A: You can tell by your hourly rate, assuming you are being paid correctly. Check your paycheck report for your hourly rate (if you don’t already know your exact rate) and look at the wage scale for the current year. When you find your hourly rate, you will also find your Step level.

Q: My manager wants to speak to me about an issue and I am concerned I may be in trouble.

A: You have a right to have a union representative present at any meeting that may potentially result in discipline. This is called your Weingarten Right and it is protected by law. Tell your manager that you want a CRONA representative for the meeting. Then contact us right away! See the Contact page to request a Nurse Advocate.

Q: Where can I find how many weeks of pre-approved vacation I can schedule?

A: That is in the Vacation Policy on the hospital intranet. This policy is protected by a contractual agreement that the hospital cannot change the policy. For new hires through three years’ employment, you may schedule a maximum of two weeks of pre-approved vacation and up to 40 hours of pre-approved Education time; for four through nine years, the maximum is three weeks of pre-approved vacation and up to 40 hours of pre-approved Education time; for Nurses with ten or more years, you may schedule a maximum of four weeks of pre-approved vacation and up to 40 hours of pre-approved Education time.

Nursing Practice & Legal Issues

Articles about topics in the law that every Nurse should know.

Meal and Rest Breaks – Know the Law

Excerpted from CRONA Newsletter, November 8, 2019 *

Your break time is important. The hospital must provide you all of your breaks, and the unit must remain within ratio when you are on your break. For a 12-hour shift Nurse, that means you must be able to take three paid 15-minute uninterrupted rest breaks and one unpaid 30-minute uninterrupted meal break during each shift.

This article summarizes the key rules to remember regarding breaks, your responsibilities, and why it matters that we all take our breaks – for ourselves, our co-workers, and our patients. Please contact CRONA if you have questions.

THREE RULES TO REMEMBER REGARDING BREAKS

1. The Hospital Must Provide You All Your Rest and Meal Breaks on Each Shift.

The Hospital must provide you a reasonable opportunity to take each of your breaks.
For a 12-hour shift Nurse, this means three paid 15-minute rest breaks and one unpaid 30-minute meal break during each shift.
For the full duration of each break, you must be relieved of all duties and the Hospital must relinquish all control of your activities.
If you go on a break and are asked to return early or asked to do any work while on break, that break does not count as a break. You must be provided time for a full uninterrupted break.
The Hospital must not impede or discourage you from taking any of your breaks.

2. The Unit Must Remain within the Required Nurse-to-Patient Ratios When Any Nurse Is on Break.

The unit must remain in ratio at all times, including when a Nurse is on break. A Nurse on break does not count in the ratio.
As a general matter, meeting the Title 22 ratio requirements means that each Nurse’s patient assignment must not be over ratio by both number of patients and patient acuity.
If a Nurse “covers” a break for another Nurse, the covering Nurse is responsible for every patient in the assignment, and this combined assignment must be within ratio by both total number of patients and patient acuity. The Nurse who covers your break is responsible for all patient care until you return from break.

3. If You Are Not Provided Opportunities to Take All Your Breaks, You Are Entitled to Missed Meal/Missed Break Penalty Pay.

If you are not provided all of your 15-minute uninterrupted rest breaks, you are entitled to a “missed break” penalty of one hour of pay. The penalty is one hour of pay for each day with a missed break, regardless of how many breaks you missed that day.
If you are not provided your unpaid 30-minute uninterrupted meal break, you are entitled to a “missed meal” penalty of one hour of pay.
Missed meal penalty pay and missed rest break penalty pay are separate. If you miss both a 15-minute rest break and your 30-minute meal break on the same day, you are entitled to two (2) hours of penalty pay.
If you go on a break and are asked to return early or asked to do any work while on break, that does not count as a break. You must be provided all your required breaks without interruption, or you are entitled to missed break or missed meal pay.

WHAT ALL NURSES SHOULD DO TO PROTECT YOUR BREAKS

1. Take Your Breaks, and Claim Missed Meal/Break Penalties When Breaks Are Not Provided:

When you are offered a break, take it – unless doing so would compromise patient care or violate staffing ratios.
Do not do work while on your break.
If you do not receive all of your breaks, make sure to claim the missed meal/break penalty.
“See Something, Say Something” – file an ADO (Assignment Despite Objection) form if your unit is too short-staffed to provide breaks.

