New Staffing ratios

pickledpepperRN · Dec 14, 2003

Just part of the FINAL STATEMENT OF REASONS amd a link to the web site where you can ask a question. There seem to be weekly answers.

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

FINAL STATEMENT OF REASONS

In October, 1999 the California State Legislature passed AB394 (Kuehl, Chapter 945, Statutes of 1999) adding section 1276.4 to the Health and Safety Code (HSC). This section was later amended by AB 1760 (Kuehl, Chapter 148, Statutes of 2000). The section requires the California Department of Health Services (Department/CDHS) to develop minimum, specific, numerical licensed nurse-to-patient ratios for specified units of general acute care hospitals. CDHS determined that the requirements listed in this section are the minimum necessary to protect the public health and safety. CDHS's policy decisions remediate the hospitals with the leanest staffing, effectively raising the bar for the standard of acceptable staffing.

In its preamble to the legislation, the Legislature "finds and declares all of the following:

Health care services are becoming complex and it is increasingly difficult for patients to access integrated services.

Quality of patient care is jeopardized because of staffing changes implemented in response to managed care.

To ensure the adequate protection of patients in acute care settings, it is essential that qualified registered nurses and other licensed nurses be accessible and available to meet the needs of patients.

The basic principles of staffing in the acute care setting should be based on the patients' care needs, the severity of condition, services needed, and the complexity surrounding those services."

The Legislature clearly believed that the quality of patient care was related to the number of licensed nurses at the bedside, and wished to ensure a minimum, adequate number. When Governor Davis signed the bill on October 10, 1999, he accompanied the measure with a "sign message" which read, in part, "Registered nurses are a critical component in guaranteeing patient safety and the highest quality health care. Over the past several years many hospitals, in response to managed care reimbursement contracts, have cut costs by reducing their licensed nursing staff. In some cases, the ratio of licensed nurses to patients has resulted in an erosion in the quality of patient care." (Exhibit A)

The CDHS considered proposing regulations requiring staffing ratios for registered nurses in acute care hospitals in 1992. However, upon further consideration, the Department instead opted for regulations requiring that hospitals have a patient classification system (PCS) in place. The PCS was intended to assure that the number of nursing staff was aligned to the health care needs of the patients, while allowing the provider maximum flexibility for the efficient use of staff. The Department spent more than four years working with key statewide nursing and hospital organizations, including the California Nurses Association and the California Healthcare Association, to develop the final regulations which became effective on January 1, 1997.

California's hospitals are currently required (22 CCR, 70053.2 and 70217) to use a PCS for determining the staffing needs of individual units. PCS are defined as systems that include:

A method to predict nursing care requirements of individual patients.

An established method by which the amount of nursing care needed for each category of patient is validated for each unit and for each shift.

An established method to discern trends and patterns of nursing care delivery by each unit, each shift, and each level of licensed and unlicensed staff.

A mechanism by which the accuracy of the nursing care validation method described in (2) above can be tested. This method will address the amount of nursing care needed by patient category and pattern of care delivery on an annual basis, or more frequently, if warranted by the changes in patient populations, skill mix of the staff, or patient care delivery model.

A method to determine staff resource allocations based on nursing care requirements for each shift and each unit.

A method by which the hospital validates the reliability of the patient classification system for each unit and for each shift.

A written staffing plan must 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 must be developed and implemented for each patient care unit and must specify patient care requirements and the staffing levels for registered nurses and other licensed and unlicensed personnel.

The plan must include the following:

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

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

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

(d)The staffing plan must be retained for the time period between licensing surveys, which includes the Consolidated Accreditation and Licensing Survey (CALS) Process.

The reliability of the patient classification system for validating staffing requirements must 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.

At least half of the members of the review committee must be registered nurses who provide direct patient care.

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.

Hospitals must 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.

These PCS requirements will not change with the addition of the minimum nurse-to-patient ratios required by HSC 1276.4.

