One of the sectors in America that is thought to change the fastest is healthcare
The way that healthcare facilities carry out their activities is continually influenced by new federal and state laws and regulations. Due to this, it is increasingly important for staffing managers to stay current with changes by incorporating regulatory requirements into their processes. How many nurses are required to operate a hospital, then? All Medicare-certified hospitals and health facilities are expected to have enough licensed registered nurses, licensed vocational (practical) nurses, and other staff members on hand to provide nursing care to patients as needed, according to Federal Regulation 42CFR 482.23(b).
While the terms "sufficient" and "as required" may sound somewhat vague, the overall message to the health care administrators is that they must provide the competent and certified staff to provide the patients with the relevant levels of care. Every nursing unit or department in the facility is required to have supervisory and staff personnel who ensure that on demand, there is an available registered nurse to provide bedside care for patients. The health facilities must take the initiative to ensure adequate nursing personnel, for instance, they could partner with staffing agencies to help in supplementing and supporting with a full-time employee base (Nursingworld.org).
Having passed the bill in 1999, the state of California is one of the states having a minimum staffing law
With other states still struggling to debate bills that would oblige health institutions to retain a required number of nurses at any particular time. The California RN Staffing Ratio Law, AB 394, provides for particular statistical nurse to patient ratios for all services including acute psychiatric, critical care, and specialty hospitals in the state (Cga.ct.gov).
Health Care Organization's Obligations to meet Patients' Legal Rights
The 42 Code of Federal Regulations (42CFR 482.23 (b)) requires healthcare facilities to "have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed." To meet the legal rights of their patients, the health care organizations must provide round-the-clock nursing services, supervised or delivered by a registered nurse. There should also be a licensed practical or registered nurse on duty, except for rural hospitals where a 24-hour nursing waiver may be granted. The facility must have procedures in place to check that nursing personnel whose licensure is required possess current and valid licensure. To ensure that only quality and appropriate care is provided, the care for each patient must be overseen and assessed by a registered nurse. The regulation also charges the healthcare facilities with the duty of ensuring that the nursing staff carries out their duties diligently by developing and keeping a current nursing care plan for every patient. The care plan could be incorporated as part of an interdisciplinary care plan.
Charged with the responsibility of patients' nursing care to other nursing personnel, a registered nurse must consider the patient's specific needs and the competence as well as specific qualifications of the staff available. In instances where non-employee but licensed nurses are working in the facility, they are required to adhere to the procedures and policies of the hospital. In light of this, the director of nursing services in the hospital must provide for adequate evaluation and supervision of non-employee nursing personnel (Cornell.edu).
The California nursing staff regulation requires all facilities to maintain a minimum nurse to patient ratio in medical facilities. July 2003 saw the California State Department of health Services release guidelines towards the implementation of the first national rules guiding nursing issues in the country's hospitals. In a nutshell, the rules stipulated that all general medical wards in Californian hospitals must have one nurse for every six patients. The timeline for this was slated for January 1, 2004, with the number of patients expected to decrease to 5 by January 2005. It was further stated that the number of nurses in specialized units had to be increased by January 2008. These moves were designed with two primary objectives; improvement of patient mortality rates and staff retention. Currently, the patient to nurse ratios in Californian hospitals is as shown below;
Ratio
Service
6.1 Patient to nurse workload in psychiatry
5.1 Patient to nurse workload in oncology, telemetry, and medical-surgical units
4.1 Patient to nurse workload in pediatrics
3.1 Patient to nurse workload in labor and delivery
2.1 Patient to nurse workload in ICU(intensive care units)
In addition to establishing extremely precise minimum patient-to-nurse ratios per shift, the law also requires additional registered nurses to be assigned on the basis of a patient classification system that measures the requirements and nursing care of the patient. These may include the complexity of the patient's condition or the severity of their illness. Besides, this section of the law does not allow assigning of unlicensed personnel and nurses in clinical areas which they have lack orientation, training, and competency (Hugh, et.al.2012).
Consequences of Non-Compliance
After the implementation of law, it is critical to have an oversight body carrying out the required monitoring and evaluation procedures to ensure compliance. The authorities do not conduct surveys to monitor compliance with staffing issues solely. However, regular inspections for compliance with other health care issues and quality of care problems during routine checks could push the survey staff towards investigating whether conformity of the nurse-to-patient ratios is a factor of the quality of services being offered. Usually, investigations into violation of nurse-to-patient staffing ratios are accorded higher priority due to the risk of patients receiving inadequate care. Patients, their families, and visitors always point out such incidences to the authorities. On the other hand, the nurses may act as monitors who report to the institutional managers and the unions in instances when the ratios are unmet.
Penalties accorded for non-compliance vary from deficiencies to fines, all dependent on the severity of the case. A related legislation, SB 554 from 2011 proposed that DPH should carry out inspections for non-compliance with the nurse-to-patient ratios during the regular hospital inspections. The bill also suggested that hospitals cited for deficiencies be investigated to gauge their conformity to the correction plan. In addition to this, the bill proposed a $10, 000 penalty for every 4th and subsequent violations within duration of six months. A further amount of $10, 000 would be charged for non-compliance with an approved correction plan. However, the provisions of this bill were later amended out (Leginfo.ca.gov). It has not been established whether violating the nurse-to-patient staffing ratio could be said to "constitute immediate jeopardy to the health or safety of patients."
Reference List
Bill Analysis. Retrieved on 5th June 2016 from ftp://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_1201-1250/sb_1246_cfa_20120807_153940_asm_comm.html
Legal Information Institute. 42 CFR 482.23 - Condition of participation: Nursing services. Retrieved on 5th June 2017 from https://www.law.cornell.edu/cfr/text/42/482.23
McHugh, M.D. et.al. (2012). Contradicting fears, California’s nurse-to-patient mandate did not reduce the skill level of the nursing workforce in hospitals. Health Aff. 30 (7); 1299-1306
Nurse Staffing Rations. Retrieved on 5th June 2017 from www.nursingworld.org/MainMenuCategories/Policy.../State/.../State-StaffingPlansRatios
