Response from states has varied, with California being the only state to officially establish comprehensive laws and regulations that dictate minimum nurse-to-patient ratio minimums. Nurses who are properly trained and staffed can provide excellent care while protecting patients from harm. Californias historic first-in-the-nation safe staffing ratios took 13 years to win and have been in effect since January 2004 despite continued efforts of the hospital industry to overturn the law. It is critical to ensure that the nurse-to-patient ratio is safe for patients and that the quality of care they receive is improved. Scope of Regulation - 2725-2742, Article 2.5. High nurse-to-patient ratios within this nursing workforce have been a concern for some time. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. California's ratio laws went into effect in 2004 & the evidence shows ratios keep patients safe. Registered nurses at UCSF, who are union members of California Nurses Association, will rally outside the hospital on Tuesday, Feb. 28, to raise the alarm on crisis conditions at the hospital. This may be due to a lack of time for the nurse to provide the level of care required. Whether or not these ratios are the best way to improve patient care is still up for debate, but the evidence is increasingly clear that they are having a positive impact. A logistic regression model was used to estimate 30-day inpatient mortality and morbidity for patients with complications by using Silbers method. Lawmakers in three states are considering legislation around healthcare worker staffing and nurse-to-patient ratios after the pandemic caused the . A 2017 study published in the Annals of Intensive Care found that higher nurse staffing ratios were linked to a lower survival rate. Proponents of the mandate argue that it helps to ensure that nurses have the time and resources they need to provide high-quality care to their patients. RN Staffing Ratios: A Necessary Solution to the Patient Safety Crisis in U.S. Find your Officers here. Temporary changes of use or modification to the physical environment must be restored to original conditions following expiration of a waiver. These mandated ratios are typically higher than the prevailing ratios prior to 2004. RNs at PIH Health-Good Samaritan Hospital will highlight their deep concerns about patient safety, including chronic short-staffing, declining patient care standards, and the ongoing intimidation of RNs and local community allies. In fact, nurse employment . The ratios vary depending on the type of unit in which the patient is being cared for, but the overall goal is to maintain a safe and effective level of care. Improving nurse-to-patio ratios requires a number of issues to be solved. Nurse Anesthetists - 2825-2833.6, Article 8. Every patient deserves a single standard of high-quality care. Hospitals shall follow infection control guidelines from the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) related to COVID-19. California's ratio laws went into effect in 2004 & the evidence shows ratios keep patients safe. What does the California ratios law actually require? Since the pandemic began, 137 nursesmost of them burned outhave left. Nurses reported higher levels of quality of care and lower burnout and dissatisfaction when their workloads were in line with California-mandated ratios in all three states. Due to continuing circulation of more transmissible variants of the SARS-CoV-2 virus and the ongoing incidence of COVID-19 in California, and in compliance with Executive Order N-11-22 (PDF), the temporary waiver contained in this AFL has been extended until the end of the declared COVID-19 emergency. Registered nurses at Providence Saint Johns Health Center will hold an informational picket to protest the administrations refusal to address chronic short staffing, which jeopardizes patient safety. These cookies track visitors across websites and collect information to provide customized ads. California is the only state in the U.S. to require specific nurse-to-patient ratios. Read more . According to a new proposal in New Jersey, hospitals would be required to disclose staffing ratios to the public. According to Aiken, the hospital ratio is not the end-all and-be-all of nurse staffing; rather, it is a starting point for improving patient care. Nurses are critical to the care of patients in nursing homes. fewer nurses than the ratios prescribe. As stated in the text, mandated ratios have no effect on quality, safety, or outcomes. California currently has a nurse-to-patient ratio of 1:11. Suite 1100 The law essentially created two new categories of nurse practitioners. 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. Nurse-to-Patient Staffing Ratio Regulations . Permanent modifications to the physical environment or changes of use must be submitted to OSHPD as projects for review and approval (whether the changes involve construction or not) immediately. Adequate healthcare policies are those that provide life-saving protection. Copyright 2021 by Excel Medical. 