In summary, CDHS responded to the mandate to establish these nurse-to-patient ratio regulations by performing an extensive literature search, soliciting the recommendations of professional organizations representing physicians and nurses, having discussions with other states and countries about their experiences with acute care staffing, and extracting the information that could be obtained about nurse staffing from the OSHPD data. CDHS also solicited input from professional nurses on its own staff, as well as the perspectives of the major stakeholders before the proposed ratio regulations were drafted. Because none of the sources of information provided CDHS with hard scientific evidence of the optimal nurse staffing ratio for each individual unit, and in order to supplement the other sources of information empirically, CDHS conducted an on-site hospital study. The purpose of the study was to discover the level of nurse staffing practiced in hospitals in the absence of these proposed ratio regulations. It also gave CDHS the opportunity to estimate the FTE and fiscal deficits that may occur with various ratio proposals, and provided a foundation for the required study evaluating the effect of these regulations five years after adoption. The Aiken study (Exhibit V-2) has recently provided validation that increasing the amount of nurse staffing in acute care hospitals has the effect of decreasing patient mortality and improving both patient and workforce outcomes.

Section 70217(a). Nursing Service Staff.

The Department proposes to adopt this section to define the nurse-to-patient ratios mandated by AB 394 (Kuehl, Chapter 945, Statutes of 1999). Proposed regulations require that hospitals provide staffing by licensed nurses, which includes registered nurses and licensed vocational nurses within the scope of their licensure, in accordance with specific nurse-to-patient ratios. Under California law, the term "licensed nurses" includes both registered nurses and licensed vocational nurses. This is specified in the regulations so that the general public will clearly understand the term as used in this regulation.

The Department clarified that the phrase "licensed nurse" includes "licensed psychiatric technicians in psychiatric units only." This change means that the general provisions of this section that apply to licensed nurses, would also apply to licensed psychiatric technicians assigned to provide care within their scope of practice in psychiatric units for the purposes of the licensed nurse to patient ratios.

The Department added the descriptors "licensed," "registered," "licensed vocational" or "licensed psychiatric technician" throughout this section to more clearly specify which licensing category is required in the regulation.

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.

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Get your answers from the authors of the ratio law!

http://www.calnurse.org/102103/safe...tml#forum#forum

NursePaula · Dec 16, 2003

Just a thought here in Northern Cal., On med-surg we used to work in teams with the CNA and now with the new ratios we will be a 1:6 ratio RN or LVN, but on PM and NOC's we have 1 or 2 CNA for 35-40 pt. plus the RN covers all meds, etc for the LVN.

pickledpepperRN · Dec 16, 2003

Originally posted by NursePaula
Just a thought here in Northern Cal., On med-surg we used to work in teams with the CNA and now with the new ratios we will be a 1:6 ratio RN or LVN, but on PM and NOC's we have 1 or 2 CNA for 35-40 pt. plus the RN covers all meds, etc for the LVN.

Oh my!

What about acuity?

An LVN must work under the supervision of an RN so the RN who "covers" is responsible for the patient.

Please check the early links on this thread. If you as the RN in your professional opinion think the staffing is unsafe it is your responsibility to tell your manager. If there is no response go through all channels up to and including the CEO and Board of directors of your hospital.

Also please check the other threads on this ratio topic.

There have been many ideas and to me unless your patients are routing with long stable hospital stays you are staffed in a very unsafe way.

Are you a rural hospital?

pickledpepperRN · Dec 23, 2003

Fact Sheet on RN Staffing Ratio Law 7/1/03

California is the first state in the U.S. to establish minimum RN-to-patient ratios for hospitals. The ratios are based on AB 394, sponsored by the California Nurses Association and signed by Gov. Gray Davis in October, 1999.

Today's announcement of the final regulations to implement AB 394 culminates a 10-year campaign by CNA to improve RN staffing in California hospitals to protect patient safety, and reverse the effects of a decade of hospital restructuring that eroded patient care conditions and produced a hospital nursing shortage.

All hospitals must be staffing with the minimum ratios as of January 1, 2004. Many CNA represented hospitals have already hired hundreds of additional RNs in preparation for implementing the law, and as a result of unprecedented CNA gains in compensation, retirement security, and workplace improvements intended to enhance retention of current experienced RNs and recruitment of new RNs.

What the Law Does

AB 394 establishes specific numerical nurse-to-patient ratios for acute care, acute psychiatric and specialty hospitals in California. The ratios are the maximum number of patients that may be assigned to an RN during one shift. The law requires additional RNs be assigned based on a documented patient classification system that measures patient needs and nursing care, including severity of illness and complexity of clinical judgment.

AB 394 also restricts the unsafe assignment of unlicensed staff and the unsafe assignment of nursing staff to hospital clinical areas where they do not have demonstrated competency, training, and orientation.

