relocating (maybe...)

hi, noelle! and, greetings from warm and sunny la! i live in arcadia which is in the la area just east of pasadena and slight south of the angeles mountains in the san gabriel valley. the sun is out this morning although i did hear some thunder last night. it doesn't normally rain that much out here. spring has been in bloom for a couple of weeks here and when i walk outside, i can just smell the blossoms! the los angeles arboretum and the santa anita racetrack are in arcadia, california. the one thing i always missed when i was out of california was jack-in-the-box. i'm sure jack is glad to hear that! i think they have the best milk shakes of any of the drive thru food places.

california is without a doubt a land of opportunity. our family took a trip out here in the early 60's and by 1970 my parents had us relocated out here. i went to nursing school at one of the community colleges out here where i got my aa in nursing. i earned my bsn in nursing from an eastern college though because i wanted to have the difference in education between the two geographic locations.

california has a nurse staff ratio law that was signed by governor gray davis in 1999. the original law stated that lvns cannot comprise more than 50 percent of the nursing workforce within a general, acute-care hospital. lvns cannot be counted as part of the "ratio staffing levels" for triage and trauma care within a hospital newborn nursery. only rns can be assigned to patients in an ed or icn. the law requires one nurse for every two patients in icus. the staffing ratios cannot be averaged for different times of the day, including breaks. there have been a few tweaks in the implementation of the law since 1999, but it is basically the same as it was originally intended. when the law went into effect 45 acute hospitals in california had to close their doors because they could not maintain the required staffing levels. one of them is down the road from me. it has become a ltc and outpatient day surgery facility. i believe that the law is section 1276.4 and 1276.5 under the california health and safety code. you can see the law by going to this site http://www.leginfo.ca.gov/calaw.html click the box for "health and safety code" and then put the number 1276 in the search box and click the "search" button. two links will come up. click on the one that contains section 1276 and when that page comes up, scroll down to that section. i also believe that the california department of health services is who administrates it, but i'm having problems finding any information about it on their website. i've seen information on one of the california government sites before but like a dunce i didn't bookmark the site, duh! i'll keep looking because people do ask about this law from time to time on the forums. here is a recent article by the massachusetts nurses association talking about the effects of this law: http://www.massnurses.org/news/2006/07/safe_staff2.htm

that law may be one of the things contributing to the nursing shortage out here. i really haven't read up on other factors. i can tell you this, however, because i have also worked in ohio, missouri and kansas. i think that i saw better nursing administration in the other states that i worked. my personal opinion is that it is because there were just not many universities offering bsns here in the southern california area at that time (80's and 90's). i believe that a bsn is much better prepared to manage and supervise than an aa prepared nurse (again, my personal opinion and not meant to start a flame war). i was put into a supervisor training program at a hospital in ohio that was absolutely superior to anything i was involved in when i was in california. that, however, is just my personal observation and someone else may have a different opinion on that.

you might also be interested to know that the california legislature has been trying for the past three years to pass a "no lifting" law for healthcare workers, specifically nurses. governor schwarzenegger has vetoed the initiative each time because he feels it is too restrictive. however, an attempt was made in september to put a much stricter law through the u.s. house of representatives and it has failed. so, something is definitely up with that issue around the country in general. texas and washington currently have state no lifting laws in effect and i have no doubt that the california nurses association is going to try to push this issue again.

with 8 years of rn experience you should have no trouble getting a job here in the la area. for some reason many of the hospitals have a problem getting people to stay on staff as full time employees. you will see all kinds of sign on bonuses offered. a day or week doesn't go by that i don't get stuff in the mail for job fairs in the local area. the last few times i have been a hospital patient i've had nurses who were agency staff. i don't think this is as big a problem in the san francisco and san diego areas.

you will need to get a california license by endorsement. start the process now. http://www.rn.ca.gov/lic/lic-end.htm. best to have a california license in hand when you arrive here so you can start looking for a job. getting your driver's license and car registration changed over will be a headache because the dmv (department of motor vehicle) lines are long. you can actually make appointments online now to cut your waiting time down drastically. you have to convert your driver's license and car registration within 30 days of arriving in the state.

