) The staffing plan required in subsections ©(1) through (3) for the time period between licensing surveys, which includes the Consolidated Accreditation and Licensing Survey process, and

(2) The record of the actual registered nurse, licensed vocational nurse and licensed psychiatric technician assignments by licensure category for a minimum of one year.

(e) The reliability of the patient classification system for validating staffing requirements shall be reviewed at least annually by a committee appointed by the nursing administrator to determine whether or not the system accurately measures patient care needs.

(f) At least half of the members of the review committee shall be registered nurses who provide direct patient care.

(g) If the review reveals that adjustments are necessary in the patient classification system in order to assure accuracy in measuring patient care needs, such adjustments must be implemented within thirty (30) days of that determination.

(h) Hospitals shall develop and document a process by which all interested staff may provide input about the patient classification system, the system's required revisions, and the overall staffing plan.

(i) The administrator of nursing services shall not be designated to serve as a charge nurse or to have direct patient care responsibility, except as described in subsection (a) above.

(j) Registered nursing personnel shall:

(1) Assist the administrator of nursing service so that supervision of nursing care occurs on a 24-hour basis.

(2) Provide direct patient care.

(3) Provide clinical supervision and coordination of the care given by licensed vocational nurses and unlicensed nursing personnel.

(k) Each patient care unit shall have a registered nurse assigned, present and responsible for the patient care in the unit on each shift.

(l) A rural General Acute Care Hospital as defined in Health and Safety Code Section 1250(a), may apply for and be granted program flexibility for the requirements of subsection 70217(i) and for the personnel requirements of subsection (j)(1) above.

(m) Unlicensed personnel may be utilized as needed to assist with simple nursing procedures, subject to the requirements of competency validation. Hospital policies and procedures shall describe the responsibilities of unlicensed personnel and limit their duties to tasks that do not require licensure as a registered or vocational nurse.

(n) Nursing personnel from temporary nursing agencies shall not be responsible for a patient care unit without having demonstrated clinical and supervisory competence as defined by the hospital's standards of staff performance pursuant to the requirements of subsection 70213© above.

(o) Hospitals which utilize temporary nursing agencies shall have and adhere to a written procedure to orient and evaluate personnel from these sources. Such procedures shall require that personnel from temporary nursing agencies be evaluated as often, or more often, than staff employed directly by the hospital.

(p) All registered and licensed vocational nurses utilized in the hospital shall have current licenses. A method to document current licensure shall be established.

(q) 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.

I dont think so.... My facility laid all of our LVN's off when ratios went into effect and there planning on doing away with CNA's for the most part too. All to pave the way for the "Mighty All Accountable" R.N.'s whom they are hiring from India and all other parts off the world just to satisfy the "ratios". Congrats CNA ( The RN UNION) you did your members well, its just everyone else involved in patient care that got screwed out of a job by the "ratio law". Really hows that gonna increase "patient safety" taking another set of eyes off your patients? Good luck is all I can say! You will no doubt have your hands full with 5 primary and no one else to cover you.

You got it right.

Hospitals have purposely misinterpreted the regulations to punish nurses. Unfortunately patients are being punished.

You got it right.

Hospitals have purposely misinterpreted the regulations to punish nurses. Unfortunately patients are being punished.

Having my head deep in the textbooks for the last year as an lvn student, I was believing what the dir. of nursing at the hospital and our instructor was telling us about not being able to hire lvns due to the state law. now that i try to find more info, i see that it is the rn union that is pushing hard to eliminate the lvn from the picture.

the hospital where i do my clinicals had lots of traveler RNs in Jan. some of them seemed questionable in their ability to provide care. now the hospital has more lvns on night shifts in med/surg. i don't know if the hospital filed for a waiver due to the rural location though.

one of the other students works at another hospital as a CNA. she confirmed the hospital is reducing its CNA staff...punishment for RNs who demand ratios to be able to provide "total patient care". i guess folks need to be careful what they wish for!

Just the opposite here . .. we have our CNA's and have LVN's who share the patient load. As the RN I do all the initial patient assessments but the LVN I work with can be counted as part of the ratio of 1:6. She cares for her patients, I care for mine.

"Licensed vocational nurses may constitute up to 50 percent of the licensed nurses assigned to patient care on any unit" . . . . .

We usually have two RN's or one RN and one LVN and two CNA's for a max of 12 patients.

steph

I am glad.

What you describe is quite safe depending on the acuity of the patients AND the competence of the LVN.

I will gladly share more than five telemetry patients with LVNs I have worked with for years. We count on each other and work together.

Once an LVN came through the registry who had not worked in a hospital for 16 years. She had done private duty in the home of one patient the whole time. She had forgotton so much she needed more attention than the patients.

