National Nurses United

Gimme a break! Hospitals target meal and rest periods as a way to undermine the ratios Ever since minimum RN-to-patient staf���ng ratios took effect in California in 2004, the hospital industry has repeatedly zeroed in on meal and rest breaks as a spot at which to chip, chip, chip away at the standards. The requirement that minimum ratio standards be in place at all times, including meals and breaks, has been in place for nearly 40 years in the ICUs, neonatal intensive care units, and operating rooms of California. Yet just before implementation of the nurse-to-patient ratios in the remainder of hospital units in 2004, the California Hospital Association (CHA) ���led a lawsuit claiming that the Department of Health Services��� (DHS) ���at all times��� interpretation was inconsistent with the language of the regulation and was not clearly stated as a requirement during the lengthy rulemaking process. Hospitals want to be allowed to make nurses cover each other���s patient assignments during breaks, effectively doubling each RN���s patient load during these times and violating the minimum staf���ng standards set by ratios. In a key ruling preserving the integrity of ratios, Sacramento Superior Court Judge Gail Ohanesian ruled that same year that CHA was aware of the requirement to maintain the minimum nurse-to-patient ratios at all times, including meal and rest breaks, and that it was the only reasonable interpretation of the nurseto-patient regulation. Judge Ohanesian stated that ���[a]ny other interpretation would make the nurse-to-patient ratios meaningless.��� [Emphasis added] She went further in characterizing CHA���s NOVEMBER 2012 arguments against meal and break replacement as ���an attack on the ratios themselves.��� Furthermore, Title 22, Section 70217 makes clear that ���assist��� and ���relieve��� do not have the same meaning. The ���assigned��� nurse must remain responsible for the provision of direct patient care, requiring the assigned nurse���s presence on the unit. If the assigned nurse were not present, another nurse would not be ���assisting��� but instead would be taking over and assuming the assigned nurse���s responsibilities. In her ruling, Ohanesian very clearly spells out that the practice of nurses doubling up on patients during breaks is a no-no. ���When a nurse takes a break during a shift, the hospital must reassign the nurse���s patient to another nurse and���reassigned patients must not cause the relieving nurse���s patient ratio to exceed the applicable ratios set forth in the regulation,��� she wrote. Under California law, employers are prohibited from staf���ng an employee for more than ���ve hours per day without providing the employee with a meal break of at least 30 minutes. Employees working between 10 and 12 hours per day are entitled to take two 30minute breaks under California Labor Code, Section 512 (a). Nurses are not exempt from this law. Although the second break can be waived by mutual consent, the ���rst one cannot. In addition, paid rest breaks of 10 minutes must be provided for every four hours worked. Overtime and premium pay for missed breaks have been the subject of collective bargaining and are often negotiated into contracts that provide the union with the power to assure compliance. Currently, state law provides that most hospital employers must pay a penalty equal to the amount of the employee���s hourly base rate of pay for each meal or rest period that the employer does not provide, up to two hours per shift. Not just anyone can provide meal and break relief for direct-care nurses. California���s Title 22, Section 70217, Nursing Service Staff, states that only licensed nurses providing direct patient care shall be included in the ratios. When a nurse administrator, nurse supervisor, nurse manager, charge nurse, or other licensed nurse is engaged in activities other than direct patient care, that nurse shall not be included in the staf���ng count in determining compliance with the ratios. To give an example, let���s consider the role of charge nurses and what happens if they relieve direct-care RNs during meal and rest breaks. The primary duty of the charge nurse it to provide indirect patient care. Charge nurses coordinate unit work ���ow; facilitate patient admissions, discharges, and transfers; monitor unit processes and outcomes; and arbitrate con���icts���as well as numerous other indirect nursing activities. The charge nurse acts as an expert W W W. N AT I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 13

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