New Staffing ratios

Hi, I work in Southern Calif in a community hospital of about 265-300 beds. My question is: How will the Gray Davis situation affect us in regards to the staffing ratios that are to take effect in January 2004? Do you think this will really happen, or will the hospitals delay due to "politics"?

Thanks. I really hope the ratios come and the hospitals are forced to staff adequately. I currently am in a critical care unit which provides great staffing, but as a nurse and a human being who could be hopitalized, I want to see safety on the floors!:)

[pickledpepperRN]

I think the law will remain the law regardless of who the Governor is.

With the cutbacks in the state budget the DHS will only enforce the ratios when there is a complaint.

Anyone can make a complaint: patient, family, or hospital staff.

Then they must investigate. Be specific about the name of the hospital, date, shift, unit, number and acuity of patients, and any actual or potential harm to patients.

[Paige Turner RN]

what is your current nurse to patient ratio...and how will the new law change it? We are currently in restructure and our new ratio will be 7 patients to one care pair (RN and NAC)

[pickledpepperRN]

More than you ever wanted to know about the ratios, but were NOT afraid to ask.

http://www.calnurse.org/finalrat/ratiobox.html

http://www.calnurse.org/finalrat/finratrn7103.pdf

http://www.calnurse.org/finalrat/qandafinalrat.pdf

http://www.calnurse.org/finalrat/7103factsheet.html

http://www.calnurse.org/cna/ratios62803/

http://www.leginfo.ca.gov/pub/99-00/bill/asm/ab_0351-0400/ab_394_bill_19991010_chaptered.pdf

http://www.dhs.ca.gov/lnc/default.htm

http://www.applications.dhs.ca.gov/regulations/search.asp?REGID=R-37-01&advanced=yes&c2=@filewrite&o2=%3E&q1=&EMERGENCY=&submit1=Begin+Search

[sharann, BSN, RN]

Today in our hospitals Telemetry unit, each RN had 10 patients. There were aides, but the LVN had their own 10 patient loads. Hows's that?

Gee thanks Spacenurse for the reading material above!

[RNConnieF]

spacenurse,

Thanks for the links: my paper, due Tuesday, is on this topic. I may have more links is anyone needs them.

[pickledpepperRN]

Originally posted by sharann

Today in our hospitals Telemetry unit, each RN had 10 patients. There were aides, but the LVN had their own 10 patient loads. Hows's that?

Gee thanks Spacenurse for the reading material above!

Well starting New Years the minimum number af telemetry patients per licensed nurse will be FIVE.

50% may be LVNs. monitor observers and aides should remain at the same percentage as before.

It will be appropriate to insist your hospital work toward the ratios now, it is just a few months away. Then you or someone else may notify the Department of Health Services (DHS).

(9)The licensed nurse-to-patient ratio in a step-down unit shall be 1:4 or fewer at any time 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, and or mechanical ventilation, for the immediate amelioration or remediation of severe pathology for those patients requiring less care than intensive care, but more than that which is available from medical/surgical care.

(10)The licensed nurse-to-patient ratio in a telemetry unit shall be 1:5 or fewer at any time 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 designated 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 for 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.

For every 10 or fewer telemetry patients, there shall be a minimum of one additional person who is legally authorized to perform the function of monitoring the telemetry screens. The person monitoring the telemetry screens shall not have any additional assignment.

[sharann, BSN, RN]

Thank you Spacenurse!

[Daisy Marie]

Hello,

I am shocked at the current ratio of Nurse to Patient on the Telemetry unit, 10:1, is unsafe. Perhaps Mr. Gray Davis would like to be one of the 10 patients, or one of our legislatures who put the breaks on passing legislation that protects the patient and the nurse. No wonder so many Nurses leave the profession. I just hope that by 2008, we will have enough qualified RN's to do the job. Of course hospitals will most likely omit or scale down "Step Down" units, and those patients will then go to a Med/Surg bed . How can Nurses and patients safe gaurd against hospitals from altering acuities to keep the ratios where they want them??

[pickledpepperRN]

Originally posted by Daisy Marie

Hello,

I am shocked at the current ratio of Nurse to Patient on the Telemetry unit, 10:1, is unsafe. Perhaps Mr. Gray Davis would like to be one of the 10 patients, or one of our legislatures who put the breaks on passing legislation that protects the patient and the nurse. No wonder so many Nurses leave the profession. I just hope that by 2008, we will have enough qualified RN's to do the job. Of course hospitals will most likely omit or scale down "Step Down" units, and those patients will then go to a Med/Surg bed . How can Nurses and patients safe gaurd against hospitals from altering acuities to keep the ratios where they want them??

Glad it was misread!

Cut and pasted from the above links:

(10) The licensed nurse-to-patient ratio in a telemetry unit shall be 1:5 or fewer at any time 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.

1:10 IS unsafe. That is double the MINIMUM RATIO!

More cut & paste:

Licensed Nurse-to-patient ratios represent the maximum number of patients that shall be assigned to one licensed nurse during 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.

In order to clarify that a hospital cannot reduce overall staffing by assigning licensed nurses to duties customarily and appropriately performed by unlicensed staff, it is stated that staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system. At 22 CCR 70053.2 and 70217(b), the PCS is defined as a system that is established to determine the amount of nursing care needed by each unit, on each shift, and for each level of licensed and unlicensed staff. Setting a minimum level of staffing for licensed nurses is not intended to alter the current requirement of the PCS to determine needed staffing levels for licensed and unlicensed staff.

(The regulations were developed by a committee appointed by the Governor. The Director of the DHS heads this committy that consists of many registered nurses with at least two years of direct patient care. She is Diana Bonta RN. The first nurse to head the state DHS.)

[pickledpepperRN]

More cut & paste. I want to add that no other state in the USA has a nurse to patient ratio law at all. NURSES did most of the work and all the lobbying.

(11)The licensed nurse-to-patient ratio in medical/surgical care units shall be 1:6 or fewer at any time. Commencing January 1, 2005, the licensed nurse-to-patient ratio in medical/surgical care units shall be 1:5 or fewer at any time. 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 or step-down 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.

[pickledpepperRN]

Originally posted by Daisy Marie

How can Nurses and patients safe gaurd against hospitals from altering acuities to keep the ratios where they want them??

The criteria are written into the law.

Nurses need to be assertive in enforcing them. Physicians can protect their patients too. If the MD orders cardiac monitoring, the patient must be staffed as telemetry. The nurses must be competent for the care and, if needed, resuscitation of the patient. Any patient on IV Insulin or pressors, a ventilator, or with any invasive monitoring (including a post cath arterial line) will be a step down patient.

The RN is responsible so by defauls will be the policeman. Reporting violations to the DHS if the facility does not follow the law are part of patient advocacy.