Issue link: https://nnumagazine.uberflip.com/i/971007
5 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, of 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 — Additional RNs Added Based on Patient Acuity and Need Additional RNs must be added to the minimum ratio based upon a documented patient classification 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 perform 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 validated current competence before assigning a nurse to a clinical area. Tempo- rary personnel must receive the same orientation and competency determination as permanent staff. Applies at All Times The ratios apply "at all times," including meals and breaks, and excused absenc es. Prohibits Averaging There can be no averaging of the number of patients and the total number of RNs. Bars Cuts in Ancillary Staff as a Result of Ratios In the first year of implementation, CNA successfully fought off challenges from several California hospitals who responded to the ratios by attempting to cut back on LVNs and unlicensed personnel, going against the intent of the law. The state's safe staffing standards maintain the existing staffing model which utilizes RNs, LVNs, and unlicensed assistive personnel. Prevents Hospitals from Using LVNs in Place of RNs LVNs are not in the ratio count and are assistive to the RN.