Question About Ratios

They are trying to combine the cleaning staff and nursing assistants into one position in our ICUs. This is a violation of the law. They cannot reduce ancillary staff. If you are a CNA represented hospital contact your rep about the campaign to monitor the ratios.

They have cut CNA's at the hospital I work at. The ones that are leaving have their last day this Saturday. We aren't even meeting ratios all the time. Last night our night shift had 7 patients each and no break nurse. Our ratios are suppose to be 5:1. So far we have been staffing with CNA like before the 1st but after Saturday they won't be around.

Originally posted by mdfog10

They are trying to combine the cleaning staff and nursing assistants into one position in our ICUs. This is a violation of the law. They cannot reduce ancillary staff. If you are a CNA represented hospital contact your rep about the campaign to monitor the ratios.

What does the law say on this issue? Does anyone know exactly?

In most places, we have negligible "support staff" so it doesn't make any difference.

Below is from the DHS site

http://www.applications.dhs.ca.gov/...t1=Begin+Search

SUPPLEMENTAL STATEMENT OF REASONS:

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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To become effective 1/1/2004:

1) Amend Section 70217 to read:

Section 70217. Nursing Service Staff.

(a) Hospitals shall provide staffing by licensed nurses, which includes registered nurses, licensed vocational nurses, within the scope of their licensure in accordance with the following nurse-to-patient ratios. Licensed nurse means a registered nurse, licensed vocational nurse and, in psychiatric units only, a licensed psychiatric technician.

Staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system.

No hospital shall assign a licensed nurse to a nursing unit or clinical area unless that hospital determines that the licensed nurse has demonstrated current competence in providing care in that area, and has also received orientation to that hospital's clinical area sufficient to provide competent care to patients in that area. The policies and procedures of the hospital shall contain the hospital's criteria for making this determination.

Licensed nurse Nurse-to-patient ratios represent the maximum number of patients that shall be assigned to one licensed nurse during one shift at any one time. "Assigned" means the licensed nurse has responsibility for the provision of care to a particular patient within his/her scope of practice. There shall be no averaging of the number of patients and the total number of licensed nurses on the unit during any one shift nor over any period of time. Only licensed nurses providing direct patient care shall be included in the ratios.

Nurse Administrators, Nurse Supervisors, Nurse Managers, and Charge Nurses, and other licensed nurses not having a specific patient care assignment, shall not be included in the calculation of the licensed nurse-to-patient ratio only when those licensed nurses are engaged in providing direct patient care. When a Nurse Administrator, Nurse Supervisor, Nurse Manager, Charge Nurse or other licensed nurse is engaged in activities other than direct patient care, that nurse shall not be included in the ratio. Nurse Administrators, Nurse Supervisors, Nurse Managers, and Charge Nurses who have demonstrated current competence to the hospital in providing care on a particular unit may relieve licensed nurses during breaks, meals, and other routine, expected absences from the unit.

Licensed vocational nurses may constitute up to 50 percent of the licensed nurses assigned to patient care on any unit, except where registered nurses are required pursuant to the patient classification system or this section. Only registered nurses shall be assigned to for Intensive Care Newborn Nursery Service Units, which specifically requires one registered nurse to two or fewer intensive care infants,. or where registered nurses are required pursuant to the patient classification system. In the Emergency Department, only registered nurses shall be assigned to triage patients and only registered nurses shall be assigned to critical trauma patients.

Nothing in this section shall prohibits a licensed nurse from assisting with specific tasks providing care within the scope of his or her practice to for a patient assigned to another nurse. "Assist" means that licensed nurses may provide patient care beyond their patient assignments if the tasks performed are specific and time-limited.

Our hospital is doing it this way: They drastically cut support staff (secretaries, CNA's...) and have the nurses doing total patient care. They are almost meeting the ratios (which is miraculous for this facility....I wonder where all those missing nurses suddenly came from?) Actually, I spoke with a registry RN in passing today, and he stated that today was the 1st time he agreed to return to our hospital in 20 years, since the ratios were pretty good now! Can you believe this. Amazing. BUT, apparently, there is a "shortage "of ancillary staff now...........................

Originally posted by spacenurse

SUPPLEMENTAL STATEMENT OF REASONS:

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.

As always, thank you Spacenurse for the great information.

So, if I'm reading this right, it looks like the reduction of other staff postions mentioned on this thread could be illegal?

If so, what can be done about it?