New Staffing ratios

pickledpepperRN · Oct 29, 2003

Once the minimum ratios are in place, ADDITIONAL staffing must be assigned based on a hospital's Patient Classification System.

Patient Classification System = (PCS) = acuity.

RNKPCE · Oct 29, 2003

Thanks Spacenurse.

We have a stepdown unit but often the doctors send them to us anyways. The stepdown unit has had a highturnover rate of employees for the past 12 years or so. The doctors know this too. It is rumored that they feel they get better care on our floor.............. that is probably why we often get the pts that should go there. It doesn't make it right though.

pickledpepperRN · Oct 29, 2003

Originally posted by batmik
Thanks Spacenurse.

We have a stepdown unit but often the doctors send them to us anyways. The stepdown unit has had a highturnover rate of employees for the past 12 years or so. The doctors know this too. It is rumored that they feel they get better care on our floor.............. that is probably why we often get the pts that should go there. It doesn't make it right though.

I think the doctors trust you more. It could be that you are familiar to them.

With the high turnover there could well be a competency or leadership problem on the step down unit. Perhaps they should think about making your unit step doen. That may be a good question to ask the people responding to the e- mails on the web site:

Get your answers from the authors of the ratio law!

http://www.calnurse.org/102103/safestaffqa.html#forum#forum

Questions and Answers about California's RN-to-patient staffing ratios, as required by the California Nurses Association sponsored Safe Staffing Law, AB 394.

Send in your additional questions. Answers, provided by CNA's nursing practice, regulatory, collective bargaining, and legal experts, will be posted here.

Here is the e- mail address. Topic should be "staffing ratio question.

[email protected]

The best way to truly learn is to attend a class.

http://www.calnurses.org/cna/ce/

wnt2besurgrn · Nov 14, 2003

SPACENURSE, THANKS FOR ALL OF THE INFORMATION YOU SENT, I APPRECIATE YOU DOING ALL THE WORK. YOU ARE VERY THOROUGH AND WOULD MAKE AN INCREDIBLE MANAGER.

pickledpepperRN · Nov 14, 2003

I work at night and weekends so the only management is the shift supervisor. Most of the time that is a friend. Unfortunately the management nurses are evaluated on the BUDGET instead of nursing care.

Plus I am better at distributing information than management. I do teach ACLS and love it!

Another article:

http://www.calnurse.org/press/111303a.html

California Nurses Association Condemns Call by LA Emergency Commission to Delay RN Staffing Ratio Law

The California Nurses Association sharply criticized a vote by the Emergency Medical Services Commission of Los Angeles County this afternoon proposing the County Board of Supervisors call for delays in California's landmark RN staffing ratio law.

Following a hearing on emergency medical services, the commission hurriedly, and without advance public notice, asked the Supervisors to urge a delay of the law, under which all hospitals must have in place safe RN staffing ratios by January 1, 2004 to protect hospital patients.

In addition to jeopardizing patients at hospitals in the county, CNA charged the commission's vote violated the Brown Act by failing to provide adequate public notice.

Noting that the commission is chaired by a hospital industry executive, CNA National Affairs Director Jill Furillo, RN, charged that the commission's vote "puts hospital industry profits ahead of public protections. They have endorsed the cynical ploy of those hospitals that want to evade compliance with a public safety law they don't like by exploiting fears about the availability of emergency medical care."

The commission is headed by Mark Costa who is also Chairman-elect of the Health Facilities Council of the Healthcare Association of Southern California (the hospital industry's union) and the Chief Operating Officer and former president of Little Company of Mary Hospital in Torrance.

In testimony before the commission Thursday, Furillo cited research documenting how safe RN staffing saves lives and improves patient outcomes. She also noted recent data about the growth of the RN workforce that demonstrates far more RNs are available for work in the state than are needed by hospitals to comply with the new law.

"The hospital industry has shamefully tried to suspend or overturn safe nurse to patient ratios using contrived and manipulated figures regarding the 'nursing shortage' and now they hope to take advantage of genuine public concerns about emergency care to further their political agenda at the expense of patients who will die in increasing numbers if these ratios do not go into effect," Furillo said.

wnt2besurgrn · Nov 17, 2003

pickledpepperRN · Nov 22, 2003

I hope you can access this.

