National Nurses United

resource person to all nursing staff and as a liaison to all other disciplines and departments. The Department of Public Health (DPH) requires that when a nurse takes a break during shift, the hospital must reassign the nurse���s patients to another nurse. Furthermore, break relief RNs must give report when handing over patients to the returning RN. It is important that RNs understand that break relief is taking over an assignment. When charge nurses act as the break relief nurse, they must be present and available to continue the care of the assigned patients as required by law. In this instance, there can be no con���ict between attending to the needs of the now-assigned patients under their break relief duties and their duties as charge nurse. Therefore, charge nurses relieving another nurse for purposes of breaks must either abandon their patients or their charge nurse duties since they cannot ful���ll both roles simultaneously. Licensed vocational nurses (LVNs) are not authorized under their scope of practice to relieve an RN for meals and breaks or other routine absences. The restrictions on the scope of practice of LVNs also apply at all times, including instances when RNs are providing meal and break relief. In addition, the patient���s need for an ongoing assessment by a registered nurse does not cease to exist when the RN who is assigned to the patient is absent from the unit during a meal or break. Therefore, RNs are not authorized under the Nursing Practice Act to transfer responsibility of clinical management of their patients to LVNs during meals, breaks, and other absences from the unit. Nurse administrators and managers who have demonstrated current competence may relieve licensed nurses during meals, breaks, and other routine, expected absences from the unit. However, nurse administrators and managers are excluded from doing so when they engage in activities other than direct patient care. ���Hedy Dumpel, RN, JD State of the Union RNs across the country are working to win ratios As the first state in the union to win ratios legislation, California provides an important flagship for this critical safe staffing standard. But in addition to national ratios legislation NNU has proposed, RNs around the country are actively organizing their colleagues, the public, and lawmakers to pass ratio bills in individual states so that patients, no matter where they live, can be cared for safely. These bills are largely modeled upon the safe staffing law, AB 394, passed in California in 1999. Florida The Florida Hospital Patient Protection Act has been introduced in the Florida Legislature every year since 2009. It would mandate RN-to-patient ratios at all times, guarantee the right of patient advocacy, and provide whistle-blower protection. More than 3,000 community supporters have signed pledges to support the legislation and 22 municipalities have passed resolutions calling on their legislative delegations to pass this important, life-saving law. Illinois RNs in Illinois have proposed ratios legislation multiple times, most recently in 2012 with the Nursing Care and Quality Improvement Act. The bill would establish minimum RN-to-patient staffing ratios and codify the right of nurses to act as patient advocates. Massachusetts In 2006 and 2008, Massachusetts nurses were successful in passing the Patient Safety Act through the state House of Representatives by overwhelming margins, but continue to fight to get similar action by the state Senate. The Patient Safety Act calls upon the Department of Public Health to set a safe limit on the number of patients Ratios take time, but are worth it. Winning ratios in California did not happen overnight. It took years of education, lobbying, organizing, and fighting to get the law finally passed in 1999. Then it took another five years of advocacy and input into the state Department of Health Services to ensure realistic and safe numerical ratios were adopted. And it takes constant vigilance to enforce the ratios and fend off efforts to undermine them or repeal the ratios entirely. 1976 California Nurses Association (CNA) wins first state-mandated ratios of 1:2 for intensive care units. 1993 CNA proposes the first hospital-wide ratio legislation in the United States, AB 1445. 1996 CNA works with consumer protection groups to put Proposition 216 on the state 14 N AT I O N A L N U R S E ballot, a measure that would have offered protections for patients against HMOs as well as establishing minimum staffing ratios for hospitals. The measure did not pass, but helped dramatically raise awareness among the public for minimum staffing standards. 1998 CNA-sponsored ratio bill, AB 695, wins approval in the Legislature for the first time. RNs flood the state Capitol with letters, calls, and postcards. Gov. Pete Wilson vetoes the bill after extensive lobbying by the hospital industry. 1999 AB 394 is introduced by Assemblymember Sheila Kuehl. CNA presents 14,000 letters in support and commissions an opinion poll showing 80 percent public support for the bill. After 2,500 CNA RNs rally at the W W W. N A T I O N A L N U R S E S U N I T E D . O R G Capitol, the Legislature passes AB 394 and Gov. Gray Davis signs it into law. The bill directs the California Department of Health Services to determine specific ratios. 2002 In a joint press conference with the CNA Board of Directors, Gov. Davis presents the ratios that are ultimately adopted. The hospital industry���s proposal of 1:10 for medical surgical, telemetry, and oncology units is soundly defeated. 2004 On Jan. 1, RN staffing ratios become effective in all California acute-care hospitals. A California Superior Court rejects a hospital industry lawsuit arguing that ratios don���t apply during meals and breaks, ruling that ratios must be maintained at all times. NOVEMBER 2012

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