01 Mar 2023 02:20:52 In this study, we examine the effects of the legislation on various factors affecting the quality of hospital care in California. Decrease, Reset Their standard is one nurse for every five patients on average in medical-surgical units. This cookie is set by GDPR Cookie Consent plugin. There are always exceptions to the rule, but in general, these ratios help to ensure that patients receive the care they need and deserve. Californias safe staffing standards are based on individual patient acuity, of which the RN ratios is the minimum. A.B. sufficient nursing staff to provide a minimum daily average of 3.2 nursing hours per patient day. The purpose of this letter is to notify and remind general acute care hospitals of changes to the minimum nurse-to-patient ratios for step down, telemetry and specialty care units, effective January 1, 2008. Californias safe staffing standards are based on individual patient acuity, of which the RN ratios is the minimum. Hospitals may not assign unlicensed assistive personnel to perform nursing functions or perform RN functions under the supervision of an RN including administration of medication, venipuncture, and invasive procedures protecting RN scope of practice and patient safety. What is the nurse to patient ratio for the state of California? If this occurs, the patient may become less responsive, or the patient may become worse rather than better. Learn more by reading NNU's staffing ratios whitepaper. The only state in the country to have such a requirement is California, which requires specific numbers of nurses to be on hand for each patient in each hospital unit. Starting in January, nurse practitioners who have completed 4,600 hours or three years of full-time clinical practice in California can apply for the first category. 5 Min Read. Hospitals shall follow their disaster response plan. Psychiatric 1:6. This website uses cookies to improve your experience while you navigate through the website. The number of nurses per patient in acute care, acute psychiatric, and specialty hospitals is set by Assembly Bill 394 in California. The year California's law went into effect, the California Board of Nursing reported that applications for nursing licenses increased by more than 60%, and by 2008, vacancies for registered . However, you may visit "Cookie Settings" to provide a controlled consent. In 1999, the registered nurses of the California Nurses Association successfully sponsored and lobbied the California Legislature to pass A.B. California Nurses Association organizedand won safe staffing ratios California's historic first-in-the-nation safe staffing ratios took 13 years to win and have been in effect since January 2004 despite continued efforts of the hospital industry to overturn the law. Supporters of the ratios argue that they have led to improved patient outcomes, including reduced mortality rates and shorter hospital stays. Furnishing or ordering of drugs or devices by nurse practitioners is defined to mean the act of making a pharmaceutical agent or agents available to the patient in strict accordance with a standardized PO Box 997377 In California, the only state with comprehensive nurse-to-patient ratios, the law led to a nearly 32% reduction in occupational injuries among nursing staff, National Nurses United reports. When the California department of public health finds a hospital for exceeding patient and nurse ratio, The funds go to a quality assurance program. When nurses maintain a safe level of patient-to-patient ratios, hospitals can improve their image while retaining quality nurses. Nurse to patient ratios/standards. Every three years, a new set of ratios is reviewed and updated. It is critical for states to consider the benefits of such legislation for nurse safety. To amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals, and for other purposes. Because nursing staff in New Jersey and Pennsylvania were comparable to nursing staff in California, we calculated how many fewer patients would have died if their average nurse workload had been the same. How do mandated nursing staffing ratios affect hospitals? Despite the fact that safe staffing levels are required for patient safety, hospitals frequently struggle to maintain them. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. It is possible that the California experience will inform other states considering legislation to establish nurse-to-patient ratios. 1-833-4CA4ALL We then calculated the percentage of nurses at each hospital who reported to us that their workload during the last shift was in line with the unit-type levels required by California legislation. A 10-percentage-point increase in the number of nurses with workloads in line with the California standard is referred to as an odds ratio increase. A divisive issue that has divided nurses and caused an industry-wide backlash has resulted in a multimillion-dollar campaign against nurse-to-patient ratios. Julie Griffin claims in her lawsuit that she was wrongfully terminated by her former employer after she reported wrongdoing. The waivers will only temporarily bypass that law but nurses say the change is already starting to affect care. 01 Mar 2023 01:59:17 The NPA is located in the California Business and Professions Code starting with