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Critical Care Plus: Staffing Law Movement Spreads Nationwide
AACN cool to concept of legislating nursing numbers
The fact that California’s Safe Hospital Staffing Law (AB 394) isn’t getting much support from the American Association of Critical Care Nurses hasn’t stopped other nursing associations that support the law from encouraging nurses throughout the country to lobby for similar staffing ratio laws. A new national group called the Healthcare Worker Alliance (HWCA) is touring the country, presenting seminars to acquaint nurses around the country with California’s soon to take effect Safe Staffing law.
Teresa Wavra, RN, clinical practice specialist for AACN, says that how the law will affect nurses at bedside remains to be seen. "AACN’s position is that staffing ratios depend on the needs of the patient and the competency level of the nurse," Wavra says. "Each patient has unique needs, and just conforming to a staffing ratio doesn’t guarantee a level of patient care. The only means to achieve that is assessing the patient’s needs and the competency level of available nursing staff and making sure the two are a good fit."
Wavra says it’s difficult to see what effects adhering to the staffing ratios as mandated by law would have, echoing AACN’s position paper on the subject, which says that "appropriate staffing of patient care areas is dependent on the ability of the nurse competency and mix to meet the needs and acuity of the patient."
HCWA was formed by the California Nurses Association (CNA) and the United Steelworkers of America (USWA). Class instructors describe the campaign CNA waged to get the law passed, and discuss the implications for improving patient care and alleviating the current shortfall of RNs working in hospitals they believe the legislation provides.
Trande Phillips, RN, a member of the California Nurses Association board of directors, reports that response to the continuing education classes her organization offers has been enthusiastic. According to CNA spokespersons, the biggest draw for the classes has been interest in California’s staffing ratio law and what steps CNA took to sponsor and secure its passage. Classes include terms for fixing patient classification systems as outlined in the California law, the prohibition for staffing based on budgetary considerations, attention to the special needs of patients, role protection and the restrictions on the use of unlicensed assistive personnel.
After the California Department of Health Services finishes reviewing and considering all testimony it received at hearings held across the state as required by law, regulations supporting the ratios will become final. California hospitals will be required to implement the ratios effective January 1, 2004.
The California law:
• Mandates nurse-to-patient ratios. Establishes minimum, specific numerical nurse-to-patient ratios for acute care, acute psychiatric and specialty hospitals.
• Assigns additional nurses based on patient acuity. Requires additional staff be added to the minimum number based upon a documented patient classification system that measures patient needs and nursing care, including severity of illness and complexity of clinical judgment.
• Controls use of unlicensed staff. Hospitals may not assign unlicensed assistive personnel to perform nursing functions—including administration of medication, venipuncture, and invasive procedures.
• Restricts unsafe floating of nursing staff. Requires orientation and demonstrated competence before assigning a nurse to a clinical area. Temporary personnel must receive the same orientation and competency determination as permanent staff.
• The Service Employees International Union (SEIU), a group of more than 110,000 nurses from every health care setting, has supported fixed staffing ratios for decades. Proposed SEIU ratios are more stringent than the state’s: 1:4 rather than 1:6 on med-surg.
• The California Healthcare Association, lobbyist for the hospital industry, has proposed delaying the staffing law indefinitely and suggested ratios that some nursing associations say will undermine safe patient care, including a 1:10 nurse-to-patient ratio for med-surg that would lower existing staffing in some California hospitals.
But Kaiser Permanente, one of the nation’s largest health care providers, endorses the staffing ratios proposed by the SEIU is currently working with Kaiser administrators to implement 1:4 ratios on med-surg and 1:3 on telemetry.