Section 1276.4 Of Article 3. Regulations From California Health And Safety Code >> Division 2. >> Chapter 2. >> Article 3.
1276.4
. (a) By January 1, 2002, the State Department of Public
Health shall adopt regulations that establish minimum, specific, and
numerical licensed nurse-to-patient ratios by licensed nurse
classification and by hospital unit for all health facilities
licensed pursuant to subdivision (a), (b), or (f) of Section 1250.
The State Department of Public Health shall adopt these regulations
in accordance with the department's licensing and certification
regulations as stated in Sections 70053.2, 70215, and 70217 of Title
22 of the California Code of Regulations, and the professional and
vocational regulations in Section 1443.5 of Title 16 of the
California Code of Regulations. The department shall review these
regulations five years after adoption and shall report to the
Legislature regarding any proposed changes. Flexibility shall be
considered by the department for rural general acute care hospitals
in response to their special needs. As used in this subdivision,
"hospital unit" means a critical care unit, burn unit, labor and
delivery room, postanesthesia service area, emergency department,
operating room, pediatric unit, step-down/intermediate care unit,
specialty care unit, telemetry unit, general medical care unit,
subacute care unit, and transitional inpatient care unit. The
regulation addressing the emergency department shall distinguish
between regularly scheduled core staff licensed nurses and additional
licensed nurses required to care for critical care patients in the
emergency department.
(b) These ratios shall constitute the minimum number of registered
and licensed nurses that shall be allocated. Additional staff shall
be assigned in accordance with a documented patient classification
system for determining nursing care requirements, including the
severity of the illness, the need for specialized equipment and
technology, the complexity of clinical judgment needed to design,
implement, and evaluate the patient care plan and the ability for
self-care, and the licensure of the personnel required for care.
(c) "Critical care unit" as used in this section means a unit that
is established to safeguard and protect patients whose severity of
medical conditions requires continuous monitoring, and complex
intervention by licensed nurses.
(d) All health facilities licensed under subdivision (a), (b), or
(f) of Section 1250 shall adopt written policies and procedures for
training and orientation of nursing staff.
(e) 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.
(f) 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
Sections 70016.1 and 70214 of Title 22 of the California Code of
Regulations.
(g) Requests for waivers to this section that do not jeopardize
the health, safety, and well-being of patients affected and that are
needed for increased operational efficiency may be granted by the
department to rural general acute care hospitals meeting the criteria
set forth in Section 70059.1 of Title 22 of the California Code of
Regulations.
(h) In case of conflict between this section and any provision or
regulation defining the scope of nursing practice, the scope of
practice provisions shall control.
(i) The regulations adopted by the department shall augment and
not replace existing nurse-to-patient ratios that exist in regulation
or law for the intensive care units, the neonatal intensive care
units, or the operating room.
(j) The regulations adopted by the department shall not replace
existing licensed staff-to-patient ratios for hospitals operated by
the State Department of State Hospitals.
(k) The regulations adopted by the department for health
facilities licensed under subdivision (b) of Section 1250 that are
not operated by the State Department of State Hospitals shall take
into account the special needs of the patients served in the
psychiatric units.
(l) The department may take into consideration the unique nature
of the University of California teaching hospitals as educational
institutions when establishing licensed nurse-to-patient ratios. The
department shall coordinate with the Board of Registered Nursing to
ensure that staffing ratios are consistent with the Board of
Registered Nursing approved nursing education requirements. This
includes nursing clinical experience incidental to a work-study
program rendered in a University of California clinical facility
approved by the Board of Registered Nursing provided there will be
sufficient direct care registered nurse preceptors available to
ensure safe patient care.