AB 1422, Gabriel. Health facilities: critical care units: critical care unit program flexibility.

Nurses are both compassionate caregivers as well as devoted patient advocates, which is why it is so important that they have a voice in critical hospital safety decisions. The author states that nurse-to-patient ratios protect patients and are instrumental in ensuring high-quality patient care. The author notes that the current process doesn’t provide an adequate opportunity for nurses to
provide input about decisions impacting care, and this bill will improve transparency and
accountability by providing the public and our frontline healthcare workers the opportunity to provide public comment on program flexibility requests.

Services Employees International Union California and United Nurses Associations of
California/Union of Health Care Professionals are the sponsors of this bill and state that this bill
guarantees a nurses’ right to safely voice their concerns regarding changes to patient care and
staffing when hospitals request program flexibility and negatively impacts nurse-to-patient
ratios. The sponsors note that this bill is a crucial step to ensure that program flexibility requests
do not compromise patient care and safety. AB 394 set the minimum ratio of nurses-to-patient by
unit. These ratios, enforced by DPH, are outlined in Title 22 of the California Code of
Regulations. Though these ratios are mandated by law, hospitals repeatedly violate staffing
requirements due to lack of enforcement. From 2008 to 2017, there were 634 out-of-ratio
deficiencies reported to DPH. The sponsors also state that during the COVID-19 Pandemic,
hospitals were granted broad authority to bypass the nurse-to-patient ratio; nurses were often
forced to take more patients than a ratio prescribed by state law with no input into if their
assignment is safe.

This bill would additionally require any program flexibility granted by the department or the Department of Health Care Access and Information to not jeopardize the health, safety, and well-being of patients. The bill would specifically authorize the department to grant a critical care unit program flexibility request pursuant to a prescribed procedure that includes, among other things, a requirement that, on and after January 1, 2023, the department post a critical care unit program flexibility request on the department’s publicly accessible internet website and solicit public comment on the request. On and after January 1, 2023, the bill would also require a health facility that submits a critical care unit program flexibility request to also post its critical care unit program flexibility request form and immediately notify affected employees, as specified. The bill would require the department to post on its internet website specified information, including a list of health facilities with approved critical care unit program flexibility, on or before February 1, 2023.

Requires the Department of Public Health (DPH) on or before March 1, 2022, to create a
standardized form for any critical care unit program flexibility request. Requires a health facility
that submits a critical care unit program flexibility request to conspicuously post a copy of the
request in a location accessible to patients and employees. Requires DPH to post all approved
requests by a health facility for critical care unit program flexibility on its internet website and
include specified information.

Here is the link to the program flex request: https://caflexinfo.powerappsportals.us/

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