so is your work following the new ratios???

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Just curious if CA hospitals are following the new ratios for Jan 2008? The one I'm at is not.

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Specializes in ICU/CCU/Oncology/CSU/Managed Care/ Case Management.

What is the new ratio in '08?? What is for ICU???

Thanks!!;)

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ICU remains two or fewer patients per nurse. That was our first ratio in 1976.

This is at all times, no averaging, and during meal and rest breaks.

Telemetry staffing is now four or fewer patients per nurse. This is defined as stable patients with cardiac monitoring. Step down is 1:3.

Specialty units such as oncology are 1:4.

http://www.dhs.ca.gov/lnc/NTP/default.htm

We are doing fine with the minimum ratio. Other than critical care there are still problems increasing staff when the acuity is high.

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What is the new ratio in '08?? What is for ICU???

Thanks!!;)

The ratio laws are only in effect for CA, and has not changed for the ICU. Maximum of two patients per nurse, and this means that you cannot legally cover another nurse for their break if you already have two patients, as it would mean that you would have their assignment as well.

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Just curious if CA hospitals are following the new ratios for Jan 2008? The one I'm at is not.

If they are not, they can be reported. But remember that the new rulings just went into effect 24 hours ago.

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For the past 3 nights I have had 5 tele patients. No different from before. What annoys me is that because I do tele and other nurses do not, I (or other tele nurses) will have to take 5 tele patients with high acuities while other non tele nurses will only have 4 or 5 EASY low acuity patients. They aren't split up fairly on this unit. One nurse will have 4 of the healthiest patients while another RN will have 5 patients with the highest acuity possible.

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Specializes in ICU/CCU/Oncology/CSU/Managed Care/ Case Management.

Hey Travel Have you spoken to your charge nurse about that?? Or perhaps your mgr?? Maybe all the nurses on the floor should be certified for tele monitoring...Just a thought;)

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Your hospital is in violation of the law.

You should never have more than four stable monitored patients.

If they are unstable you should have no more than three. This includes breaks.

...The licensed nurse-to-patient ratio in a step-down unit shall be 1:4 or fewer at all times.

Commencing January 1, 2008, the licensed nurse-to-patient ratio in a step-down unit shall be 1:3 or fewer at all times.

A "step down unit" is defined as a unit which is organized, operated, and maintained to provide for the monitoring and care of patients with moderate or potentially severe physiologic instability requiring technical support but not necessarily artificial life support. Step-down patients are those patients who require less care than intensive care, but more than that which is available from medical/surgical care ...

...The licensed nurse-to-patient ratio in a telemetry unit shall be 1:5 or fewer at all times.

Commencing January 1, 2008, the licensed nurse-to-patient ratio in a telemetry unit shall be 1:4 or fewer at all times.

"Telemetry unit" is defined as a unit organized, operated, and maintained to provide care for and continuous cardiac monitoring of patients in a stable condition, having or suspected of having a cardiac condition or a disease requiring the electronic monitoring, recording, retrieval, and display of cardiac electrical signals. ...

http://www.dhs.ca.gov/lnc/pubnotice/NTPR/R-37-01_Regulation_Text.pdf

http://www.dhs.ca.gov/lnc/pubnotice/NTPR/R-37-01_FAQ2182004.pdf

http://www.dhs.ca.gov/lnc/NTP/default.htm

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By definition it is a tele unit.. but they call it DOU. We have patients on Cardizem GTT, Heparin, and BIPAP. ILots of acute MIs and new onset afib. once showed up for work and I was assigned to 4 patients.....3 were on cardizem gtt for afib with RVR No other nurse (there are usually 7) had a card gtt patient. Yes the supervisor has been notified (all the time)...They say things like well I'm not going to make another nurse 4:1 just so you dont have 3 card gtt. At the time tele nurses would have 5 patients unless they had a card gtt patient or a patient on bipap for resp distress. Another nurse at a different time showed up to work and was assigned two patients with BIPAP for resp distress plus two other high acuity patients. Same thing, they weren't going to have two nurses as 4:1 just so they wouldn't have to call a nurse in. There was never nurses to relieve for breaks. You could either have another nurse on the floor take your cell or you could just hold on to it and stay on the floor to eat. If another nurse took your cell you would have a total of 10 patients to watch for up to an hour. Most nurses that gave there cell away would be gone 45 min to an hour. The other day they assigned all the tele nurses 4 patients...then said take another patient or we are sending the aide home. So now since after the new year, they are using bribes...keep the person doing VS or take a 5th tele patient (which breaks ratio). If you have a patient going bad you would have to put the on a drip or bipap and keep them on the floor and still keep the 5 patients you orginally had.

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If the unit is tele, then it is treated as same. They cannot just adjust the acuity of the unit to meet the ratios. Have heard of another facility doing things similar with their ICU and ER as well. Wonder if it is the same..............They should not be considering some patients Med-Surg and others Tele to meet the ratios. And if the nurse is not tele-certified, then they should not be caring for any patients on that unit. It is that plain and simple. With the above post of Spacenurse, there are links listed and one includes how to report a facility to the state.

please send me the name via pm, do not post it here.

And if they are not meeting the ratios, they can threaten all that they want, but they are breaking the law in CA and can be held accountable.

I do hope that you are keeping a log of all of this to back you up. And if you are doing a travel assignment there, is your agency aware of this?

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If the unit is tele, then it is treated as same. They cannot just adjust the acuity of the unit to meet the ratios. Have heard of another facility doing things similar with their ICU and ER as well. Wonder if it is the same..............They should not be considering some patients Med-Surg and others Tele to meet the ratios. And if the nurse is not tele-certified, then they should not be caring for any patients on that unit. It is that plain and simple. With the above post of Spacenurse, there are links listed and one includes how to report a facility to the state.

please send me the name via pm, do not post it here.

And if they are not meeting the ratios, they can threaten all that they want, but they are breaking the law in CA and can be held accountable.

I do hope that you are keeping a log of all of this to back you up. And if you are doing a travel assignment there, is your agency aware of this?

On our med surg floors we have stable tele pts with no drips these floor are not staffed by tele nurses at all. We have a stepdown unit as well but they do have tele nurses.

We are staffing 5:1 on med surg. and 3:1 on stepdown. 4:1 on oncology only on the day a pt is getting chemo. peids we staff 4:1 and sometimes 3:1. peids is about the only place where they take the bedside nurse's word for it that a pt needs to be 3:1 or less.

However, I have seen in a crisis acuities adjusted to more closely resemble the staffing.

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