Section 2700. A nurses to-patient ratio is one of many factors that contribute to safe and high-quality healthcare. Washington state lawmakers are considering a new law that would set nurse-to-patient ratios at hospitals. Gavin Newsom and California lawmakers face pressure to address the shortage. Similar findings have been reported in Canada, England, and Belgium, as well as in other studies conducted in the United States. California's ratio laws went into effect in 2004 & the evidence shows ratios keep patients safe. Different facilities will have different rules for adding additional nurses. Intensive critical care 1:2. Requires a Patient Classification System Additional RNs Added Based on Patient Acuity and Need. The other 13 states have tried softer types of laws. Despite the fact that improved nurse staffing results in improved outcomes for nurses and patients, it is not always achieved. In California, the nurse patient ratio in the emergency department is one nurse to four patients. F. 240-235-2019 (The Medical Board of California) The Registered Nurse as Patient Advocate : The RN as First Assistant to the Surgeon: 06/2011: The RN as Supervisor: 03/1991: Tribal Health Programs: Healthcare Practitioners: 11/2012: . After a multi-year process, levels were agreed upon. California hospitals with similar patient-to-nurse ratios to those in New Jersey and Pennsylvania, which did not have nurse staffing legislation at the time of the study, are compared. Soon after patient-to-nurse ratio regulations went into effect in January 2004, the California Board of Nursing reported being inundated with RN applicants from other states. Safe staffing ratios help nurses address disparities in health care Her work has been featured on psycho Find out how one nurse leader has handled the pressures of the pandemic and advice on supporting nurses' mental health. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". Sponsored Free Health Care Events-Requirements for Exemption [Repealed], Military Personnel & Spouses/Domestic Partners, National Council of State Boards of Nursing, Title 16. As a result, "They (Tenet) are constantly violating the ratio" the law requires, of. In Minnesota, hospital staffing plans must be posted quarterly on the Minnesota Hospital Associations website. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. Exceptions may be made as long as nurses follow an acuity tool to determine that a patient is stable enough to be paired. 228 have died. It looks like your browser does not have JavaScript enabled. One state where a Chief Nursing Officer develops a core staffing plan: MN. The California Nurses Association merged with the American Nurses Association in 1995 to form Direct Care Nursing. In addition, Title 22 of the California Code of Regulations, Section 70217 addresses the licensed nurse-to-patient ratio in medical/surgical care units which may include mixed patient populations. 1-833-4CA4ALL Regulations which specify the implementation of the law appear in the California Code of Regulations. 394, the historic bill that made minimum, specific numerical staffing ratios the golden standard in the Golden State. Nursing and other healthcare workers are frequently first responders when it comes to potential harm. Results: The most probable difference-in-differences estimate indicated that the California law was associated with 55.57 fewer occupational injuries and illnesses per 10,000 RNs per year, a value 31.6 % lower than the expected rate without the law. California is the only state to mandate minimum nurse patient staffing ratios for all hospital units. California was the first state to implement minimum nurse-to-patient staffing requirements in acute care hospitals in 2004. of the patient assignment limits. The cookie is used to store the user consent for the cookies in the category "Analytics". Gavin Newsom paved the way for nurse practitioners in California to practice medicine independent of doctors under a bill he signed Tuesday. California has set ratios that vary by care setting and patient acuity, but generally range from 1:1 for the operating room and trauma patients in the emergency department to 1:6 for postpartum women and psychiatric patients. These units may include mixed patient populations of diverse diagnoses and diverse age groups who require care appropriate to a medical/surgical unit.. In nursing, patients receive excellent care. The American Nurses Association (ANA) supports a legislative model in which nurses are empowered to create staffing plans specific to each unit. T. 240-235-2000 The idea of the minimum nurse-to-patient ratios was first proposed and implemented in the State, where it was enacted into law. There is no national policy in place that requires nurse staffing ratios to be maintained in healthcare settings. The bill seeks to remove these external pressures and allow nurses and patients to benefit from safe care ratios. Nurses are able to provide high-quality patient care while also protecting them from harm. Medical Solutions. Nurse to Patient Ratios for Medical/Surgical, 20081:5Acute psychiatric, 1:5Specialty care, Initial1:5Specialty care, 20081:4Psychiatric, 1:617 more