The specific ratios:

AB 394 required the state Department of Health Services to establish the specific ratios for specific hospital units. In 2002, the DHS issued the proposed regulation to implement AB 394, including the specific ratios for every hospital unit, and held public hearings.

On July 1, 2003, Gov. Davis and the DHS issued the final regulations incorporating extensive testimony presented during the hearings and public comment, including from 500 CNA RNs who testified in the hearings, and nearly 25,000 RNs whose letters were submitted by CNA to the DHS.

Why the Law was needed

The purpose of the law was to address the growing crisis in patient care in California hospitals caused by managed care and market based decisions on hospital care that resulted in California having among the worst RN staffing in the nation and a growing exodus of RNs out of hospitals creating a serious nursing shortage.

CNA campaigned for 10 years to get the law enacted, including the largest gatherings of RNs in California history, major rallies drawing thousands of RNs to the Capitol.

California's law was the first (and still only) ratio law in the nation. It is the single most effective response to protecting patient safety in hospitals and reducing the nursing shortage. The California law is considered a national, even international model, and has generated extensive attention from the national media and RN organizations around the world.

How the ratios will protect patients

Safe RN staffing is the single most essential element to safe patient care in hospitals. In the last year alone:

*JCAHO, the Joint Commission on Accreditation of Hospital Organizations, announced that 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 past five years

*A New England Journal of Medicine study documented that improved RN-to-patient ratios reduces rates of pneumonia, urinary infections, shock, cardiac arrest, gastrointestinal bleeding, and other adverse outcomes. No similar links were found for LVNs or other nursing staff.

*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%. No similar findings were associated with improved ratios for LVNs or other staff.

Where will the RNs come from to meet the ratios?

*DHS has projected that California will need 5,000 RNs to meet the ratios that go into effect in January. That is the same number of RNs who graduate every year from California's 72 schools of nursing.

*The approach of the ratios is already having an effect on overcoming the nursing shortage. In the past fiscal year, the number of RNs increased by 4% -- the largest increase since 1989, reports the Board of Registered Nurses. The number of exam applicants increased by 18% and the ratio of RNs entering and exiting the state continues to make a dramatic change with 1,664 more RNs coming into the state than leaving.

*In the three years since the law was signed, according to BRN data, applications for RN licenses from new graduates and from RNs outside California, has grown from 22,372 applications in fiscal year 1999-2000 to 27,551 in fiscal year 2000-2001 to 32,368 in fiscal year 2001-2002.

*In Victoria, Australia, ratios were enacted in 2001. By February 2002, the full-time RN workforce had increased by 16.5 percent.

*The real key to meeting the ratios is for hospitals to hang on to the RNs they already have. Many CNA-represented hospitals have taken big strides by enacting significant improvements, though collective bargaining with CNA, in retirement security, compensation, and improved patient care conditions.

More background information is available at: http://www.calnurse.org/cna/ratios62803/

pickledpepperRN · Dec 29, 2003

The first link explains that nursing supervisors and managers may be disciplined for not providing competent nursing staff to the patients. At our hospital we plan to fill out the form from the link on the bottom if this is not done.

A manager who is not allowed to call in registry must go up the chain of command to the DON.

http://www.rn.ca.gov/policies/pdf/npr-b-21.pdf

http://www.rn.ca.gov/policies/pdf/npr-b-44.pdf

http://www.rn.ca.gov/enforce/whatisenforce.html

http://www.rn.ca.gov/pdf/cpltfrm.pdf

Our plan (except for a couple too afraid of management to advocate for OUR patients) is to:

1. Keep accurate records of the dates , times, staffing, and what we reported to who.

2. Tell each manager that in our opinion as professional registered nurses the staffing is not safe (only when and if that is the case).

3. Put it in writing and keep a copy.

4. Fill out an incident report too.

5. State that unless staffing is safe we will report the nursing supervisor, manager, or administrator to the BRN.

6. On the same form inform them the hospital NOT the nurses is responsible for any adverse effect on patient care from meals delivered cold to preventable death.

7. If, God forbid there is a sentinel event we will report it to the JCAHO.

rebelwaclause, ASN, RN · Jan 16, 2004

Originally posted by spacenurse
Fact Sheet on RN Staffing Ratio Law 7/1/03

California is the first state in the U.S. to establish minimum RN-to-patient ratios for hospitals. The ratios are based on AB 394, sponsored by the California Nurses Association and signed by Gov. Gray Davis in October, 1999.

