National Nurses United

16 J U N E 2 0 0 5 C A L I F O R N I A N U R S E which pump at what time. RNs were warned not to borrow or loan a "key" because they could be disciplined for the error of another RN. Registry RNs did not have a key, so staff RNs were required to program, replace batteries, and trou- bleshoot the IV pumps of patients assigned to registry RNs. The City of Hope Professional Practice Committee (PPC) started an in- depth investigation. Working with the Nursing Practice Program, they gained a clear understanding on the various state laws and regulations the hospital circumvented. Here are the applicable laws and interpretive statements on the issue of competency; the competency standards to which the BRN holds the RN account- able are specified in the Nursing Practice Act (Business and Profession Code, Section 2725) and the Standards of Com- petent Performance (California Code of Regulations Section 1443.5) The BRN has determined that "the RN is always responsible for providing safe, competent nursing care. Therefore, before accepting an assignment, the RN must have the necessary knowledge, judg- ment, skills, and ability to provide the required care." Furthermore: "If the RN accepts an assignment for patient care and is not clin- ically competent, the RN license can be disciplined." The BRN continued to state that "Nursing administrators, supervisors, and managers have a crucial responsi- bility to assure appropriate and compe- tent nursing care to patients/clients. The BRN requires nursing administrators, supervisors, and managers to only assign patient care to RNs who are clinically competent. Nursing administrators, su- pervisors, and managers may have their licenses subject to discipline if they do not ensure assignment of clinically com- petent RN staff." The new provisions in Health and Safety Code Section 1276.4 (e) mandate that "No registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has first received orientation in that clinical area sufficient to provide competent care to patients in that area, and has demonstrated current competence in providing care in that area." (Emphasis added) Since 1996 the California Code of Regulations Title 22 section 70214 Nursing Staff Development requires organized in- service education that shall include, but not be limited to, orientation and the process of competency validation that include written policies and procedures for patient care which contain competency standards for staff performance in the delivery of patient care—established, implemented, and updated as needed for each nursing unit. [California Code of Regulations Section 70213] Competency standards for RNs are a determination based on the satisfactory performance of the statutorily recognized duties and responsibilities of the RN, as set forth in Business and Professions Code Section 2725, et seq, and regulations promulgated there under [California Code of Regulations Section 70016.1 (a) (1)]. Competency validation must be com- pleted prior to being assigned responsi- bility for the care of the patient attached to the equipment. This requires didactic, observation, practice, and return demon- stration. The PPC members demanded the fol- lowing of nursing administration: 1. Do not assign an RN to care for a patient attached to new equipment until that RN's competency has been validated by return demonstration. 2. Until all staff has validated compe- tency for the new pumps, use the "pilot" procedure that has already been success- ful at City of Hope. 3. Ensure that an RN with validated competency (either from the company or City of Hope staff) is present on each unit, without a direct patient care responsibil- ity, until the majority of RNs are compe- tent with all aspects of using these new pumps. The PPC demanded a timely re- sponse so no patient would be harmed by the RNs' lack of competency in the use of these pumps. The PPC invited the Director of Nursing (DON) to a meeting. All the PPC members and most of the RN staff of the two units piloting the pump attended. When the DON and Human Resources Director arrived at the PPC meeting, extra chairs had been brought in. The DON stated, "We are outnumbered. I did- n't expect so many of you," and demand- ed that everyone who was not a PPC member leave, saying the room was too crowded. The PPC Co-Chair stated, "I am read- ing from the fire marshal's sign. We don't exceed the allowed number of occupants." All RNs stayed. The PPC began explaining that the RNs had serious concerns about the safe- ty of the new IV pumps. One at a time, RNs explained how the noise of the pumps awakened very sick patients causing increased pain, nausea, and vomiting. The next nurse explained the concern about infection control for reverse isolation patients when other patients have active infections. A question was raised as to why the surveillance results of each nurse's use of the pump was being sent to FluidSense's company headquarters in Kentucky. The response was that if there was a medica- tion error, the hospital would know who was responsible. RNs expressed concern that there could be errors from Kentucky. They also said it seemed the patient's con- fidentiality was being breeched by send- ing medication records out of state for the purpose of evaluating medical equipment. Had the patients given consent for this? There was no response. The next day the old pumps were brought out of storage. The FluidSense pumps were taken away. Southern California Acute Care Hos- pital: This was an act of bold enforcement by an individual RN patient advocate. This RN, who was employed by a SoCal hospi- tal, attended one of CNA's patient advo- cacy continuing education classes and learned that the ICU 1:2 or fewer nurse- to-patient ratio applied at all times, includ- ing meal and rest breaks. Because her hospital had an existing partnership agree- ment, she was told not to publicly criti- cize the hospital. Proceeding solo, the RN collected hospital documentation which indicated that the hospital staffed one RN for every two patients regardless of the patient's acuity with no provisions for relief during meals and breaks. The hospital also engaged in the practice of "averaging" so that when a patient was a 1:1, a second nurse would be assigned three patients. When the patient went on a "road trip" to MRI or CT scan, a nurse who was already assigned two patients "picked up" the sec- ond patient of the nurse accompanying her patient off the unit. And when a nurse went to lunch, another nurse would have to "cover" so s/he would be responsible for four patients at that time. All this information was reported by the RN to the Department of Health CE | Home Study Course

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