It is written into the law on the CCR web site!

Try this link:

http://ccr.oal.ca.gov/Templates/CCR/Sectem.htm

Then:

Enter title: title 22

Enter section: 70217

Search terms: (leave blank)

http://ccr.oal.ca.gov/cgi-bin/om_isapi.dll?clientID=193138&infobase=ccr&softpage=Browse_Frame_Pg42

Click 'go to specific section' on the lower right.

Type "title 22" in the first area.

Just below type "70217"

let me check.

sharann, BSN, RN · Nov 22, 2003

Is it REALLY law?

I can't believe it.

Slap me siily!

Thanks for the link Spacenurse. You are great at finding this stuff. The DHS site makes me nutty. I spend an hour trying to search and get zippo.

pickledpepperRN · Nov 22, 2003

It is PDF. I believe it is to prevent any editing or deleting!

Here it is! I am excited too sharann!

Use this link:

http://ccr.oal.ca.gov/Templates/CCR/Sectem.htm

Then:

Enter title: title 22

Enter section: 70217

Search terms: (leave blank)

pickledpepperRN · Nov 22, 2003

Hospital industry seminars advise administrators how to evade RN ratios

http://www.calnurse.org/102103/hospindustry.html

California's hospital industry has been holding seminars across the state in recent weeks advising hospital administrators on how to undermine and avoid compliance with the new RN staffing ratios that go into effect on January 1, 2004.

While some hospitals are hiring hundreds of RNs to meet the ratios, and some are promising to fully cooperate in implementation, the seminars indicate that a number of industry executives are seeking to evade the regulations and overturn the law - regardless of the consequences for patient safety, and the likelihood of driving more RNs from the bedside.

The seminars are hosted by the California Healthcare Association, CHA, (the union for hospital officials) and the Association of California Nurse Leaders, ACNL (the nurse executive association, a CHA affiliate). Seminars have been held in Fresno, Chico, Fremont, Long Beach, Los Angeles and San Diego, attended by hundreds of nursing supervisors and other hospital officials.

Presenters have included top officials of the CHA, hospital management attorneys, and nurse executives, such as Carol Bradley, the new chief nursing officer for Tenet Healthcare Corporation and the former editor of NurseWeek.

Among the industry plans:

'Close beds and cry wolf'

Voluntarily close or downsize beds or units, citing an inability to "find" sufficient RNs to meet the ratios. The goal is to fan hysteria in hopes of softening public support for the ratios, winning regulatory exemptions to compliance, and generating political support for legislation to repeal or suspend the ratios.

Delay elective surgeries, declare healthcare "emergencies," both to force RNs on staff to work more hours and to engage in a PR war to subvert the ratios.

To ratchet up public pressure, some hospitals may close units or suspend operations every day, and will meet with legislators to place the blame on the ratio law. The officials concede that hospitals may in some cases have difficulty receiving permission to reopen beds or units that have been temporarily or permanently shut down.

Seminar packets provide:

1. Detailed information on temporary and permanent closures of units and suspensions of beds

2. Sample letter to DHS requesting bed suspension

3. Sample letter to employees and medical staff announcing unit closures

4. Sample press release for participants headlined "(Facility/System Name) Closes XXXX Unit Because of Lack of Nurses. Despite Recruitment Efforts, Hospital Unable to Hire Enough Nurses to Meet New State Law."

Hospital officials are told to view their PR department as their new best friend, and that the "CHA PR will help as well."

Keep the doctors in line, on all the strategies, from avoiding the ratios to downsizing, closing units, and suspending surgeries. Physicians are also seen as vital in public and legislative campaigns to reverse the ratio law.

Attacks on RN practice

Use LVNs to comprise up to 50% of the ratios, doubling the RN work load.

Hospital industry officials hope to distort the intent of the law by assigning patients directly to LVNs, rather than have LVNs be assistive to, and under the supervision of, the RN. Under the final AB 394 regulations, hospitals must use RNs because of scope of practice and patient acuity, based on a hospital's patient classification system.