Today's announcement of the final regulations to implement AB 394 culminates a 10-year campaign by CNA to improve RN staffing in California hospitals to protect patient safety, and reverse the effects of a decade of hospital restructuring that eroded patient care conditions and produced a hospital nursing shortage.

All hospitals must be staffing with the minimum ratios as of January 1, 2004. Many CNA represented hospitals have already hired hundreds of additional RNs in preparation for implementing the law, and as a result of unprecedented CNA gains in compensation, retirement security, and workplace improvements intended to enhance retention of current experienced RNs and recruitment of new RNs.

What the Law Does

AB 394 establishes specific numerical nurse-to-patient ratios for acute care, acute psychiatric and specialty hospitals in California. The ratios are the maximum number of patients that may be assigned to an RN during one shift. The law requires additional RNs be assigned based on a documented patient classification system that measures patient needs and nursing care, including severity of illness and complexity of clinical judgment.

AB 394 also restricts the unsafe assignment of unlicensed staff and the unsafe assignment of nursing staff to hospital clinical areas where they do not have demonstrated competency, training, and orientation.

The specific ratios:

AB 394 required the state Department of Health Services to establish the specific ratios for specific hospital units. In 2002, the DHS issued the proposed regulation to implement AB 394, including the specific ratios for every hospital unit, and held public hearings.

On July 1, 2003, Gov. Davis and the DHS issued the final regulations incorporating extensive testimony presented during the hearings and public comment, including from 500 CNA RNs who testified in the hearings, and nearly 25,000 RNs whose letters were submitted by CNA to the DHS.

Why the Law was needed

The purpose of the law was to address the growing crisis in patient care in California hospitals caused by managed care and market based decisions on hospital care that resulted in California having among the worst RN staffing in the nation and a growing exodus of RNs out of hospitals creating a serious nursing shortage.

CNA campaigned for 10 years to get the law enacted, including the largest gatherings of RNs in California history, major rallies drawing thousands of RNs to the Capitol.

California's law was the first (and still only) ratio law in the nation. It is the single most effective response to protecting patient safety in hospitals and reducing the nursing shortage. The California law is considered a national, even international model, and has generated extensive attention from the national media and RN organizations around the world.
How the ratios will protect patients

Safe RN staffing is the single most essential element to safe patient care in hospitals. In the last year alone:
*JCAHO, the Joint Commission on Accreditation of Hospital Organizations, announced that 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 past five years
*A New England Journal of Medicine study documented that improved RN-to-patient ratios reduces rates of pneumonia, urinary infections, shock, cardiac arrest, gastrointestinal bleeding, and other adverse outcomes. No similar links were found for LVNs or other nursing staff.
*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%. No similar findings were associated with improved ratios for LVNs or other staff.
Where will the RNs come from to meet the ratios?
*DHS has projected that California will need 5,000 RNs to meet the ratios that go into effect in January. That is the same number of RNs who graduate every year from California's 72 schools of nursing.
*The approach of the ratios is already having an effect on overcoming the nursing shortage. In the past fiscal year, the number of RNs increased by 4% -- the largest increase since 1989, reports the Board of Registered Nurses. The number of exam applicants increased by 18% and the ratio of RNs entering and exiting the state continues to make a dramatic change with 1,664 more RNs coming into the state than leaving.
*In the three years since the law was signed, according to BRN data, applications for RN licenses from new graduates and from RNs outside California, has grown from 22,372 applications in fiscal year 1999-2000 to 27,551 in fiscal year 2000-2001 to 32,368 in fiscal year 2001-2002.
*In Victoria, Australia, ratios were enacted in 2001. By February 2002, the full-time RN workforce had increased by 16.5 percent.
*The real key to meeting the ratios is for hospitals to hang on to the RNs they already have. Many CNA-represented hospitals have taken big strides by enacting significant improvements, though collective bargaining with CNA, in retirement security, compensation, and improved patient care conditions.
More background information is available at: http://www.calnurse.org/cna/ratios62803/

Just an FYI...It is my understanding that LVN's are INCLUDED in the nurse-staff ratio's. Seems there has been a HUGE misunderstanding that LVN's are NOT licensed nurses, therefore LVN's ratio's can be, well, anything. DHS R-37-01 clearly states who licensed nurses are, and how ratios are applied to licensed nurses, but news articles especially California Nurses Assoc literature would lead to believe these staffing ratio's are reserved for RN's only.

