Statewide and national impact of California's Staffing Law on pediatric cardiac surgery outcomes.

OBJECTIVE: The objective of the study was to examine the impact of staffing ratios on risk-adjusted outcomes for pediatric cardiac surgery programs in California and relative to other states combined. BACKGROUND: California performs 20% of the nation's pediatric cardiac surgery and is the only state with a nurse ratio law. Understanding the imposition of mandated ratios on pediatric outcomes is necessary to inform the debate about nurse staffing. DATA SOURCES: Patient variables were extracted from the Healthcare Cost and Utilization Project Kids' Inpatient Database. The American Hospital Association database was used for institutional variables. METHODS: Descriptive analyses were used to identify and describe patient, nursing, and hospital characteristics. Changes in nursing ratios and full-time equivalents (FTEs) between 2003 and 2006 were examined. Associations between nursing characteristics and each outcome variable were examined using general estimating equation models. The RACHS-1 (Risk Adjustment for Congenital Heart Surgery) risk adjustment method was used for mortality. RESULTS: Hospitals in California significantly increased RN FTEs (P = .025) and RN ratios (P = .036) after enactment of AB 394 in 2006. Neither RN FTEs nor RN ratios were associated with mortality, complications, or resource utilization after risk adjustment. After the law, California's standardized mortality ratio (SMR) decreased more (33%) than in all other states combined (29%). Standardized complication ratio (SCR) increased by 5% but decreased by 5% for all other states combined, and the increase in charge differential ($53,443) was more than twice the increase ($23,119) for other states combined. CONCLUSION: Hospitals in California made upward adjustments in nursing FTEs and ratios after enactment of AB 394. There was a substantial increase in California's charge differential, a decrease in SMR, and an increase in SCR after enactment of the legislation.

Preoperative consent: how to make sure your practice is legal--Part one.

Perioperative practitioners encounter consent issues constantly in their practice, both in terms of the main procedure listed and procedures they will undertake personally to enable the main procedure to be carried out safely. The law on consent has previously been governed by case (common) law but is now also partly governed by the Mental Capacity Act 2005 (MCA) (HMSO 2005). The onus is on practitioners to ensure that their practice is legal. This article and the subsequent companion article aim to emphasise the key legal points.

Registered nurse circulator legislation in Connecticut.

Developing regulations or legislation in every state to mandate an RN as the circulator in operating and invasive procedure rooms is critical to patient safety. Current regulatory language is ambiguous and may lead health care facility administrators to consider using licensed practical nurses, licensed vocational nurses, or surgical technologists in the circulator role. The State of Connecticut currently has no legislative or regulatory language regarding the RN as circulator, but some nurses are trying to change this. Communication with state legislators, has made it clear that legislators are in need of education about perioperative nursing and the circulator role.