"NEW" proposed Federal ESRD regulations

imperial · Feb 20, 2005

Yes, I agree. Everyone involved should read and make public comment. These regulations have not been revised in over 30 years, now what does that tell you?

jnette, ASN, EMT-I · Feb 20, 2005

To effictively implement these new (as well as all current standing regulations) the need for adequate staffing ratios MUST be addressed.

It seems like there is always more and more piled on us (and often the new changes ARE justified, I'm not denying that improvements are timely or necessary!) but the staffing ratios remain the same.

It is becoming next to impossible to continue to provide the detailed attention and care our patients deserve without the proper and necessary amount of staff. :stone

I do wish the Federal Guidelines would addresse THIS as well.. so these for profit corporations would be forced to comply.

grrrrrrrrrrrrrr...rrr !!!

jnette, ASN, EMT-I · Feb 20, 2005

hmmmmmmm... just glanced over the headlines of the changes and found that we have already incorporated most of these, with VERY few exceptions...

will be reading more in teh days ahead.. thank you for the link info ! :)

imperial · Feb 21, 2005

The proposed language states that states, some, not all, already have staffing ratios in place which are to be followed. However, if there is negative outcome the units can be cited for insufficient staffing if it relates to same.

Again, many states have this in place already. Corporations are going to do what is cheapest, as we well know. Also, it is the dialysis techs that do most of the care.

I was glad to see that the CDC recommendations are now mandated as this is a great problem in units.

jnette, ASN, EMT-I · Feb 22, 2005

The proposed language states that states, some, not all, already have staffing ratios in place which are to be followed. However, if there is negative outcome the units can be cited for insufficient staffing if it relates to same.
Again, many states have this in place already. Corporations are going to do what is cheapest, as we well know. Also, it is the dialysis techs that do most of the care.
I was glad to see that the CDC recommendations are now mandated as this is a great problem in units.

imperial..

the staffing ratio is lip service only.

Yes, we have now been certified to do "Ultra Care".. a big deal for FMC. While there are some great aspects to the "upgrade", and we have incorporated all of them, the one component NOT being addressed (yet greatly touted in Ultra Care) is the staffing. It remains on paper only. IF this were to be enacted, it would be the best thing that ever happened to dilaysis. But as you say, this would certainly cost $$ and I don't look forward to the company implementing this aspect of it anytime soon.. if ever. :stone

Again, it is a wonderful marketing tool.

As it is, our NM is being pressed to make sure the staff has NO overtime.

Which is next to impossible, as they continually increase our census and the patients we are now accepting are more and more "disabled"... having to employ the use of the hoyer lift, etc. is all very timeconsuming. Add to that all the truly TECHNICAL tasks we end up doing so they won't have to send out the technical crew.

These companies speak with forked tongue.

P.S.

Can you provide a link to the staffing ratios you mentioned above ?

jnette, ASN, EMT-I · Feb 22, 2005

imperial..

I was able to find this, but my gosh, this is SO vague it can be interpreted any way at all ! And we all know how the corporations will choose to interpret ! :rolleyes:

I mean just what is the definition of "adequate staff in /adequate numbers"??? :stone Could they not have been more SPECIFIC?

Sec. 405.2162 Condition: Staff of a renal dialysis facility or renal

dialysis center.

Properly trained personnel are present in adequate numbers to meet

the needs of the patients, including those arising from medical and

nonmedical emergencies.

(a) Standard: Registered nurse. The dialysis facility employs at

least one full time qualified nurse responsible for nursing service.

(See Sec. 405.2102.)

(b) Standard: On-duty personnel. Whenever patients are undergoing

dialysis:

(1) One currently licensed health professional (e.g., physician,

registered nurse, or licensed practical nurse) experienced in rendering

ESRD care is on duty to oversee ESRD patient care;

(2) An adequate number of personnel are present so that the patient/

staff ratio is appropriate to the level of dialysis care being given and

meets the needs of patients; and

(3) An adequate number of personnel are readily available to meet

medical and nonmedical needs.

offers self-care dialysis training, a qualified nurse is in charge of

such training (see Sec. 405.2102.)

[41 FR 22511, June 3, 1976. Redesignated at 42 FR 52826, Sept. 30, 1977,

as amended at 43 FR 48953, Oct. 19, 1978; 51 FR 30362, Aug. 26, 1986]

jnette, ASN, EMT-I · Feb 22, 2005

Actually, I'm having trouble finding the new proposed language.. any direct links? Thanx ! :)

imperial · Feb 22, 2005

J'nette: What is ultra care? What does it encompass in training? What is the goal? In other words, what IS ultracare? Can you give a few examples of ultracare?

Each state has their own staffing ratios. To be honest, these are in hospitals and nursing homes and I really don't know how they apply to renal outpt units. I do know, according to the regulations, that some states do have ratios for renal units. The states are specifically mentioned in the proposed language, although I do not remember. I do know, from my reading, that in California recently, the Governor vetoed the bill that would have mandated staffing ratios in hospitals.

Do other companies have the same as FMC i.e. ultracare?

jnette, ASN, EMT-I · Feb 22, 2005

J'nette: What is ultra care? What does it encompass in training? What is the goal? In other words, what IS ultracare? Can you give a few examples of ultracare?
Each state has their own staffing ratios. To be honest, these are in hospitals and nursing homes and I really don't know how they apply to renal outpt units. I do know, according to the regulations, that some states do have ratios for renal units. The states are specifically mentioned in the proposed language, although I do not remember. I do know, from my reading, that in California recently, the Governor vetoed the bill that would have mandated staffing ratios in hospitals.
Do other companies have the same as FMC i.e. ultracare?

Cna you lead me to a link which provides the listing of the states that DO have ESRD outpatient renal clinic staffing ratios?

re Ultra care:

it is the new FMC deal, and they make a really BIG deal of it.

It would take me forever to list all the benefits/advantages, but I'll see if I can find you a link, ok?

imperial · Feb 22, 2005

How I get to the proposed language is put in the search engine 'federal register 2/4/05 and it comes up..

As far as adequate staffing. A facility, to my knowledge, would be cited for this requirement if a patient experienced a negative outcome related to not having enough staffing. Of course, acuity would be looked at, etc.

jnette, ASN, EMT-I · Feb 23, 2005

How I get to the proposed language is put in the search engine 'federal register 2/4/05 and it comes up..
As far as adequate staffing. A facility, to my knowledge, would be cited for this requirement if a patient experienced a negative outcome related to not having enough staffing. Of course, acuity would be looked at, etc.

You have much to learn, my friend. :)