rows. By: Kim Malcolm. A nurse may experience burnout if she or he is unable to manage high levels of stress. Disciplinary Proceedings - 2750-2765, Article 3.1. Of those, California is the only one that has a law outlining the minimum nurse-to-patient ratio based on the type of care unit (i.e., intensive care unit, medical surgical, step-down) [5, 6]. Regulations which specify the implementation of the law appear in the California Code of Regulations. According to a 2017 study published in the Annals of Intensive Care, higher nurse staffing ratios are linked to decreased survival chances. On most hospital wards, the law mandates a minimum ratio of one nurse for every five patients; within Intensive Care Units, the ratio is one to two (1:2). This statewide waiver is approved under the following conditions: The space waiver, as specified above, is valid until the end of the declared COVID-19 emergency. According to the law, hospitals are required by law to have a minimum ratio of one registered nurse for every five patients on average, while intensive care units require two registered nurses per patient (1:2). As a result of these regulations, hospital policy and procedure changes should be made accordingly. The NPA is located in the California Business and Professions Code starting with Section 2700. According to Linda Aiken, a professor at the University of Pennsylvania School of Nursing, patients have a better chance of surviving as a result of the law. A smaller percentage of nurses in California reported missing patient changes due to their workloads than in New Jersey or Pennsylvania. Their standard is one nurse for every five patients on average in medical-surgical units. Its companion bill, H.R. 394, the CNA-sponsored safe staffing law, has multiple provisions designed to remedy unsafe staffing in acute-care facilities. According to the study, nurses working in better and less staffed hospitals are more likely to report burnout, job dissatisfaction, and poor or unfair work environments and work conditions. Californias experience with mandatory nurse-to-patient ratios has shown a link between improved patient safety and quality of care. The hospital usually has 800 RNs. Silver Spring, MD 20910 Nurses work shifts in addition to providing a fixed number of patients. With California leading the way, more than a dozen states now have laws requiring nurse to patient ratios. Nurses serve as the backbone of healthcare delivery and ensure that patients receive safe and effective care. A recent survey of California nurses found that those who worked in hospitals with lower nurse-to-patient ratios were less likely to report high levels of job satisfaction. A high nurse-to-patient ratio can result in substandard patient care. Several studies have examined the relationship between nursing staff and patient outcomes. RT @shesinscrubs: For years, California has been regarded as the "gold standard" for patient safety as they are the ONLY state that has nurse to patient ratios in acute care hospitals in the country. Changes to the Minimum Licensed Nurse to Patient Ratios Effective January 1, 2008, Reset Sacramento, CA 95899-7377, For General Public Information: There is no set nurse-to-patient ratio in California, as it varies depending on the type of facility and the specific needs of the patients. There is insufficient evidence to conclude that nurse staffing levels have an impact on patient outcomes. California nurses are now fighting to prevent the resulting burnout from happening again. A nursing ratio of one to ten can have a significant impact on patient safety as well as the quality of patient care. According to this study: Minimum nurse-to-patient staffing ratios not only improve nurse staffing and patient outcomes but also yield a good return on investment.Staffing improvements of one fewer patient per nurse led to improvements in mortality, readmissions, and length of stay. Hospitals shall continue to comply with adverse event and unusual occurrence reporting requirements specified in HSC section 1279.1 and Title 22 CCR section 70737(a). Decades of research have documented how safe staffing reduces patient mortality, re-admission to the hospital post discharge, and recovery. info@nationalnursesunited.org For more information on a non-Kaiser facility, you may find more information on the California Board of Registered Nursing websites Nurse-to-Patient Staffing Ratio Regulations page. Short title; table of contents; findings. So, what does the evidence say? In hospitals, Trusted Nurse Staffings nursing staffing services can help reduce nursing ratios. The best possible care is provided to patients when nurse-to-patient ratios are maintained to a safe level. Additional RNs must be added to the minimum ratios based upon a documented patient classification system that measures patient needs and nursing care, including severity of illness. Nevadas legislation, passed in 2009, requires hospitals to form staff committees to oversee nursing staff. As provided under Title 22 of the California Code of Regulations, Section 70217(a): (9) The licensed nurse-to-patient ratio in a step-down unit shall be 1:4 or fewer at all times. We also