It is not an initial assessment only. You are required as the RN to make ongoing assessments. planning, evaluations, teaching, and do the documentation of all this. I bet you do too. If you don't have time, you are short staffed.

When I was an LVN I worked with a wonderful RN who is still my friend. We always considered that we shared the patients. We made rounds together assessing the patients. I did all routing PO meds. (We had an IV team then). She did the care planning, checked the labs, and so on. She was the one to call the doctor. I guess my point is that as I learned in RN school to understand WHY I did some things I understood also WHY the RN is responsible for the nursing care. As an LVN I was responsiblr for reporting and referring abnormal values, signs, and symptoms to the RN. I was also responsible for performing all tasks correctly. If I made a medication error it was my error. If the RN had "trusted" me enough to ignore my patients it would have been her license at risk if I failed to sysnthsize the data in time to prevent patient harm or death.

Example: The LVN who gave a sleeping pill at 2100 to an agitated patient. Too bad the patient was agitated due to hypoxia. That LVN should have reported to the RN before giving a PRN. (patient coded)

Communication and attitude are key.

Why make an LVN do the work of an RN without increasing the pay?

Again the law since 1983:

70215. Planning and Implementing Patient Care

(a) A registered nurse shall directly provide:

(1) Ongoing patient assessments as defined in the Business and Professions Code, Section 2725(d). Such assessments shall be performed, and the findings documented in the patient's medical record, for each shift, and upon receipt of the patient when he/she is transferred to another patient care area.

(2) The planning, supervision, implementation, and evaluation of the nursing care provided to each patient. The implementation of nursing care may be delegated by the registered nurse responsible for the patient to other licensed nursing staff, or may be assigned to unlicensed staff, subject to any limitations of their licensure, certification, level of validated competency, and/or regulation.

(3) The assessment, planning, implementation, and evaluation of patient education, including ongoing discharge teaching of each patient. Any assignment of specific patient education tasks to patient care personnel shall be made by the registered nurse responsible for the patient.

(b) The planning and delivery of patient care shall reflect all elements of the nursing process: assessment, nursing diagnosis, planning, intervention, evaluation and, as circumstances require, patient advocacy, and shall be initiated by a registered nurse at the time of admission.

© The nursing plan for the patient's care shall be discussed with and developed as a result of coordination with the patient, the patient's family, or other representatives, when appropriate, and staff of other disciplines involved in the care of the patient.

(d) Information related to the patient's initial assessment and reassessments, nursing diagnosis, plan, intervention, evaluation, and patient advocacy shall be permanently recorded in the patient's medical record.

I dont think so.... My facility laid all of our LVN's off when ratios went into effect and there planning on doing away with CNA's for the most part too. All to pave the way for the "Mighty All Accountable" R.N.'s whom they are hiring from India and all other parts off the world just to satisfy the "ratios". Congrats CNA ( The RN UNION) you did your members well, its just everyone else involved in patient care that got screwed out of a job by the "ratio law". Really hows that gonna increase "patient safety" taking another set of eyes off your patients? Good luck is all I can say! You will no doubt have your hands full with 5 primary and no one else to cover you.

You don't know what you are talking about. CNA has established a position that only RN's count in the ratio's. But they are equally adament that no ancillary staff is to be cut for the ratio's ie LVN's CNA's etc. That is a ploy of the hospitals to cut the CNA's and LVN's.

Just the opposite here . .. we have our CNA's and have LVN's who share the patient load. As the RN I do all the initial patient assessments but the LVN I work with can be counted as part of the ratio of 1:6. She cares for her patients, I care for mine.

"Licensed vocational nurses may constitute up to 50 percent of the licensed nurses assigned to patient care on any unit" . . . . .

We usually have two RN's or one RN and one LVN and two CNA's for a max of 12 patients.

steph

Of course you realize that as an RN YOU ALONE are responsible for all 12 patients. I like LVN's, but no way I will ever take responsibility for any patient that I did not directly take care of.

You don't know what you are talking about. CNA has established a position that only RN's count in the ratio's. But they are equally adament that no ancillary staff is to be cut for the ratio's ie LVN's CNA's etc. That is a ploy of the hospitals to cut the CNA's and LVN's.

it is definitely tougher to find the stuff in print about keeping LVNs aboard...if you have an lvn under you, how many patients would you be willing to take on? or do you prefer not to even delegate bedbaths, dressing changes, etc.? in your opinion is the whole ratio thing of 1:5 based on the notion that an LVN and CNA would help provide the total care...or that the RN would do it all?

just very curious as i've never seen an RN do a bedbath outside of ICU.