2. Account For All Missed Meals and Missed Breaks in API (SHC) or KRONOS (LPCH):

If you do not clock out for an unpaid meal break during your shift, API will automatically add a missed meal penalty. For LPCH, check the appropriate “missed break” or “missed meal” on the daily staffing sheet.
If you do not receive a 15-minute rest break, you will have to add the code to API. Under your last clocking for the day, add the Special Code “MBPR” to request the penalty pay. It is a good idea to include an explanation in the “requested reason” text box so your manager is aware of what happened.

3. Protect Against Improperly Modified Timecards:

Your manager should not modify your time card to add a clocking for a missed meal break you did not receive. Please notify CRONA immediately if this happens so we can follow up.
Some Nurses take a screenshot of their clockings on days they have missed a break, so they can compare their entries to their final time card. This is a good idea.
If your time card was modified by your manager and is no longer accurate, do not sign off on your time card at the end of the pay period. Instead, send your manager an email to report the inaccuracies as soon as you notice them. You can copy CRONA on the email.

4. What Resource Nurses Can Do to Help Nurses Get Their Breaks:

Ask a manager about getting a Float Pool nurse, contact the Nursing Supervisor, or ask management for other assistance to help cover breaks.
Encourage Nurses who missed breaks to add the missed meal/missed break penalty to API.
“See Something, Say Something” – file an ADO (Assignment Despite Objection) form if not all Nurses get their breaks. Document on the form why Nurses could not get their breaks, what you did to get help, who you told, and what was the result.
If you feel you are being harassed/intimidated by your manager when you report a missed meal or break, please notify CRONA.

WHY BREAKS MATTER

We Nurses are caretakers, and sometimes it is difficult to advocate for ourselves, or to see how advocating for ourselves is also advocating for other Nurses. When Nurses pass on taking breaks because the unit is busy, because they feel badly about burdening other Nurses with work while they are on break, or any of the other reasons Nurses give for giving up their breaks, it impacts every Nurse on the unit. When we give up our breaks, we contribute to a culture where that is expected, and it pressures everyone to do the same. When the work culture is bad like this, a Nurse who does advocate for herself and takes all her breaks can wrongly be seen by others as a troublemaker, or entitled. Please don’t let this be your unit’s work culture.

When Nurses get their breaks, we have the opportunity to rest, eat, and hopefully relax. Morale is better, we feel better, and we take better care of our patients and each other. When we practice advocacy and insist on our breaks, but have to take penalty pay because there isn’t sufficient staff to provide breaks, that helps communicate to the hospital that we are short-staffed and need to increase our staffing numbers and/or hire more staff. As long as we accept being short-staffed and overworked by giving up our breaks or not claiming missed break/meal penalty pay, that short-staffing and overworking will continue. Questions or issues? Please contact us at crona@crona.org

* Information in this article is current as of the date of publication of this newsletter. For most current information, please refer to most current version of state and federal laws and the CRONA contract.

Title 22: Nurse-to-Patient Ratios and Staffing by Acuity

Excerpted from CRONA Newsletter December 7, 2019

Nurse to patient staffing ratios are only a minimum baseline for staffing. Every unit must have a patient classification system (acuities) that defines how units are staffed. Every Resource Nurse should be knowledgeable about the patient classification system. If you haven’t seen the patient classification system for your unit, ask your manager.

The CRONA contracts also specify that a Resource Nurse may use professional judgement to determine staffing needs – keep reading for more information.

Does this mean that the total patients assigned to a nurse could be fewer than the basic ratio?

Yes. Staffing is determined by patient acuity according to the patient classification system. Depending on patient acuity, staffing needs may be more than the minimum according to ratio. For example, if patients are high acuity then the maximum number of patients assigned to a nurse in an ICU may be 1:1 instead of 1:2. How would a bedside nurse know if her assignment is excessive? By understanding the acuity of the patients.
The CDPH (California Department of Public Health) is the state agency responsible for public health, including licensing of hospitals and other health facilities, and enforcement of some California Health and Safety Codes. CDPH said this about staffing to patient acuity and ratios:
“It is imperative that hospitals staff according to patient acuity…It is far more important that hospitals pay attention to the patient classification system and the needs of the patient rather than the minimum staffing requirements.” -CDPH All Facilities Letter 07-26

What type of staff are included when determining staffing ratios?

