Today's Law As Amended


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AB-2144 Staff-to-patient ratios.(2013-2014)



As Amends the Law Today


SECTION 1.

 Section 1276.45 is added to the Health and Safety Code, immediately following Section 1276.4, to read:

1276.45.
 (a) By January 1, 2016, the State Department of Public Health shall adopt regulations that establish minimum, specific, and numerical licensed nursing staff-to-patient ratios by licensed nursing classification and minimum, specific, and numerical ancillary staff-to-patient ratios for all health facilities licensed pursuant to Section 1250 that are operated by the State Department of State Hospitals.
(1) Administrative, supervisory, and non-unit-based staff shall not be included when calculating staff-to-patient ratios. Ratios shall be calculated on a unit-by-unit basis. Averaged figures across units shall not be used in determining staff-to-patient ratios.
(2) Under no circumstances shall the minimum, specific, and numerical licensed nursing staff-to-patient ratios by licensed nursing staff classification or ancillary staff-to-patient ratios be below the following standards for safe staffing and effective psychiatric care purposes:
(A) For long-term units, the ratio for each of the four ancillary staff classifications described in paragraph (1) of subdivision (g) shall be not less than one ancillary staff person for each 25 residents. Nursing staff-to-patient ratios for these units shall be not less than one licensed nurse or psychiatric technician for each six residents during day and evening shifts, and not less than one licensed nurse or psychiatric technician for each 12 residents during overnight shifts.
(B) For admissions units, the ratio for each of the four ancillary staff classifications described in paragraph (1) of subdivision (g) shall be not less than one ancillary staff person for each 15 residents. Nursing staff ratios for these units shall be not less than one licensed nurse or psychiatric technician for each six residents during day and evening shifts and not less than one licensed nurse or psychiatric technician for each 12 residents during overnight shifts.
(C) For units that have severely aggressive or severely self-injurious patients, including, but not limited to, enhanced treatment units and units that practice dialectical behavioral therapy, the ratio for each of the four ancillary staff classifications described in paragraph (1) of subdivision (g) shall not be less than one ancillary staff person for each 12 residents. Nursing staff ratios for these units shall be not less than one licensed nurse or psychiatric technician for each six residents during day and evening shifts and not less than one licensed nurse or psychiatric technician for each 12 residents during overnight shifts.
(b) The department shall review these regulations five years after adoption and shall report to the Legislature regarding any proposed changes.
(c) These ratios shall constitute the minimum number of staff 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.
(d) The department may grant a waiver to this section if the waiver does not jeopardize the health, safety, and well-being of patients and staff affected and is needed for increased operational efficiency.
(e) In case of a conflict between this section and any provision or regulation implementing that provision defining the scope of practice for nursing staff or ancillary staff, the scope of practice provisions shall control.
(f) The regulations adopted by the department pursuant to this section shall augment and not replace existing nurse-to-patient ratios that exist in law and regulation.
(g) For purposes of this section, the following definitions shall apply:
(1) “Ancillary staff” means rehabilitation therapists, licensed social workers, psychologists, and psychiatrists.
(2) “Nursing staff” means registered nurses and licensed psychiatric technicians.