the community college tuition is currently $20 a credit hour for state residents. you have to have lived here for 12 months to be a resident and you prove that by the date on your california driver's license. get ready to serve jury duty because a california id or driver's license puts you in the jury pool and you will get called yearly if you live in la county. tuition at the california state colleges and university of california colleges is also lower for state residents and much less than most other states. here is a list of the rn to bsn programs in california. there aren't many colleges out here that have that option (another reason why i went to ohio to get my bsn). http://www.rn.ca.gov/schools/pdf/rntobsn.pdf if you are going on for your bsn i think you will be much happier in a program with other rns seeking their bsns. otherwise, you will find yourself in a basic nursing program of "kids" looking to get their rns and it really isn't the same. i had a very enriched bsn completion program where we were treated like peers by the professors. the program was specifically designed for practicing rns. you don't need to go through all that hoopla that newbies go through, so don't do that to yourself and find yourself in a sea of greenhorn learners (no offense students!) where you become a tutor when you should be just another student. there are other subjects that you can and should be focusing on as you get your bsn.

if you have to hit your husband over the head with a club, do it if that is what it will take to get him here! tell him i said so. you can't beat the sunshine. i grew up in ohio and illinois isn't much different weatherwise unless you live right on the lake. does he really think he'll miss driving to work in slush and snow every winter? one or two winters out here and he'll be calling back home to friends and relatives after hearing about a snow storm to lord it all over them about how the sun is shining away out here and he had to wear sunglasses because the sun glare was so bad on his way home from work.

here are some links for you:

http://www.californiacolleges.edu/campustour/default.asp?switchto=statewide - list of all california colleges with links to information about the different california supported state colleges and universities and community colleges.

http://www.rn.ca.gov/schools/rnprgms.htm - list of rn programs in california from the california board of nursing (just in case you want to see where they are!)

http://www.choosenursing.com/paying/calfinaid.html - financial aid available for nursing students in california. california is very rn friendly.

http://www.rn.ca.gov/index.html - california board of rn nursing

ok, here's the latest information that i could find on the california nurse staff ratio law. it was all on the california board of nursing site, i just wasn't looking in the right place! the law is actually administrated through the california department of health services since they are the dudes who license the health care facilities in california. have fun reading! the first document is 20 pages long, but it pretty well explains the law for the hospital administrators.

http://www.dhs.ca.gov/lnc/pubnotice/ntpr/r-37-01_faq2182004.pdf - nurse-to-patient staffing ratios for general acute care hospitals faqs (january 2004).

http://www.applications.dhs.ca.gov/pressreleases/store/pressreleases/04-70.html - november 4, 2004 proposed changes to the nurse-to-patient ratio law

the last california attempt at a no-lifting, zero-lift or safe patient handling bill (call it what you like) was sb 1204 and it was mandating zero-lift policies in healthcare facilities. i believe that the bill may have been titled as safe patient handling and movement practices. the weblink to the text of the bill was at: http://www.leginfo.ca.gov/pub/05-06/bill/sen/sb_1201-1250/sb_1204_cfa_20060327_165922_sen_comm.htm, but i am unable to pull up the page. since it was vetoed, it may have been pulled off the internet.

http://www.leginfo.ca.gov/pub/05-06/bill/sen/sb_1201-1250/sb_1204_vt_20060929.html - governor schwarzenegger's veto statement of the bill.

i did quite a bit of research on this as i did a paper for a class about the subject. the washington law mandates that there be one mechanical lift for every 10 inpatient beds or equipment available for use by a lift team by january of 2010. there must also be mandatory yearly inservices on the policies for the use of lift equipment and devices of all staff who work directly with patients. hr6182 (the nurse and patient safety & protection act of 2006) that was proposed by john conyers of michigan was/is an amendment to the occupational safety and health administration act of 1970. it calls for the elimination of manual lifting of patients and the establishment of federal grants for the purchase of required mechanical lifting devices by healthcare facilities. the last i heard this bill was in several subcommittees. one of the big objections to this bill and the one that was proposed in california is that it forces facilities to have to purchase patient lifting equipment which is quite expensive and which could prove to be a financial burden for smaller facilities.