7/1/03 UPDATE: Calif Nurse Ratios info here

[NRSKarenRN]

Forwarded by PSNA.org:

The California Department of Health Services (DHS) announced this week that its revised nurse-to-patient staffing regulations will be published on June 30 or July 1.

The comment period will begin the same date and end on July 17. Comments will be accepted only on the revisions, and there will be no public forum for comments. Instead, all comments should be sent to DHS at the address

published with the revisions.

The California Healthcare Association (CHA) and the Association of California Nurse Leaders (ACNL) are planning a series

of educational programs throughout the state in September that will focus on the final nurse-to-patient regulations. (SOURCE: CHA News, June 20, 2003)

[pickledpepperRN]

http://www.sanluisobispo.com/mld/sanluisobispotribune/news/editorial/letters/6300658.htm

Posted on Mon, Jul. 14, 2003

Implement the RN staffing ratio law now!

The Tribune

As of Jan. 1, 2004, California hospitals will be required to be staffed according to the minimum ratios approved by Gov. Gray Davis and the Department of Health Services (DHS). The ratio law, AB 394, requires minimum RN staffing for all hospital units, and is a critical measure to restore the patient safety net in California hospitals. All hospitals will be required to meet the staffing levels by January 2004. The final regulations are out and proposals by the California Nurses Association (CNA) to protect RN professional practice and patients are a key part of the rules hospitals must follow to comply with the CNA-sponsored Safe Staffing Law. California hospitals, including hospitals in SLO, have resisted gearing up for new RN-to-patient ratios set to take effect in January (and signed into law in 1999) are complaining now they can't find nurses.

As a registered nurse who works here in San Luis Obispo and as an elected leader in the California Nurses Association, I say to the hospital industry and their administrators -- stop complaining and start hiring.

In Wednesday's Tribune (July 2, 2003), local hospital administrators were quoted as saying, in essence, they will do their best to comply with this law but there just aren't enough registered nurses available, and if they can't find RNs, they'll have to hire more expensive traveler nurses. In reality, these "traveler nurses" are simply registered nurses, usually from outside this area, who are willing to come here to work temporarily for higher pay and free housing. Our local hospitals are currently staffed with many travelers already, temporarily filling positions that are open because RNs cannot afford to live here on local wages. Maybe I'm missing something, but doesn't this tell us something? And doesn't this phenomenon contradict the industry's claim that there aren't enough nurses available? To paraphrase a line from the movie "Field of Dreams," doesn't this mean that if you pay them adequately they will come? SLO-area hospitals are notoriously stingy with their RNs and, no surprise, they have a hard time finding sufficient numbers of RNs willing to work in this area.

The California Nurses Association has negotiated landmark contracts around the state with certain health care groups such as Catholic Healthcare West, Kaiser Permanente and the University of California system with significant wage rates for RNs as well as meaningful retirement programs and improvements to working conditions, including implementation of the RN-to-patient ratios. As a result, these healthcare employers are beginning to see their difficulties in hiring and retaining RNs turn around. Sadly, SLO-area hospitals such as Sierra Vista, which is owned by the for-profit system Tenet Healthcare, are lagging way behind and the RNs are, not surprisingly, harder to employ here.

There's no longer any doubt that more registered nurses means better care. California horror stories about under-staffing are backed up by major studies reported in the Journal of the American Medical Association and the New England Journal of Medicine. Even the hospitals' own oversight agency, the Joint Commission on the Accreditation of Healthcare Organizations, agrees that inadequate RN staffing leads to deaths and serious injuries.

People care about this. The RN-to-patient ratio issue has generated more public comment than any other topic in the history of the Department of Health Services. And hospitals have known that more RNs would be needed since Gov. Davis signed legislation back in 1999, and yet, many have done nothing.

For the sake of patients in the San Luis Obispo area, it's time to stop making excuses and immediately implement the staffing ratio law pioneered by the California Nurses Association.

Los Osos resident Sherri Stoddard has been a Registered Nurse at Sierra Vista Regional Medical Center for the past 16 years, with a total of 21 years as an RN. She is also on the Board of Directors of the California Nurses Association for this region of the state.

