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frenchxtoast's Latest Activity

  1. frenchxtoast

    COVID 19 Regulation Waiver

    Hi, I'm an RN currently working in a small, rural, "critical access" hospital in California. Recently, we had a meeting and the floor manager posted a letter from the CDPH (California Department of Public Health) which can be viewed here: https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-26.aspx Here is a link to Executive Order N-27-20 https://www.gov.ca.gov/wp-content/uploads/2020/03/3.15.2020-COVID-19-Facilities.pdf The floor manager claims that this letter, AFL 20-26, citing Executive Order N-27-20, waives the facility from having to abide by normal patient ratios, and that we nurses on med surg may have to take 6+ patients instead of our normal 1:5 ratio. The floor manager also said that the DON will be calling the BRN and reporting any of us who refuse out of ratio assignments to have them pull our RN licenses. I responded by saying "that's threatening retaliation for not accepting an out of ratio assignment, and that's illegal." The manager replied "that's not a threat, that's a promise." Does anyone know anything about this letter or executive order? Is there any sort of burden of proof on the facility to show they tried their best to get RN's from staffing agencies or travelers, or are they just point blank exempt from patient ratios until 06/30/2020? The actual real life implications of this letter are unclear to me. I've recently had issues with this facility, as outlined in this previous post. https://allnurses.com/RN-lvn-ratio-acute-care-t713736/?tab=comments#comment-7528295
  2. frenchxtoast

    RN/LVN Ratio Acute Care

    FINAL UPDATE: I had a meeting with the DON and floor manager and they agreed to hire more RNs, which they did. Ratios have been in compliance lately, but now they are saying they can go out of compliance again due to COVID-19, including having us take care of > 5 patients at a time. Making a new thread on this subject.
  3. frenchxtoast

    RN/LVN Ratio Acute Care

    UPDATE: I called back again, and apparently the floor manager can serve as a charge nurse, but the DON cannot, unless the critical access hospital applies for this "flex" and has it approved, and posts the flex nexts to the facility license. However, if the floor manager is being counted among the RN/LVN ratios, the manager can be held legally liable for the LVNs care, and is supposed to be doing patient care IE hanging IV abx, managing PICC lines etc.
  4. frenchxtoast

    RN/LVN Ratio Acute Care

    UPDATE: I found the California Department of Public Health website and clicked on the district offices link (https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/DistrictOffices.aspx), from where I found the District Office for my county's jurisdiction. I called them, and an official told me that staffing > 50% LVNs on the floor is illegal regardless of it being a critical access hospital or swing bed status. He also said the ratios must be on a day to day basis, they cannot be averaged over a time period. Additionally, critical access hospitals do have one exception: they are exempt from the rule forbidding an "administrator of nursing services" from serving as charge nurse or performing direct patient care. It's unclear if they can be counted in the ratios or not.
  5. frenchxtoast

    RN/LVN Ratio Acute Care

    Unsure if this is the correct subforum to post this in, but wasn't sure where else to go. If there's a more appropriate forum, I'll repost it there if mods tell me to. I work at a small, rural, "critical access" hospital in California. The acuity of patients is relatively low, there are many LVNs employed here doing direct patient care as well as support roles like wound care. This is technically a Med-Surg floor (says so on the door and management refers to it as such) but we have many "swing" patients which are basically rehab patients similar to what you'd see in the "post acute" or rehab wing of a nursing home (PICC lines, long term abx, PT/OT, wound care). The issue is that the boss has formerly insisted we have at least 1 RN for every LVN, and not allowed us to do schedule swaps before do to this, but recently I got scheduled where I was the only RN on the floor for all the LVNs (4 of them). It's not that the LVNs are bad nurses or incompetent, its that I don't think this is legal, and its a real chore to hang everyone's antibiotics for them while I have 5 patients of my own. I confonted the manager and she cited title 22, which she claimed enables her to have only one RN on the floor. The section she highlighted on page 42 of Title 22 California Code of Regulations Division 5 reads: However, it also says on page 46 that Does this mean section (i) and (j) of the same document? That refers to administrators not being counted as charges or something, or is there some whole other document or part of the document I need to look up? It reads to me like a pretty clear cut mandate on a maximum of 50% LVNs on the floor. Am I wrong? The manager got frustrated and scheduled a meeting with me and the DON on Monday 01/20/2020 at 14:00. Thanks for reading this thread! I'll be checking back when I can!
  6. Today I was called by a law office representing a post acute/LTC facility I previously worked at full time and still work at on call. They want me to come in for an interview. They said the facility is being sued regarding a patient who rolled out of bed and hit his head, requiring transfer to an acute care hospital with ICU stay. The patient came in after a stroke, and when his wife asked me "so when I leave and go home right now, you're guaranteeing me he won't fall?" to which I replied "absolutely not, the only way to do that is to get a 1:1 CNA and the facility is not doing that at this time." The law office said that its the facility and their insurance policy the lawsuit is after, not me, but how can I trust them not to try and throw me under the bus to save the facility? Any suggestions on how to handle this interview? I have NSO liability insurance but I don't want to accidentally incriminate myself somehow. Any advice would be appreciated.
  7. frenchxtoast

    I now have an RN license, LVN expiring soon

    So I drove down to the BVNPT today, someone there told me in person that the only real course of action is to just let my LVN license run delinquent, and that there are no consequences to doing so. After 4 years of delinquency, it will be canceled. Just felt like posting this update in case anyone else needs an answer to this question, it will save them the time. Thanks all!
  8. I have been working as an RN for the past year, and my LVN license expires in June. How exactly should I handle this? Should I write a letter to the BVNPT? I live in CA.
  9. I have years of food service experience, as well as 4 years of CNA experience in long term care. I'm well acquainted with the unreasonableness of people.
  10. I was considering any prison in CA where I could get a solid med surg experience and build strong skills. In particular, Folsom prison, or Salinas Valley Correctional, or Soledad.
  11. Thank you! I'll try to get a tour of the prisons if I can.
  12. Thank you very much! Any idea how I should go about finding out which prisons have more hospital like settings?
  13. Hi, I am a "new grad" RN (graduated BSN Spring 16, got my license May 17), looking to build a solid skill base for my career. I'm curious how prisons work: do they have an ED, med surg, ICU etc floor like a hospital would, or how does it work? I live in CA and the job market for new grads is tough right now, I've been applying for jobs in the prison and jail system and the descriptions of the jobs themselves seem vague to me, like I can't tell if I'm applying for an ICU job, a med surg job, etc or if that's even relevant. It is very important to me to build a strong, broad skill base transferable to many environments, would I get this at a prison or jail or would it be something highly specific to that environment? Thanks so much for your opinions ahead of time!
  14. Thanks for the words! I just want to be competent, and any advice for how to get there.
  15. Yes, the license risking patient overload is a fear of mine in SNF as well. I worked in a few as a CNA. I guess it depends heavily on which SNF you go to. Will this look decent on a resume for a med surg position?
  16. Thank you for the feedback, I'll look for subacute rehab then!

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