Only the licensed nurses assigned to provide direct patient care to particular patients. There may be no averaging of the total licensed nurses on a unit. A nurse who is on a rest or meal break is not counted in the ratio while on break. A nurse who is off the unit to transport a patient (such as to CT scan or other testing) is not counted in the ratios for the patients who remain on the unit. A supervisor, manager, or Resource Nurse (Charge Nurse) may not be counted unless providing direct patient care. Float/breaker/Team Lead nurses are not counted in the ratios. When a Resource Nurse, float/breaker/TL nurse, or supervisor relieves a bedside nurse for a break, meal, or other routine absence from the unit, the Resource Nurse or other relieving nurse assumes full responsibility for the patient assignment and is counted in the staffing ratio only for the time spent relieving the bedside nurse.

Nursing assistants, unit clerks, and other staff are not counted in nurse to patient staffing ratios. Staffing for nursing assistants, sitters, patient companions, unit clerks, and other staff are determined by the unit’s patient classification system. A unit is still understaffed if the patient classifications system calls for non-nurse staff and those staff are not provided.

Who determines the patient classification system?

The hospital is required to have a written patient classification system. The reliability of the patient classification system for validating staffing requirements must be reviewed annually by a committee; at least half of this review committee must be bedside nurses. The hospital must have a documented process by which all interested staff may provide input about the patient classification system, the system’s required revisions, and the overall staffing plan. If you are interested in providing input about the patient classification system and do not know how to do this, ask your manager.

SB 227 Health and Care Facilities: Inspections and Penalties

Why does SB 227 matter? The short answer is money. When first enacted, Title 22 had no teeth. Hospitals could be cited for violations but there were no fines. SB 227 changed the law to impose fines if hospitals are found to be in violation of staffing requirements by both ratio and acuity, or if there is a deficiency that constitutes an immediate jeopardy violation. “Immediate jeopardy” means a situation in which noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to the patient. Fines range from $15,000 for first violation, then $30,00 for second and subsequent violations of staffing ratio laws; immediate jeopardy violation fines start at $75,000 for first violation, then $100,000 for second violation and $125,000 for third and subsequent violations. SB 227 was signed into law on October, 2019.

To read SB 227 for yourself: SB-227 Health and care facilities: inspections and penalties To read the nurse-to-patient ratio language: Title 22, Division 5, Chapter 1, Article 3, Subsection 70217

CRONA Nurses have additional protections

Our contracts provide that a nurse’s professional judgement is included in staffing decisions, combined with acuity and staffing matrices. Section 32.3.3.a (LPCH) or 33.3.3.a (SHC): “In meeting the staffing needs of the unit, the Resource Nurse is permitted to use judgment in adjusting staffing levels that may not be fully addressed by the acuity and staffing matrix.”

The contracts also require each hospital to have a Nurse Practice committee, a joint CRONA-Nursing Administration committee that may review each unit’s current acuity and matrix tool, and monitor the appropriateness of staffing levels by reviewing the Nursing Department’s benchmarks and quality indicators.

Who is on the Nurse Practice committee?

Regular readers of CRONA newsletters may recall that in July, CRONA requested volunteers to serve on the Nurse Practice Committee. At SHC, the CRONA members of the Nurse Practice committee are Colleen Borges, CRONA President; Kathy Stormberg, CRONA Vice President (Imaging Services Float Pool); Charon Brown (ICU J2, cardiac), and Annamarie Varo, CRONA Secretary (Operating Rooms). At LPCH, the CRONA members of the Nurse Practice committee are: Colleen Borges, CRONA President (Bass Center, pediatric hematology/oncology/BMT); Eileen Pachkofsky, CRONA Vice President (Bass Center, pediatric hematology/oncology/BMT); Carrie Bommarito (Neonatal Intensive Care Unit); and Nancy Uschersohn (Intermediate Care Nursery).

Competency: Required by law

By law, in order to be assigned to provide care, every nurse must demonstrate current competence in providing care in that area, and have also received orientation to that hospital’s clinical area sufficient to provide competent care to patients in that area. Even for providing breaks, a manager or supervisor must have demonstrated current competence in providing care on a particular unit.

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