National Nurses United

must address the amount of nursing care needed, by patient category and pattern of care delivery, on an annual basis, or more frequently, if warranted by the changes in patient populations, skill mix of the staff, or patient care delivery model. The PCS system also requires (1) a method by which the amount of nursing care needed for each category of patient is validated for each unit and for each shift; (2) a method to discern trends and patterns of nursing care delivery by each unit, each shift, and each level of licensed and unlicensed staff; (3) a mechanism by which the accuracy of the nursing care validation method described above can be tested; (4) a method to determine staff resource allocations based on nursing care requirements for each shift and each unit; and (5) a method by which the hospital validates the reliability of the patient classification system for each unit and for each shift. Following the adoption of the PCS, DHS spent more than four years working with nursing and hospital organizations, including the California Nurses Association, to develop the final PCS regulations, which became effective on January 1, 1997. Although it does not appear that any formal studies were conducted to determine the effectiveness of the PCS, it was the perception of many direct-care RNs that the PCS was not meeting the patients��� needs for staffing. CNA claimed this perception was supported by a 1998 survey conducted by the DHS itself. According to the Senate Health and Human Services Committee, as reported by the Senate Rules Committee: ���In 1998, the DHS surveyed over 160 acute-care hospitals during the Consolidated Accreditation and Licensing Survey and found that most of the hospitals surveyed were not in compliance with Title 22 patient classification. 61% of the facilities were out of compliance with Title 22 with 87% deficient in the specific sections that require the facility to establish a PCS and to staff based on patient needs. It became clear that the majority of facilities were not complying with Title 22.��� Consequently, CNA concluded that the PCS was not meeting its intended purpose, and sponsored AB 394 to require the establishment of minimum, numerical licensed RN-to-patient ratios. AB 394 is the first RN-to-patient acute-care staffing ratio law in the United States. There Ought to Be A Law! Organized Nurses and Patient Needs Versus the Hospital Association Bottom Line the california nurses association sponsored AB 394 to ensure safe staffing for patients in California. AB 394 was introduced by California Assemblywoman Sheila Kuehl and it was passed by the Legislature after extensive and aggressive lobbying and highly visible mobilization campaigns by RNs as advocates for the adoption of this important patient safety legislation. It was signed into law by Governor Davis on October 10, 1999, adding section 1276.4 to the Health and Safety Code (HSC). This law is the nation���s first law mandating RN staffing ratios for acute-care hospitals. In adopting the new bill, the Legislature declared that the accessibility and availability of nurses is essential ���to ensure the adequate protection of patients in acute-care settings.��� The Legislature clearly believed that the quality of patient care was related to the number of licensed nurses at the bedside, and wished to ensure a minimum, adequate number. The California Department of Health Services (DHS) was charged with determination of and implementation of the staffing ratios. Previous attempts had been made to obtain mandated ratios in California. The first attempt was in 1993 when AB 1445 was introduced into the Assembly, but the bill died in committee. In 1996, CNA sponsored an HMO reform ballot initiative, Proposition 216, which included a requirement for the DHS to set ratios in healthcare SEPTEMBER 2012 settings. In 1997, AB 695 passed the Legislature, but it was vetoed by then-Governor Wilson after an aggressive anti-reform lobbying campaign financed by the hospital and insurance industry. AB 394 was introduced in February 1999. It immediately encountered strong opposition. The Assembly Committee on Health reported the hospital industry���s opposition to legislatively mandated nurse-to-patient ratios for acute-care hospitals in its April 6, 1999 report on AB 394: ���The California Healthcare Association (CHA) opposes the bill because it legislates nurse staffing levels for hospitals based on ratios. CHA believes the public policy of the state should be to require hospitals to base nurse staffing levels on the specific care needs of the patients as measured each shift for every unit, not on staffing ratios.��� As a matter of fact, such regulations were already, and continue to be, in effect ��� an inconvenient truth, perhaps for an industry that all but ignores them. The CHA also argued that the ���nursing shortage��� would make it very difficult for hospitals to recruit and hire the nurses needed to meet the ratios. In California, based on the legislative findings, the statute expressly directed the DHS to adopt, for acute-care health facilities, ���regulations that establish minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit.��� (Health & Safety Code �� 1276.4(a).) The legislation also, and importantly, expressly provides that the ratios are to be minimums, and that the existing Patient Classification System (PCS) shall remain in place. The minimum nurse-to-patient ratios were intended to set the baseline licensed staffing requirements for each unit type without disturbing the existing PCS staffing requirements which may require supplemental staffing as circumstances warrant. Accordingly, the legislation provides that notwithstanding the minimum nurse-to-patient ratios, ���[a]dditional staff shall be assigned in accordance with the documented patient classification system for determining nursing care requirements.��� (Health & Safety Code �� 1276.4(b).) The statute further directs that the minimum staffing ratio regulations shall be adopted ���in accordance with the department���s licensing and certification regulations, as stated in Sections 70053.2, 70215, and 70217 of Title 22 of the California Code of Regulations, and the professional and vocational regulations in Section 1443.5 of Title 16 of the California Code of Regulations.��� (Health & Safety Code �� 1276.4(a).) These sections describe or explain the professional obligations of registered nurses in the provision of healthcare. For example, section 70053.2 describes the Patient Classification System. Section 70215 provides that a registered nurse must provide, among other things, ongoing patient assessments as defined in the Nursing Practice Act, and the planning, supervision, implementation, and evaluation of nursing care to each patient in accordance with the elements of the nursing process. Section 70217(j) likewise provides that nursing personnel shall assist the administrator of nursing services, provide direct patient care, and provide clinical supervision and coordination of care given by licensed vocational nurses and unlicensed nursing personnel. And, as discussed above, section 1443.5 of Title 16 describes the applicable nursing ���Standards of Competent Performance.��� The statute provides that ���in case of conflict between this section and any provision or regulation defining the scope of nursing practice, the scope of practice provisions shall control.��� (Health & Safety Code �� 1276.4(h).) W W W. N A T I O N A L N U R S E S U N I T E D . 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