National Nurses United

Ratios 101 A.B. 394 — the CNA-sponsored safe staffing law — has multiple provisions designed to remedy unsafe staffing in acute-care facilities. California's safe staffing standards are based on individual patient acuity for which the RN ratio is the minimum. Mandates Minimum, Specific Numerical Ratios Establishes minimum, specific numerical RN-to- patient ratios for acute-care, acute psychiatric, and specialty hospitals. Requires a Patient Classification System — RNs Added Based on Patient Need Additional RNs must be added to the minimum ratio based upon a documented patient classifica- tion system that measures patient needs and nursing care, including severity of illness, complexity of clinical judgment, and the need for specialized technology. Regulates Use of Unlicensed Staff Hospitals may not assign unlicensed assistive personnel to perform nursing functions or per- form RN functions under the supervision of an RN, including: administration of medication, venipuncture, and invasive procedures. Restricts Unsafe Floating of Nursing Staff Requires orientation and demonstrated current competence before assigning a nurse to a clinical area. Temporary personnel must receive the same orientation and competency determination as permanent staff. Break Coverage The law provides that a charge nurse, RN manager, or relief nurse without a patient care assignment and with validated competencies must relieve RNs during our breaks. However, most CNA/NNU contracts prohibit managers from doing bargaining unit work. No Averaging The ratios are the maximum number of patients assigned to any one RN at all times during a shift. No Cuts in Ancillary Staff The California Department of Health Services safe staffing standards maintain the existing staffing model that utilizes RNs, licensed vocational nurses (LVNs), and unlicensed assistive personnel. Licensed Vocational Nurse Basics The RN and LVN licenses are not interchangeable. There is no parity between the RN and the LVN licenses for the purpose of the ratios. » LVNs are assistive to the RN. » An LVN cannot be assigned overall responsibil- ity for a patient. » When working with an LVN, the RN is legally responsible for the patient. » LVNs cannot give or take shift report or transfer of assignment. » LVNs cannot substitute for RNs in break coverage. RNs cannot be assigned their patients as well as "cover" an LVN's duties. 23

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