RNKPCE · Jan 16, 2004

I would love to see the DHS post quarterly results of which hospitals are meeting the ratios by percentage and make this known to the public. This would mean being in compliance all shift or it doesn't count.

pickledpepperRN · Jan 17, 2004

http://www.calnurse.org/jan104splash/ratmonbasic.pdf

CNA's groundbreaking legislation mandating safe RN staffing ratios is now in effect despite the continued efforts of the hospital industry to have the law overturned or weakened.

These are our ratios! It is now up to bedside RNs to ensure that hospitals are in compliance in order to protect our patients. If you are in a CNA Facility contact your Labor rep to volunteer to be a ratio monitor. If you are in a non-CNA represented facility please call

1-800-287-5021 for more information on how you can monitor ratios on your unit.

Many RNs were LVNs before earning their RN. Clearly an LVN is a licensed nurse. The rational is that the staffing decisions must be based on the assessment mane by a registered nurse.

The RN is responsible for the nursing process. Each patient in an acute care hospital must be assigned to a registered nurse.

Many RNs are very happy to work as a team with those LVNs whose abilities they are familiar with.

Tenet and some other hospitals want to substitute a registry, float, or new grad LVN for an experienced and competent nurse.

The care given is the responsibility of the RN.

It comes down to TIME. and PATIENT CARE.

pickledpepperRN · Jan 17, 2004

Last year when I took a class on the ratios the RN, JD who taught it said that in 2001 whe the DHS did its study:

Of all licensed nurses working in hospitals less than 18% were LVN.

Critical care was less than 3%.

Most hospitals eliminated the use of LVNs in ICU/CCU/critical care when the severity of illness imcreased.

We can keep people alive who once would have died.

Many patients who a couple decades ago would have been in ICU are now on telemetry and medical- surgical units.

Skilled nursing units and facilities now have patients who would have been admitted to a hospital prior to managed care. There is a ratio law in the works for them, I wish I knew more about it. We are all one accident or illness away from needing a nurse.

Just last night a registry nurse told me she had not been working because a member of her family was in a hospital and she felt she needed to stay to assure adequate care. I remember when it was not like this.

I remember when we had a Head Nurse (not called manager) whose job was clearly the quality of nursing care (not the budget).

She was supportive rather than punative.

We who worked then are still friends. Some of us still work together as we struggle to preserve safe care. We have attended funerals and keep up with the families of our friends.

rebelwaclause, ASN, RN · Jan 21, 2004

Originally posted by spacenurse
http://www.calnurse.org/jan104splash/ratmonbasic.pdf

These are our ratios!

Many RNs were LVNs before earning their RN. Clearly an LVN is a licensed nurse. The rational is that the staffing decisions must be based on the assessment mane by a registered nurse.

The RN is responsible for the nursing process. Each patient in an acute care hospital must be assigned to a registered nurse.
Many RNs are very happy to work as a team with those LVNs whose abilities they are familiar with.
Tenet and some other hospitals want to substitute a registry, float, or new grad LVN for an experienced and competent nurse.
The care given is the responsibility of the RN.

I agree with most of your statements above. But even so, The ratios are for RN's AND LVN's...Licecensed nursing staff.

http://www.dhs.ca.gov/lnc/pubnotice/NTPR/R-37-01_Regulation_Text.pdf

The argument I've faced is getting management to understand that we DO need more RN's on the floor when LVN's are scheduled to work. To make the ratio's work FOR BOTH RN'S AND LVN'S, there has to be adequate RN staffing. Poor decisions have been made to max LVN's with a higher ratio of patients (1:6), while RN's have lower ratio's (1:2 or 3) to accommodate lack of RN staffing. This does not resolve the ratio problem, it only makes it worse when RN's DO NOT accept the responsibility for whatever reasons and simply "sign-off" the work an LVN has done at the end of the shift. Is that really "covering" an LVN? Is that responsible patient care?

By the way, regarding "Many RNs are very happy to work as a team with those LVNs whose abilities they are familiar with"...