Hospitals hope to expand LVN scope of practice to permit direct assessment of patients. Some also project expansion of "team nursing" to sharply expand the role of LVNs from data collection and med administration to performing more nursing care functions. The hospital industry is meeting with the LVN Board on the issue of assessments, presumably to encourage ongoing efforts by the SEIU-dominated LVN Board to expand LVN scope in assessing patients.

Additionally, many hospitals project using LVNs for meal and break relief for RNs.

SEIU has also promoted 50% LVN ratios. Click here for more on SEIUs role

Eroding the ratios at the bedside

Distort the use of acuity systems or other tools to reduce staffing. According to ACNL in one seminar, acuities are no longer a factor in staffing.

Some Tenet hospitals are employing a pilot staffing program borrowed from Tenet hospitals in Texas. The tool monitors labor efficiency in census driven units. In order to meet "production goals," managers can flex the number of hours of care to make staffing adjustments to meet budget targets. Managers are told to input acuity ratings to use the tool as a patient classification system to preclude the appearance of violating the staffing law.

Manipulate triage and work flow in the Emergency Department.

One non-CNA hospital in Southern California uses "operational flow redesign" of patients presenting to the ED to reclassify some patients as "office level" so they will first be seen by a Physician Assistant rather than by an RN, along with the expanded use of an EMT to reduce the amount of triage performed by an RN.

Quicker discharge of patients so staffing can be reduced.

Layoff non-RN staff thereby increasing the RN work load and violating the intent of AB 394.

Challenge or ignore ADOs and other RN efforts to monitor and protest violations.

The industry officials concede that ADOs are not illegal, but also tell the hospitals there are no legal regulations covering the use of ADOs. Hospital officials worry that ADOs and other reports by RNs to object to unsafe assignments and document unsafe staffing pose civil liabilities for hospitals that violate the law.

They advise managers to ignore or not respond to the reports, and recommend hospitals develop their own, in-house reporting tool, like an incident report, which staff are required to use, instead of forms developed by CNA.

Subverting the DHS

Continue to use existing, even expired, "program flexibility" waivers from the Department of Health Services to avoid compliance with the ratios and hope that no one notices.

According to one seminar speaker, DHS has said it will not grant new waivers for the ratios, but if a hospital has an alternative method for meeting the "spirit" of the law, it will be reviewed. Seminar packets include program flexibility request forms. Hospitals are advised to carefully document the "need" for waivers.

Pressure or cajole DHS to not enforce the law.

Seminar speakers note that DHS, already understaffed, is facing another 20% funding cut - and may face further cuts under Gov. Schwarzenegger. Hospital officials are also encouraged to cozy up to local DHS officers, and explain that the nursing supervisor is the expert for their unit. The officials are advised that they need to "educate" DHS.

Re-introducing anti-ratio legislation

Reintroduce AB 847, the hospital industry bill CNA helped to defeat last year. The bill would have required indefinite delays in implementation of ratios until iron clad studies prove there are sufficient numbers of RNs and that ratios improve patient outcomes.

Cover your tracks

RN supervisors and hospital administrators are advised to carefully record all their efforts to recruit RNs and comply with the law.

Industry officials advise hospitals to systematically keep track of all their efforts to find RNs to meet the ratios, from contacting all their own staff and registries to time and money spent on ads, travel and other recruitment efforts. The purpose: to have a record to justify decisions to close services and seek repeal or revisions in the law.

Hospitals are encouraged to "self-report" their violations of the law, because they can control what is reported rather than waiting for RNs or CNA to report the violation.

Seminar packets also include a sample "Documentation of Nursing Service Assignments" to demonstrate to the DHS or JCAHO the staffing plan on a day-to-day, shift-by-shift basis for every unit, and the specific number of RNs, LVNs, and PTs assigned.

pickledpepperRN · Nov 27, 2003

http://www.calnurse.org/cna/press/112503.html>

Data Shows Growth of RN Workforce as California

Nears Implementation of Landmark Safe Staffing Law

The advent of California's landmark Safe Staffing Law is helping to increase the size of the registered nurse workforce - far beyond the number of new RNs needed to meet the requirements of the law, the California Nurses Association said today.