[pickledpepperRN]

http://www.thedesertsun.com/news/stories2003/opinion/20030716014002.shtml

Focus Letter: Nurse wants ratios enacted pronto

July 16th, 2003

In answer to the July 8 Our Voice column on nurse-to-patient ratios, bull. Nurses have left the field in droves because of the high nurse-to-patient ratios. As a practicing registered nurse, I say the sooner the ratios are enacted the better. Then maybe nurses will return to the fields, and patients will get the care they deserve.

I am tired of skimping on teaching and caring because I have six very sick patients and am covering another patient or two for a licensed vocational nurse. I entered the nursing field to care for people, not just push pills.

Marlen Wears

Cathedral City

[pickledpepperRN]

http://www.pe.com/localnews/opinion/editorials/PE_SPL_nnursed.a244e.html

More nurses; better care

07/16/2003

California is the first state to order nurse-to-patient ratios for hospitals. Health officials estimate the new ratios will cost hospitals more than $950 million by 2008, when the ratios are fully in place.

With the first phase of ratios taking effect in January, some hospital officials predict the ratios will cause cuts in medical services and the closing of facilities.

These administrators suggest hospitals will be unable to find enough nurses because of the nationwide nursing shortage and, because of that, hospitals could be faced with running afoul of the regulations.

The nurse shortage is acute. California needs an additional 30,000 nurses over the next few years; by 2010, demand will be for another 100,000. Over the longer run, though, the lower nurse-patient ratios should promote nursing as a profession and cut into the shortage.

Nurses pushed for the ratios, saying many of their colleagues have fled nursing because of poor working conditions. Some complained they cared for 10 patients at a time. Under the new rules, hospital burn units, post-anesthesia care and labor and delivery units will have to staff one nurse for every two patients. For pediatrics, ER and step-down wards, the ratio will be 1-to-4.

Hospitals throughout the state have labored themselves under cost-controls of managed care. Some medical facilities will be tempted to adjust prices for additional nurses or even shutter units. They should be circumspect.

Arguably, these lower nurse-patient ratios were something hospitals should have been working toward anyway. Nurse morale in hospitals is a key issue. It is in the interest of hospitals to increase the number of nurses.

In the shorter term, however, state health officials will have to use common sense in enforcing these ratios in light of nurse availability. When, the dust settles, the health care profession should find common ground in the intent of lower ratios: better patient care.

[66nurse678]

Does the amended statement really state Registered nurse or does it still say licensed. This is a fine point, in CA both RN's and LVN's are considered licensed nurses. I know of one facility that has increased the number of LVN's dramatically and has RN's covering the LVN and her own patients as well. This is exactly what I predicted would happen when the initial bill was passed stating licensed even though CNA kept telling all the nurses it meant RN's. Would like some clarification, I am no longer a member of the group of nurses who "slave" daily to make sure their patients are well cared for. However I am still working as a nurse in private industry.

[pickledpepperRN]

Yes, it is licensed. RNs will have to document that an LVN cannot be assigned to patients. They must be assistive to the RN.

In hospitals and units with a strong assertive staff the requirement for the ratios to be the 'floor' and staffing must increase according to the needs of individual patients the 'staffing up' may be with LVNs. The committee at my hospital has kept all the schedules for each unit. We will not agree to ingreasing the percentage of LVN to RN as they decrease the numbers of patients to licensed nurse.

For instance on the oncology unit patients receiving chemotherapy were staffed at 1:3. All others were 1:6 on days and 1:8 on nights. NO LVNs.

Already the night shift takes only 6 patients. As a specialty unit there will be only 5 per nurse by 1/1/2004.

Telemetry now has similar. Ventilator patients are 1:3 while the others are 1:6. There is one LVN on days, two on nights. When full 11 or 12 total licensed nurses work so that less than 10% are LVN. The increase in staffing when the acuity of 1 or more patients need more care MAY be an LVN or an RN depending on the needs of the patients. Our committee is 50% of the acuity committee and presents the facts in a way that on most units the manager agrees.

A couple units are weaker and unless they participate may end up responsible for the patients "assigned" to an LVN instead of working as a team with all nursing staff as is already the case on strong units.