All hospitals do not "team" nurse. Mine does not. I have an individual patient assignment, with several different RN's assigned to "cover" each individual patient as the state mandates. Whether or not an RN personally likes an LVN's abilities is not an issue if that LVN is hired staff and is scheduled to work. I'm here and not going anywhere, so let's deal with it fairly. Myself personally, I'd never work in an ICU/CCU or highly specialized department because I realize my scope of practice limits me from performing certain vital, life saving tasks. I feel it is better for a patient to have a COMPETENT and skill trained RN to care for them. My opinion is I could only be a "reporter", and could potentially slow down vital patient care.

Just my opinion.

pickledpepperRN · Jan 21, 2004

rebelwaclause:

You are so right on!

Our patients need all of us.

What I meant about knowing the competency is the practice of assigning nurses in violation of the requirement for competency validation. We had a registry LVN assigned to 5 patients who had been doing private duty home care for the last 14 years. She needed to be hired and oriented to a hospital yet was sent by her registry to our hospital. She was a very nice person who ended up standing in the med room crying because she could not remember how to calculate dosages with decimals. She then gave four tablets instead of 1/2.

I actually had 10 telemetry patients shared with her AND I was registry too!

To make it worse a staff LVN and RN had been floated.

I notified the supervisor in writing the assignment was unsafe bothe because they ignored the acuity of the patients and the competency and orientation of the other registry nurse was not validated.

You sound so well informed, like i was as an LVN. That not only helps the patient it protects your license. If you report to the RN your legal obligation is discharged. Of course there is the moral obligation to the patient if the RN does not act on your report.

I hope this is making sense, I am going back to sleep.

rebelwaclause, ASN, RN · Jan 22, 2004

originally posted by spacenurse
rebelwaclause:

you are so right on!

our patients need all of us.

what i meant about knowing the competency is the practice of assigning nurses in violation of the requirement for competency validation. we had a registry lvn assigned to 5 patients who had been doing private duty home care for the last 14 years. she needed to be hired and oriented to a hospital yet was sent by her registry to our hospital. she was a very nice person who ended up standing in the med room crying because she could not remember how to calculate dosages with decimals. she then gave four tablets instead of 1/2.

i actually had 10 telemetry patients shared with her and i was registry too!

to make it worse a staff lvn and rn had been floated.

i notified the supervisor in writing the assignment was unsafe bothe because they ignored the acuity of the patients and the competency and orientation of the other registry nurse was not validated.

you sound so well informed, like i was as an lvn. that not only helps the patient it protects your license. if you report to the rn your legal obligation is discharged. of course there is the moral obligation to the patient if the rn does not act on your report.

i hope this is making sense, i am going back to sleep.

hey spacenurse...thanks for the post. yes, i do keep myself abreast on issues by a number of articles i receive via email and by listenning/learning right here at "home" :)

that is so sad about the situation between you and the traveler. but i say, know yourself - your skill level, weaknesses and strengths before accepting an assignment - or any other job for that matter. no one will be fooled when the moment of truth comes, and you're stuck in the narc room crying because you didn't say "no...i cannot do it"

then again, i can't judge without walking in her shoes...so i'll hope for something better for you and her next time

my views have not always been as rn "fair", i know. probably because i haven't been made to feel that my profession is respected in the industry. a knowledgable lvn is an asset to the team, not a hinderance. i know if there's a slew of iv abx's and other things out of my scope, that person may be better off assigned to an rn, based on accuity. unfortunately, fighting tooth-and-nail with rn's who make patient assignments - who assign based on "hooking up" their buddies who are coming on shift, or by getting back at me for voicing my opinion the night before is a common practice. sigh...i say sigh. acuity and patient safety fall short full circle.

oh...and regarding "if you report to the rn your legal obligation is discharged."...i know you are kidding...right? my license can be snatched and probably even more so. i have heard of rn's saying they where not informed of a patients condition, and the lvn getting flogged for it. or its the lvn's fault for not fillowing up with the rn on any given patient care issue. this is when teamwork, trust and personal dedication to being up on changes and advances in nursing and your own scope comes to light. i've worked with excellent rn's and others who i wouldn't let touch me on the side of the road. same with lvn's. i've witnessed lvn's in the hospital setting get it bad for things that was clearly an rn's responsiblity, but the rn wiggled out of it, and managment pursued the lvn instead. i guess rn's are harder to come by.

...sorry.....i know that's a whole "nutha" arguement

thanks again!