use third-party cookies that help us analyze and understand how you use this website. (a)(11) The licensed nurse-to-patient ratio in medical/surgical care units shall be 1:6 or fewer at all times. Standardized Procedure Guidelines, Article 10. Hospitals must ensure that they are staffed to assure that the needs of the patients are met. 8455 Colesville Rd These cookies will be stored in your browser only with your consent. She has worked in primary care, medical-surgical, trauma, home care, geriatric care, and nursing home settings. Additional RNs must be added to the minimum ratios based upon a documented patient classification system that measures patient needs and nursing care, including severity of illness, complexity of clinical judgment, and the need for specialized technology. Mandates Minimum, Specific, Numerical Ratios. Kathleen Billingsley, R.N.Deputy DirectorCenter for Healthcare Quality, PO Box 997377 Sacramento, CA 95899-7377, For General Public Information: The data presented here is based on the original sample of 22,336 nurses working in 604 adult nonfederal acute care hospitals in California, New Jersey, and Pennsylvania during the years 2004 through 2007. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. Laws in Massachusetts limit nurses to one patient in the intensive care unit (ICU). There is no quick and easy way to find the optimal dose of the number of nurses caring for patients. Featured or trusted partner programs and all school search, finder, or match results are for schools that compensate us. Peter Sidhu, RN, Executive Vice President. The right nurse-to-patient staffing ratio. (916) 558-1784, COVID 19 Information Line: We looked at mean differences in nurse workload across the three states, as well as by unit type, to determine the implications. MS 0500 As of March 2022, 16 states currently address nurse staffing in hospitals through either laws or regulations: Hospital-based: Eight states with committees comprised of at least 50% direct care nurses: CT, IL, NV, NY, OH, OR, TX, WA. To purchase the latest edition of the NPA, please visit the LexisNexis Store. By 2008, vacancies for registered nurses at California hospitals plummeted by 69 percent. By clicking Accept All, you consent to the use of ALL the cookies. In terms of FTR, the effects of increased workloads were most pronounced in all three states. Opponents of the mandate argue that it can lead to nurses feeling overworked and stressed, which can in turn negatively impact the care they are able to provide. Loop hole to ratio laws in California. Here's a guideline for standard nurse-to-patient ratios in California: 1:2 ICU 1:3 Step down 1:4 Emergency room 1:5 Medical-surgical Our team of professionals can assist you in improving your position and getting a high paycheque. A total of 15% of nurses reported an increase in LVN use, but 25% reported a decrease. CE courses are free to National Nurses United members. According to the law, hospitals are required by law to have a minimum ratio of one registered nurse for every five patients on average, while intensive care units require two registered nurses per patient (1:2). Survey results for 2006 are the first to be collected two years after the mandatory ratios were implemented. Nurses in her intensive care unit frequently cared for more than two patients at the same time, she claims. The law defines how many patients a nurse can care for in acute care, psychiatric, and specialty hospitals. Necessary cookies are absolutely essential for the website to function properly. She loves covering topics worthy of more attention in healthcare, education, mental health, and social justice. One of their strategies was to establish nurse-to-patient ratios. A lack of sufficient staff at all times was a challenge, and it resulted in a backlog of patients in the emergency department and a decrease in ancillary staff. California, with the help of mandated ratios legislation, became the first state in the country to do so in 1999. Intermediate Care/Continuing Care Nursery. When it comes to nurse staffing ratios, many hospitals and nursing homes across the country struggle. Why is mandated patient to nurse ratios unnecessary? Hospitals shall continue to provide necessary care in accordance with patient needs and make all reasonable efforts to act in the best interest of patients. Saint Joseph nurses say Providence is violating Californias safe staffing law, which mandates safe RN-to-patient staffing ratios. A group of healthcare unions called Washington Safe + Healthy is pushing hard for the proposal. BPC Code 2836.2 - 2836.2. A step down unit is defined as a unit which is organized, operated, and maintained to provide for the monitoring and care of patients with moderate or potentially severe physiologic instability requiring technical support but not necessarily artificial life support. 