19 April 2000

More on Californian Nursing Laws!

New laws in California which mandate minimum nursing staff ratios and skills mix were sponsored by that state's nursing union - the California Nurses' Association and were enacted with the help of politicians who recognised that the critical loss of qualified nurses in Californian hospitals was now impacting on the health and safety of hospital patients.

The Californian legislation indicates that while existing law provides for the licensing, registration and regulation of nurses and sets forth their scope of practice, this has been inadequate to ensure proper staffing levels and skills mix in many health care institutions.

The principles underpinning the new legislation have been set forth as follows:

"SECTION 1. The legislature finds and declares all of the following:

1. Health care services are becoming complex and it is increasingly difficult for patients to access integrated services.
    
   
2. Quality of patient care is jeopardised because of staffing changes implemented in response to managed care.
    
3. To ensure the adequate protection of patients in acute care settings, it is essential that qualified registered nurses and other licensed nurses be accessible and available to meet the needs of patients. 
   
   
4. The basic principles of staffing in the acute care setting should be based on the patient's care needs, the severity of the condition, services needed and the complexity surrounding those services."

The introduction to the Bill states in part:

"This Bill would prohibit a general acute care hospital, an acute psychiatric hospital and a special hospital, as defined, from assigning an unlicensed person to perform nursing functions in lieu of a registered nurse, or from allowing unlicensed personnel under the direct clinical supervision of a registered nurse to perform certain functions."

Interestingly, the law now strictly prohibits the performance of nursing work by unlicensed personnel - even where that work has been assigned and is performed under the supervision of a registered nurse. This was in response to employers seeking to employ licensed staff only in a supervisory capacity - a cost cutting strategy that our aged care members are increasingly becoming familiar with!

Other important aspects of the legislation include:

• A strong statement that the law is providing for minimum staffing only and that "additional staff shall be assigned in accordance with a documented patient classification system for determining nursing care requirements." 
• A requirement 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."
• "the written policies and procedures for orientation of nursing staff shall require that all temporary personnel shall receive orientation and be subject to competency validation consistent with ……the California Code of Regulations".

Members can access full details of this Bill on the Californian Nurses' Association Website!