New California Nurse to Patient Ratio

Career Columnist / Author · Jan 10, 2021

Cancer surgeries can still take place. Last week I recall a craniectomy. But ortho surgeries, hysterectomies, procedures such as colonoscopies...not. And I think the word "elective" is key.

Our OR/PACU staff are directed to the floors to help as much as they're able, and GI lab is converted to additional ICU beds.

When ICU is at zero capacity, it's scary to think about a surgery going wrong and the pt needing an ICU bed.

The predictors say infections will peak at the end of January.

allnurses Guide · Jan 10, 2021

On 1/9/2021 at 10:02 AM, Nurse Beth said:

LVNs haven't worked in acute care for some time, but they could certainly be used now.

From 1998 to 1982 I worked as an LVN in critical care after taking a critical care university course. (My fellow students were RNs planning to be Clinical Nurse Specialists.

Staffing was two RNs and me for six patients. Each RN was responsible for ongoing assessments and the entire nursing process for three patients. I took vital signs, wound care, administer routine medication, bring all IV equipment to the RN (Then potassium was added to IV fluid by nurses, bath, suction ET tubes as well trachs, trach care, ROM, positioning, assisting physicians insert Swan Ganz and other central lines, chest tubes, and other bedside procedures, and such. We were all busy as I helped with six patients, and they each had three critical care patients. I remember most of the time patients were well cared for. BUT it was NOT ideal.

Decades later I testified before the California Department of Health Services That there must NOT be averaging of the number of patients and the total number of licensed nurses on the unit during any one shift or over any period of time. That ONLY licensed nurses providing direct patient care should be included in the ratios. I said, "If I have one patient needing 1:1 nursing care my colleague MUST NOT be assigned three patients as my hospital did. They claimed 1 plus 3 = 4, Four divided by 2 equals two therefore staffing in critical care the number of occupied beds is divided by two to determine staffing for the shift.

But NOW LVNs could be very helpful.

Thank you Nurse Beth!

Career Columnist / Author · Jan 10, 2021

27 minutes ago, herring_RN said:

From 1998 to 1982 I worked as an LVN in critical care after taking a critical care university course. (My fellow students were RNs planning to be Clinical Nurse Specialists.

Staffing was two RNs and me for six patients. Each RN was responsible for ongoing assessments and the entire nursing process for three patients. I took vital signs, wound care, administer routine medication, bring all IV equipment to the RN (Then potassium was added to IV fluid by nurses, bath, suction ET tubes as well trachs, trach care, ROM, positioning, assisting physicians insert Swan Ganz and other central lines, chest tubes, and other bedside procedures, and such. We were all busy as I helped with six patients, and they each had three critical care patients. I remember most of the time patients were well cared for. BUT it was NOT ideal.

Decades later I testified before the California Department of Health Services That there must NOT averaging of the number of patients and the total number of licensed nurses on the unit during any one shift or over any period of time. That ONLY licensed nurses providing direct patient care should be included in the ratios. I said, "If I have one patient needing 1:1 nursing care my colleague MUST NOT be assigned three patients as my hospital did. They claimed 1 plus 3 = 4, Four divided by 2 equals two therefore staffing in critical care the number of occupied beds is divided by two to determine staffing for the shift.

But NOW LVNs could be very helpful.

Thank you Nurse Beth!

Bravo to you!!

Sour Lemon · Jan 10, 2021

12 hours ago, Nurse Beth said:

LVNs haven't worked in acute care for some time, but they could certainly be used now.

Last night, our directer mentioned trying to hire some LVNs. We used to have some, but they were unceremoniously laid off a few years ago- right before the Winter holidays.

I do wonder what will happen to any hired LVNs after things settle down. The ones who were let go before had been long-time, good employees.

Jedrnurse, BSN, RN · Jan 10, 2021

It's just a cynical gut feeling, but I can't help but wonder if some hospitals will try to make some of these emergency changes the new normal after the pandemic. (The ones that give them short-term economic benefit, that is...)

Career Columnist / Author · Jan 10, 2021

3 hours ago, Jedrnurse said:

It's just a cynical gut feeling, but I can't help but wonder if some hospitals will try to make some of these emergency changes the new normal after the pandemic. (The ones that give them short-term economic benefit, that is...)

No doubt. Either that, or I'm a cynic right along with you :). Some may try. But in the end, once the waivers are expired, it's back to ratios.

Nunya, BSN · Jan 10, 2021

So much for their highly touted nurse: patient ratio huh? I guess they should have said those are the ratios unless they don't have staff....?

Maybe if people would do what they should be doing the US wouldn't have this problem....

Jedrnurse, BSN, RN · Jan 10, 2021

2 hours ago, Nurse Beth said:

No doubt. Either that, or I'm a cynic right along with you :). Some may try. But in the end, once the waivers are expired, it's back to ratios.

I guess I was generalizing about the whole country. For example, an ICU 1:3 becoming the "industry norm" in the majority of states (which do not have mandated ratios...)

BSN-to-MSN, ADN, BSN, RN · Jan 11, 2021

I'm not in California, but the ratio on my cardiac/stepdown floor are now 1:5 and 1:6, normally 1:4. The house supervisor also adopted a nasty strategy of starting our day as 1:5 and then pulling a nurse at 9AM, and a tech at 10 AM, making our ratio 1:6, and often only one tech for 24 patients. We call it "being plucked", not floated.

allnurses Guide · Feb 2, 2021

Nurses applaud as state marks the end of waivers extending safe staffing ratios

After months of working to meet the new allowances of patient-nurse ratios approved by the state, California nurses will soon take a sigh of relief.

The California Department of Public Health announced that as of Monday, the department will no longer accept any new expedited staffing waivers. Furthermore, all existing approved staffing waivers will expire on February 8, unless CDPH determines on an individual waiver basis that there is an unprecedented circumstance.

Hospitals must maintain efforts to meet required staffing levels at all times...

... If CDPH has any indication that hospitals have not maintained efforts to increase staffing, CDPH will investigate and require hospitals to provide documentation of their efforts. Additionally, CDPH may do unannounced audits to assess these efforts.

“This is an incredible victory for patients and nurses, because we know that safe staffing saves lives,” said Zenei Triunfo-Cortez, RN and a president of the California Nurses Association and its national organization, National Nurses United.

Bakersfield Memorial Hospital nurse Sandy Reding told 23ABC last week these waivers were harsh for nurses on the floor and could actually be harmful to patients...

https://www.turnto23.com/news/coronavirus/a-small-victory-nurses-applaud-as-state-marks-the-end-of-waivers-extending-safe-staffing-ratios

The ratio regulations:

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

EssieMarie · Mar 5, 2021

I am just not sure how 1:3 ratios in the ICU can be safe. I understand staffing shortages but I think it is unfair to ask a nurse to put their license at risk and patient safety. I hope all that are working under these conditions get relief soon!

MTRN18, BSN · Mar 5, 2021

Sorry to hear that so many of you have had to take unsafe 3:1 ICU assignments. Hoping that ICU ratios are back to 2:1 soon!