The California Department of Public Health (CDPH) recently released an All-Facilities Letter (AFL) on the nurse ratio regulations. In addition to restating the administrative penalties for non-compliance, AFL 23-27 clarifies what constitutes an “unpredictable” and “uncontrollable” situation affecting staffing levels which would excuse non-compliance.
For example, CDPH will not consider staff callouts during flu season to be unpredictable and uncontrollable, unless those callouts are truly at an unprecedented level.
As a reminder, the ratio penalty statute states the following:
A general acute care hospital shall not be subject to an administrative penalty if the hospital demonstrates to the satisfaction of [CDPH] all the following:
- Any fluctuation in required staffing levels was unpredictable and uncontrollable.
- Prompt efforts were made to maintain required staffing levels.
- In making those efforts, the hospital immediately used and subsequently exhausted the hospital’s on-call list of nurses and the charge nurse.
CHA believes that, by releasing this letter, CDPH intends to signal stronger enforcement of the ratio requirements soon. CHA recommends the following:
- Hospitals should review the regulations and their written policies related to nurse staffing and confirm that actual practice aligns with both.
- Hospitals should document callout levels and all efforts made to maintain staffing levels.