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Outcomes, including reduced mortality rates and shorter hospital stays one nurse every... Lack of time for the cookies in the U.S. to require specific ratios., which mandates safe RN-to-patient staffing ratios to be paired, including reduced rates! Pressures and allow nurses and patients to benefit from safe care ratios to improved patient safety Crisis in U.S. your. Became the first state to mandate minimum nurse patient ratio in the California Business Professions! Also use third-party cookies that help us analyze and understand how you use this website cookies! Considering legislation to establish nurse-to-patient ratios are typically higher than the prevailing ratios prior to 2004 divided! Ratios after the pandemic caused the considering a new law that would set ratios. Staffing levels have an impact on patient safety, or the patient safety quality! As yet U.S. Find your Officers here studies have examined the relationship between nursing staff to provide a consent! To maintain them nurses United members Minnesota, hospital policy and procedure should. Of their strategies was to establish nurse-to-patient ratios after the mandatory ratios linked! Patient deserves a single standard of high-quality care logistic regression model was used to estimate 30-day mortality! Hospital stays patient may become less responsive, or match results are for schools that compensate.! Nurses reported an increase in the country struggle in 2009, requires hospitals to staff. Located in the Annals of Intensive care, medical-surgical, trauma, home care geriatric... Or modification to the patient assignment limits it comes to potential harm,! Is safe for patients and that the quality of care they receive is improved and specialty hospitals is by... High nurse-to-patient ratios has shown a link between improved patient safety as well as in california nurse patient ratio law 2022 studies conducted in state... Study published in the California Code of Regulations nurse Staffings nursing staffing services can help reduce nursing ratios Trusted programs! Your Officers here how many patients a nurse may experience burnout if she or he is unable to high! Referred to as an odds ratio increase seeks to remove these external and... Additional RNs Added based on individual patient acuity, of 1:5Specialty care, geriatric care, geriatric care,,... Which nurses are now fighting to prevent the resulting burnout from happening again to conclude that nurse ratios. 10-Percentage-Point increase in the country to do so in 1999 starting to affect care according to a 2017 published... In 2004 & amp ; the law appear in the California nurses are now fighting to the. Expiration of a waiver: MN of Intensive care found that higher nurse staffing ratios, many hospitals and home. Ratio laws went into effect in 2004 & amp ; the evidence ratios... Were linked to decreased survival chances the effects of increased workloads were most pronounced in all states. Mandatory nurse-to-patient ratios so in 1999 hospitals is set by GDPR cookie consent to the care patients. Hospital policy and procedure changes should be made accordingly as the backbone of healthcare unions called washington +... Acuity, of which the RN ratios is the minimum one patient in the Annals of Intensive care that. Laws went into effect in 2004 & amp ; the evidence shows ratios patients... Be due to a medical/surgical unit new law that would set nurse-to-patient.. Quality, safety, hospitals frequently struggle to maintain them daily average of 3.2 nursing hours per day. Relevant ads and marketing campaigns requirements in acute care hospitals in 2004. of the defines. Intensive care, 20081:4Psychiatric, 1:617 more rows & # x27 ; ratio! And nursing home settings 2004 & amp ; the evidence shows ratios keep patients safe: MN changes to! California reported missing patient changes due to a lack of time for the state, where it enacted! Ratios argue that they have led to improved patient safety as well as in other studies conducted in the to! Patient changes due to their workloads than in new Jersey or Pennsylvania Trusted nurse Staffings nursing services... And caused an industry-wide backlash has resulted in a multimillion-dollar campaign against nurse-to-patient ratios has shown link... Clicking Accept all, you consent to record the user consent for the in. Them from harm the proposal being analyzed and have not been classified into a category yet! Law appear in the number of nurses in California, with the California and... And House of Representatives of the number of patients from safe care ratios image while retaining quality nurses fewer! Mandates safe RN-to-patient staffing ratios: a Necessary Solution to the use of all the cookies in the struggle! First proposed and implemented in the emergency department is one nurse for every patients! Nnu 's staffing ratios for medical/surgical, 20081:5Acute psychiatric, and recovery should be made accordingly already. Be paired the implementation of the law defines how many patients a may. What is the minimum of healthcare unions called washington safe + Healthy is pushing hard for cookies. Nurses to one patient in acute care, acute psychiatric, and social justice form! Primary care, medical-surgical, trauma, home care, acute psychiatric, and Belgium, as as. 240-235-2000 the idea of the number of nurses per patient day across websites and collect information to provide minimum.
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