As of January 1, 2004, all hospitals must be staffed in accordance with the new law, sponsored by CNA, which requires minimum RN-to-patient ratios in all hospital units. While some hospitals are hiring RNs and working to comply with the law, some are continuing to seek delays or revisions claiming they are unable to find the needed RNs due to the nursing shortage.

But data compiled by the state Board of Registered Nursing, the agency that licenses RNs in California shows that overall California today has over 30,000 more actively licensed RNs than the BRN estimated the state would have at this date - six times the number the state health department estimated would be needed for the ratios.

The Department of Health Services has said that statewide a total of 4,880 RNs additional will be needed to meet the ratios in 2004 and another 2,350 in 2005, numbers well within reach for hospitals that are actively working to implement the law, says CNA.

In 1997, the last time the BRN conducted a statewide survey of RNs, the BRN projected a small annual increase of only 2,000 RNs per year (based restructuring era trends and the number of new grads, minus those leaving the workforce). But the numbers have been growing by about 10,000 per year, even after subtracting those leaving.

Specifically, the BRN projected that based on trends in evidence in the mid-1990s, the number of actively licensed RNs in California entering 2004 would be 253,939. As of September 30, 2003, California had 285,134 actively licensed RNs (BRN stats).

Much of the increase results from a dramatic influx of RNs into California from other states or countries, but the numbers also reflect the first signs of the rebuilding of the nursing education and training infrastructure in California.

Every year California's nursing schools graduate 5,100 new RNs. After years of cuts in nursing education, California has increased capacity in its nursing programs the past two years and can now admit 6,600 students per year (of the 10,000 annual applicants for nursing school).

California last year approved a new $60 million nurse workforce initiative. The first phase, $21 million, allocated through 13 regional partnerships, will add an additional 2,000 RNs. The next stage, $24 million over three years, will boost the RN rolls by another 2,400.

Further, Australia has provided an example of the salutary effect of ratios on expanding the RN workforce.

In Victoria, Australia, where ratios were implemented in 2001, hospitals are able to staff with the ratios - while other Australian states battle their own nursing shortage - and demand for nursing courses is up 26.5%.

Ratios should help repair the patient safety net

The ratio law should also go a long way to helping repair the patient safety net which has been tattered by years of the adverse effects of corporate-oriented business practices in the hospital industry and managed care. Studies by the nation's most respected scientific and medical researchers affirm the significance of the ratio law for patient safety.

The Institutes of Medicine of the National Academy of Sciences reports that "nurse staffing levels affect patient outcomes and safety." Insufficient monitoring of patients, caused by poor working conditions and the assignment of too few RNs, increases the likelihood of patient deaths and injuries at a time when avoidable medical errors kill up to 98,000 people in U.S. hospitals every year. (IOM, November 4, 2003)

Inadequate staffing precipitated one-fourth of all sentinel events - unexpected occurrences that led to patient deaths, injuries, or permanent loss of function - reported to JCAHO, the Joint Commission on Accreditation of Hospital Organizations, the past five years. (JCAHO, August 7, 2002)

A New England Journal of Medicine study documented that improved RN-to-patient ratios reduce rates of pneumonia, urinary infections, shock, cardiac arrest, gastrointestinal bleeding, and other adverse outcomes. (NEJM, May 30, 2002)

Research in the Journal of the American Medical Association found that up to 20,000 patient deaths each year can be linked to preventable patient deaths. For each additional patient assigned to an RN the likelihood of death within 30 days increased by 7 percent. Four additional patients increased the risk of death by 31%. (JAMA, October 22, 2002)

Nurses intercept 86% of all medication errors made by physicians, pharmacists, and others prior to the provision of those medications to patients. (JAMA, 1995)

More information is also available on the CNA website at http://www.calnurse.org http://www.calnurse.org> http://www.calnurse.org>>

pickledpepperRN · Dec 3, 2003

There is another thread about our ratio law.

https://allnurses.com/forums/showthread.php?threadid=50894