New Nurse to patient ratio law continued

  1. Second, please see first half of this article.
    New Nurse to patient ratio law continued:
    "There are over 450 licensed hospitals in the state," state regulator Henning said. "Less than 10 percent have asked for flexibility. That means 90 percent think they don't have a problem."
    Sutter Roseville Medical Center asked for and got a waiver that allows the hospital to continue a new triage procedure using a doctor up front, instead of a nurse, to move patients through the emergency department more quickly.
    Marshall Medical Center in Placerville asked that six hospital units -- ranging from the emergency department to the medical/surgery unit -- be relieved from a requirement to meet the staffing ratios when nurses take breaks or lunch.
    The hospital also wanted to count a radio responder nurse toward the ratios, and count the triage nurse when there are lots of patients.
    The state said no to both.
    Overall, the ratio law still draws criticism from a hospital industry that claims the rules are impossible to meet due to frequent changes in census and a severe shortage of nurses.
    The California Healthcare Association sponsored legislation that would delay further toughening of the ratio for medical/ surgery units in 2005 to 1 nurse for 5 patients. It is 1:6 now.
    Assembly Bill 2963 by Republican Assemblyman Rod Pacheco from City of Industry failed to get out of its first policy committee April 20.
    The trade group hopes the court system will step in on another issue.
    'At all times': The ratios rule around the clock, with no exceptions. Meal and break times for nurses are a particular problem, hospitals say.
    In the past, hospitals have juggled workers on a shift to make sure patients were covered during breaks. Now they have to hire extra nurses to pick up the slack. This rule alone will cost Catholic Healthcare West, parent of local Mercy hospitals, an estimated $40 million to $50 million a year.

    The hospital group's lawsuit asks the court to prohibit an "at all times" interpretation of the law and rule that it's OK for hospitals to let on-duty nurses go on breaks without jeopardizing compliance.
    Instead, hospitals want the rules to be interpreted to mean "regular assigned staff the beginning and end of each shift."
    "Nine out of 10 hospitals are out of compliance with the 'at all times' requirement," said hospital association spokeswoman Emerson. The trade group has lobbied the Schwarzenegger administration to consider changes to the ratio regulations, so far without success.
    Nurses are expected to be out in force in Sacramento May 14, the date for the first court hearing on the lawsuit. A rally will begin at the Capitol at 10 a.m., followed by a march to the courthouse.
    "If you look at the way hospitals are organized -- mostly 12-hour shifts -- breaks for an hour could mean four to six hours a day when ratios are not met," said Furillo of the nursing union. "Disease processes do not recognize meals and breaks. Patients can crash during them."
    Licensed or registered? There's still controversy over what kind of nurses can be counted toward compliance with the new ratio law. The regulations require a "licensed nurse," and hospitals read that as both LVNs and RNs.
    "Both the statute and the regulations refer to 'licensed,' " said Henning of Health Services. "That's minimal line nurses, not RNs."
    The kinds of tasks LVNs can do are more limited under state law than those performed by RNs -- and RNs want to protect their turf. RNs can assess patients. LVNs can't. If an LVN covers for a RN and a patient gets worse, the less-skilled nurse may not be in a position to make a good judgment call, Furillo said.
    Scope-of-practice issues are up to the state agencies that regulate them, not the Department of Health Services. The two boards that oversee RNs and LVNs are putting together language to clarify the situation, Henning said. "We are working with other parties on this issue of LVNs," said Louise Bailey from the Bureau of Registered Nurses. She declined to say more.

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    Last edit by pickledpepperRN on May 10, '04
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  3. by   RNGranny
    Unfortunately, administrators seldom recognize when they have a problem. All too often, nurse managers are so stressed that they cannot adequately look out for their staff. Plus- all too often the administration does not listen to the nurses or concern themselves with the nursing issues of their hospitals. They are 'brainwashed' to only be concerned with the doctors and fail to recognize that it is the nurses who are their 24/7, not the doctors!