By Michael Strauss, LVN
On Dec. 2nd, 2014, California prison healthcare officials implemented a statewide 1 to 100 nurse to patient med-pass staffing ratio. Basically, the ratio means each nurse is responsible to prepare and pass medications to 100 patients up to four times a day.
In addition to the new 1-100 ratio, prison healthcare officials reduced prison nursing staff through a layoff process. The layoffs took effect on the same day the new 1-100 nurse to patient ratio was implemented. Nursing staff was reduced and an increase in the number of patients we pass meds to was dramatically increased. In addition to the new staffing model’s implementation, the remaining nurses’ workloads were effectively doubled via new duty requirements.
Let’s look at how many nurses the private sector would need to have for 100 patients using private sector staffing ratios:
Hospital: 16 nurses per 100 medical – surgical patients
Rehab facility: 8 nurses per 100 patients
Skilled nursing facility: 4 nurses per 100 patients
The numbers I used for the private sector staffing levels are based on my own experiences as a private sector staff nurse plus state mandated nurse to patient ratios.
The private sector nurse does not have to contend with the typical barriers prison med pass nurses encounter on a daily basis, such as lockdowns, riots, staff assaults, inmate assaults, first emergency responders, etc.
One thing we share with the private sector is the fact all of us have a 2-hour window in which a scheduled medication must be administered to the patient. If a medication is to be given at 0800, the nurse has from 0700 to 0900 to legally administer the med. Our State Board of Nursing mandates this 2-hour window.
You may wonder how California prison healthcare officials concluded that a 1/100 nurse to patient med pass ratio in the prison system would work. I have wondered about the same thing and I truly have no idea how the ratio was decided upon. I do know the line nurses who pass meds were never consulted about the ratio. I also know it is ludicrous to believe one nurse can prepare and pass meds to 100 patients within a period of 2 hours.
It’s important to understand our patients have multiple medical problems, which require multiple types of medications. It’s not like the average patient receives one medication per day. It is not an exaggeration for me to say, using this new ratio, that one nurse could be expected to administer over 1000 pills to their patients during a single med pass.
I haven’t even factored in the time needed to complete the legally required documentation for each patient we administer medication to. Each nurse must document every single dose of medication given to the patient at the time the medication is given to the patient. There is also no agreement that triggers an addition of another medication nurse once our patient load exceeds 100 patients. Anyone looking at the numbers and documentation requirements has to be thinking how in the world all can be accomplished in 120 minutes. It can’t!
A California Correctional Health Care Services spokesperson admitted in a recent interview with the Salinas Californian newspaper that even though the prison population has decreased due to AB 109, those inmates left are a sicker population than those inmates who exited the prison. The same spokesperson also said it wasn’t the first time she’s heard nurses concerns over their proposed staffing model. The spokesperson said the receivership is awaiting the results of a study analyzing the amount of medical work versus the number of nurses. The spokesperson said she was unsure when the results of that study would be available.
So, let me be clear on what the spokesperson for CCHCS stated: By their own admission, the new staffing model was implemented without any studies or analyzing of the effects on the nurses’ ability to perform the expected duties.
In another article, a CCHCS spokesperson said the ratio of LVN’s to inmates would be closer to 1:68 once new medical staff is hired. Please excuse me for a moment as I step outside to scream. Did the same people who just finished laying off state nurses on Dec. 2nd really say they were going to lower the ratio once new medical staff are hired? It’s hard to believe a CCHCS spokesperson admitted all this in an interview and expected no one to comprehend the absurdity of it all.
It should be evident to anyone who read the spokesperson’s comments the receiver’s new staffing model was not something much thought was put into. It was only through the angry howls of protests by nurses and the intervention by our union that CCHCS officials put on hold and under review this new staffing models implementation.
CCHCS officials and our union reached an agreement, which required prison healthcare officials to examine the proposed staffing model at each individual prison before implementing any changes. The agreement included language basically ensuring the state will negotiate staffing arrangements locally at each prison with members of the union.
Even with this agreement in place some prisons have already implemented the new staffing model and, predictably, it has been a disaster for all healthcare staff involved.
Our mission as nurses is to provide the best care we can to our patients. The role of a prison nurse is complex but our role as nurses does not change. We provide care for our patients while working within a medical system that can best be described as archaic when compared with private sector facilities.
This new staffing model will drastically affect the quality of care prison nurses will be able to provide to our patients. The plan also places our nursing licenses at great risk while being expected to operate under such limited conditions. Even more troubling to me is that the court appointed receiver is even promoting a staffing plan doomed to failure. This plan is from the same federally court appointed receiver who was mandated to ensure quality medical care is provided to the inmate/patient.
Why we are being set up for failure remains the unanswered question and only one the receiver’s office can answer.