As registered nurses, it is our responsibility to protect our patients and our license by following Title 22 regulations. However, many hospitals routinely try to cut expenses by decreasing staff and not following State-mandated nurse-to-patient ratios during breaks and lunches. Nurse-to-patient ratios must be followed at all times, there is no exception for short periods of time such as during breaks and lunches.
According to Title 22, “Nurse Administrators, Nurse Supervisors, Nurse Managers, and Charge Nurses, and other licensed nurses shall be included in the calculation of the licensed nurse-to-patient ratio only when those licensed nurses are engaged in providing direct patient care. When a Nurse Administrator, Nurse Supervisor, Nurse Manager, Charge Nurse or other licensed nurse is engaged in activities other than direct patient care, that nurse shall not be included in the ratio.”
The Department of Health Services (DHS) enforces nurse-to-patient ratios and many other requirements, but they have a difficult time doing so without the help of those who actually work in the hospitals.
All RNs are encouraged to fill out Patient Safety Reporting forms or Assignment Despite Objection forms every time you experience or witness a violation. If you do not file an ADO form, you are accepting the assignment and will have a difficult time proving the violation occurred. You should fill out and submit an ADO form if you are placed out of ratio at any time, or if you miss any break or meal period because of a lack of relief staff.
EXAMPLES OF VIOLATIONS
- Assigned more patients than Title 22 regulations allow
- Patients admitted or transferred without provision of additional staff
- “Averaging” the number of patients and the total number of RNs on the unit during any one shift or over any period of time. A nurse who is not assigned patients (for example, a charge RN) can not be included in the ratios.
- Patient acuity not taken into account or indicate need for transfer to higher level of care
- Having to cover another RN’s patients to relieve them for a break or meal period.
If you need an ADO form or are unsure what to do, contact your Union Representative. If you do not know who your Union Rep is, go to "Our Hospitals" and click on your hospital. Your Union Rep is listed at the top of the page.