With California's nurse staffing ratios going into effect Thursday, state authorities are providing hospitals advice on meeting one of the toughest parts of the law: maintaining minimum staffing ratios "at all times."
On Tuesday, the California Healthcare Association, which represents hospitals in the state, filed a lawsuit against the state Department of Health Services, seeking to void the law. In a release, the group claims that "virtually all hospitals" won't be able to comply with the new ratios.
The law will require hospitals to have at least one registered nurse for every six patients in the main medical ward and one RN for every four patients in the emergency room.
Hospital officials have been especially concerned about meeting the "at all times" rule. In response, the Department of Health Services lists several ways on its Web site to deal with that rule:
- A charge nurse, or nurse manager can fill in for a licensed nurse during breaks or lunches.
- In a post-anesthesia recovery unit, an OR nurse can cover if there are no surgeries and the nurse has current competence in the PACU.
- Any nurse in the hospital can "float" between units to cover if he of she is competent to perform tasks required in that unit.
- Nurses from a higher-acuity unit can always cover nurses in a unit with lower-acuity patients.
- Taking patients away from the unit for tests temporarily reduces a nurse's assignment, allowing him or her to assist another nurse.
- Hospitals can delay new admissions or cancel elective surgeries when they don't have sufficient numbers of critical care nurses.
- Hospitals can ask physicians if any patients could be safely discharged earlier in the day.
- Hospitals can monitor the number of new admissions and discharges and plan for staffing the next shift.
The department says it would launch an investigation within 48 hours of receiving a complaint if it is "a credible allegation of serious and immediate jeopardy to patients." But if the allegation does not constitute "serious and immediate jeopardy," it would investigate the complaint during the next periodic survey or along with the next "serious" complaint, the department says.
The department says there is no penalty or monetary fine for a violation of the ratio regulations. But if it concludes that if the violation is "so severe that it poses an immediate and substantial hazard to the health or safety of patients," it may order the hospital to reduce the number of patients or close a unit until additional staffing is obtained.