"ratios"? and pay in California? - page 2

I keep seeing some mention of "ratios" in the "everybody moving to California" thread. But I have not seen any explanation of what that means. I'm wondering if someone could tell me. Also I am... Read More

  1. by   luv2shopp85
    You'd have to talk to the hospital you're interested in working at to get pay prices. I've talked to quite a few hospitals in orange county and the pay ranges from 26-30dollars an hour. When you say 30-40 dollars an hour I'm guessing that is i nthe San fransisco area because they get paid more.
  2. by   pickledpepperRN
    I work registry as well as my regular job. Critical care, telemetry, step down, and med-surg. Last year one place tried to keep 1:6 in med-surg when it went to 1:5. Another hospital will give a nurse 6 if there are dischare orders on one. Also sometimes there isn't meal and break relief.

    BUT most of the time the minimum ratio is met so far as I know.
    The big problem is the requirement to staff up when the acuity is high.
    It seems to be common to take a nursing assistant from the rest of the patients when one needs a sitter.
    Bad for our backs, patients are given a bed pan who should be assisted to the bathroom, and on days patients who need to be fed often get cold food, their meals are inturrupted so we can answer a call light, really heavy patients are not gotten up as they should.

    It is still much better than before the ratio law went into effect.
  3. by   RNmommy
    To clarify: In CA the ratio in Mother-Baby is 4 couplets-1, so basically 8-1, not 2 couplets as mentioned above.

    This is also the recommendation for patient safety from AWHONN. So, even though I am now in Texas where there is no "Ratio Law", we are maxxed out at 4 couples. I'm pretty sure that is how most hospitals do it.
  4. by   pickledpepperRN
    Quote from RNmommy
    To clarify: In CA the ratio in Mother-Baby is 4 couplets-1, so basically 8-1, not 2 couplets as mentioned above.

    This is also the recommendation for patient safety from AWHONN. So, even though I am now in Texas where there is no "Ratio Law", we are maxxed out at 4 couples. I'm pretty sure that is how most hospitals do it.
    This is true.
    Our post partum/couplet care unit staffs an LVN who assists two RNs with higher acuity patients with underlying illnesses such as post C-section, diabetes, asthma, or mental health diagnosis.
    There is also a charge nurse with no assignment and a nurse who can go to a delivery, relieve for meals and breaks, or take admissions.
    There is always an RN assigned to the nursery for when mothers request or need it.

    Here is a link to the ratio regulations:
    http://www.dhs.ca.gov/lnc/pubnotice/...ation_Text.pdf
    Here is the web site on the ratios: http://www.dhs.ca.gov/lnc/NTP/default.htm
  5. by   rosie26
    wow Halinja- only 23$ hour??? where are you?
  6. by   Halinja
    Quote from rosie26
    wow Halinja- only 23$ hour??? where are you?
    Beautiful sunny (and somewhat air quality challenged) Kern County.
  7. by   Jokerhill
    We are not in the ratio requirement alot. You do know there must be someone to relieve you when you are on a break that does not have another assignment. If you just rely on one another you are not in compliance. At no time should there be a nurse with twice the responsability of what the ratios call for. There are many times when we are out of compliance as well, there is just not enough of us and the population is growing all the time. We use alot of travlers and floats, but to fix our problem the hopital is just going to have to increase wages and improve the benifits or we will never have enough nurses. At one time both were the best in town but those days are long gone. The pay is now 10% below other local hosp.'s and they are getting a 23-28% raise over the next 3 years. So in our place even the light at the end of the tunnel has been turned out to save money. And the mass exadis is comming soon Ratios be dambed.
  8. by   luv2shopp85
    What if nurses call off and there is no one to cover for them? Won't this increase the nurse to patient ratio and theres nothing you can do about it? The nurses can't just say well i can't have more than 5 patients so i'm not taking any of the other nurses patients.
  9. by   DeepFriedRN
    I know that several hospitals in my area have cut the use of aides altogether. I also know that where I work when a sitter is needed it comes out of our staffing already on the floor- we don't get any extra staff. So basically I believe that the ratio concept is an excellent one, however I don't think it solves everything. Because it only regulates the use of licensed personnel, many hospitals have just gone ahead and cut out CNA's altogether. (2 in my area have) And I have personally seen hospitals in noncompliance. I've not worked outside of Cali., so I don't have that perspective, but I don't think the ratios are the magic formula.
  10. by   Sheri257
    Quote from luv2shopp85
    What if nurses call off and there is no one to cover for them? Won't this increase the nurse to patient ratio and theres nothing you can do about it? The nurses can't just say well i can't have more than 5 patients so i'm not taking any of the other nurses patients.
    Actually, I've seen nurses refuse extra patients first hand. I've even seen nurses refuse to take full loads allowed under the law because even though it was less than the ratio law requires ... they had too many critical, high acuity patients.

    I've never actually seen management force nurses to break ratios. For one thing ... that's what charge nurses are for ... to fill in when people call in sick, etc.

    However, if management tries to break ratios there are several things you can do. For one thing, you can report the violation to the Department of Health. If you work for a union hospital, you can also get the union involved.

    And, under California laws and regulations, you can file an incident report stating that management is breaking the law and giving you an unsafe assignment so, if anything bad happens ... the liability is on them, not you. You can also do this even if they stay within ratios but assign you too many high acuity patients.

    Also, if somebody calls in sick at the last minute or whatever and you've already worked a full shift ... you can give them four hours notice that if they don't find a replacement after that four hours you are unsafe ... and you are no longer obligated to take those patients. You will not be charged with patient abandonment by the board as long as you document that notice.

    From what I understand, they cannot legally fire you for doing any of these things. But, you're probably more protected with a union hospital because they cannot fire you without cause. As long as you document the ratio violation ... they're not going to have a leg to stand on in that case.

    :typing
    Last edit by Sheri257 on Nov 16, '06
  11. by   Tanningtulip
    Every hospital that I have talked to still has nurses aides. We need them even though they don't provide you with nearly enough. The patients in the hospitals now are really sick and it takes two people to turn them etc. I always end up helping my aide but I don't mind.
  12. by   UKRNinUSA
    All I know is that before the ratios went into effect I had no real control over patient assignments. I remember working registry at an LA hospital med/surg floor in the late 90's and having 11 patients and half a CNA to help out (the CNA had an assignment of 25 patients). It was all I could do just to pass the meds, hang the IV's, turn/change the most vulnerable patients (every 4 hours) and make sure everyone was still breathing. And these were sick patients!
    Now we have mandated ratios and I get to give the care I was educated to provide. I worked at one facility recently where there was a dedicated break nurse assigned just to fulfill the ratio requirements and so for the first time in my nursing career I actually got ALL my breaks- even the 10 minute ones. Sure emergencies would crop up from time to time, but most of the time, most of us got most of our breaks. It's not perfect, it's not foolproof, but it is a heck of a lot better than it was. I no longer daydream about the day when I finally get out of nursing or get up in the morning to dread going to work.
    Since I came over in the early nineties, my pay has more than doubled and I am finally recognized for my years of experience (the pay scale rewards years of experience rather than years of service).
    Thanks, California Nurses Association!
  13. by   Sheri257
    Quote from Tanningtulip
    Every hospital that I have talked to still has nurses aides.
    Every hospital I've been in still has aides also. I've heard of a few cutting aides but, I haven't actually seen it.

    :typing
    Last edit by Sheri257 on Nov 20, '06

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