"ratios"? and pay in California? - page 4

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   NewJA
    Quote from NurseguyFL
    I know I am coming in on the back end of this discussion, but I want to add my 2 cents to a comment Lizz made about ratios in California. Yes, the law is a good thing but what others have said about the rules being broken in some hospitals is also true. No I am not talking about emergency situations, but cases where the hospital deliberately and repeatedly violates the law. I came to California as a traveler, and until recently I was working at an HCA facility that does this on a fairly regular basis. They do not like to spend money on registry nurses, although in many instances they have been forced to because they often don't have enough staff nurses (and after being there for only a short while I could understand why!)

    When a nurse goes on his/her breaks this hospital hospital expected that those of us who are on the floor should cover the patients, even if we already have the maximum of five patients. If you refused they would try to find ways to penalize you. What they often do when they are short staffed is tell nurses not to clock out when they take their breaks, but to just go and come back within the allowed time. Then they ask us to fill out a 'missed break' form which states that we did not actually take a break because of the need to stay in ratio. There is no doubt in my mind that this is both fraudulent and illegal because we were signing a document which states that we missed our breaks when we, in fact, took them and were off the floor, and our five patients were, during our break time, divvied up among other nurses, all of whom already had five patients. Since there were usually at least two nurses off the floor on these 'unofficial breaks' at a time, the nurses who were on the floor ended up carrying 6 or 7 patients (sometimes eight, depending on the census) each during the break periods.

    So far they have been getting away with it because there is no punch clock evidence to prove that nurses actually leave the floor for two 15 minute breaks and a 30 minute lunch break. If one were to add up all these minutes for every nurse, it would amount to quite a few hours of being out of ratio every week and this is routine, not an emergency. This may seem like no big deal to some people, but it could very easily escalate into a huge deal if something seriously bad happens to a patient that we are supposed to be responsible for during those 15 or 30 minutes while we are gone. If the worst happens, I can easily see the hospital pointing fingers at the nurses for being off the floor on unauthorized breaks, and there would be no official record of anything to prove otherwise.

    It is not a secret that HCA doesn't have the best reputation when it comes to ethics, but from what I've heard they are not the only ones that are doing this. The entire time I was working there I was always very nervous that at some point state regulators would bust the place and that I could possibly lose my license for wilfully committing fraud and patient endangerment. It was shocking to me that so many of the staff nurses who were working at this particular hospital didn't seem to think anything of it, I guess because the practice has become an acceptable part of the culture.

    This is also one of the hospitals that had removed most of the nursing assistants from the floors, so most of the time we had no help with moving or turning heavy patients, had to bathe all our patients and change bed linens, pass meal trays, etc. Often there is no secretary, and sometimes no charge nurse either so we were pretty much on our own there, too. I hear that no traveler ever renews his/her contract at this hospital and they are always trying to hire because the nursing turnover is so high. The effects of the neverending drive to cut costs were also unbelievably bad and the deteriorated state of the facility itself was nothing to be desired. I understand that these for-profit hospitals need to make money for their shareholders but some of what I have seen is just ridiculous, unsafe, and unsanitary. Workorders to fix broken beds and faulty bathroom fixtures are always being put in, but no one shows up to do the repairs until several days later. In the mean time, patients are going into other patients rooms to use the toilet because the toilet in their own room doesn't work and has unflushed excrement sitting in it for days.

    And did I mention the faulty equipment? Nurses fight for a functional med cart at the beginning of each shift because some of them do not work. The batteries in the med cart computers are so old that they don't hold a charge for long so they keep cutting off and you have to keep moving furniture to plug them in as you push the cart from room to room. Then there is the huge problem of clutter in all the hallways on the floor becuse this is where all the med carts and blood pressure machines are plugged in, and also where wheelchairs, repiratory equipment, and just about every other device is 'parked'. I don't know how the fire marshall allows them to get away with this because it is a HUGE fire hazzard. In case of a fire, I don't see how they expect to quickly move the patients out with all that stuff cluttering up the halls. I've never seen such a thing in any other hospital where I'ved worked, and when I raised it as a safety issue people looked at me as if I'm crazy. Another issue I had with these med carts is that they are never sanitized by housekeeping, and we were not given any cleaning materials to do it ourselves even though we had to push these carts into isolation rooms to scan the patients.

    And most annoying of all was the discharge planning nurse, who would always show up at the busiest time of the morning demanding that we all drop everything that we are doing to give her report on all our patients. I never understood that one because all the information she is asking us for she could just as easily have gotten from the patients' charts herself. Its supposed to be her job to talk to the patients, their families, the physicians, and coordinate the discharge plan with whatever facility or home health care they are going to, but she would always find some way to put all of that responsibility on the nurses and then disappear until long after the patients are gone, then she would come back asking for another report!

    I would never work at an HCA facility again, not in California or anywhere else. It was a good learning experience though because at least now I know exactly what questions to ask before accepting another travel gig.






    When you feel like complaining, just think of how much worse things could be, and that should brighten you right up.

    If the patient is not at risk, then don't complain. If the patient is at risk, then don't gripe, just try to do something about it.
    Last edit by NewJA on Jun 5, '07
  2. by   NurseguyFL
    Jeff A,
    Good nursing care is not just about earning high salaries, and I seriously doubt that most of us in this profession are doing it just for the money. (Quite honestly, I don't think we get paid anywhere near enough for all the responsibility we take on with each patient. But, we do it anyway because we want the best outcomes for our patients.)

    The point I was making in my previous post is that there's an important quality issue that some hospital administrators give a lot of lip service to but purposefully fail to support because they're trying to save a buck. I understand your point, but I'm sure you realize that nursing and bricklaying are two very different things. The difference is that nurses are legally responsible for the safety of all the people in their care, and the implications of this are vast! Even simple mistakes (omissions or commissions) can have serious and lasting consequences, not just for the patients and their families but also for the nurse. For example, failure to pass critical medications on time because you couldn't get the med cart to work. If serious harm (or even death) comes to the patient as a consequence, the lawyers won't care about the problems you were having with your med cart. They are going to say that you were negligent, and the hospital will simply hire another nurse to take your place after the Board of Nursing takes your license away.

    True that some nurses complain a lot, but many times the complaints are legitimate.
    Last edit by NurseguyFL on Jan 5, '07 : Reason: grammar
  3. by   ivan57
    More about the pay factor. What is the going rate for experienced icu rn in souther CA compared the the bay area? What about doing per diem with a hospital (ie UCSF, UCSD)?
  4. by   NurseguyFL
    Quote from ivan57
    More about the pay factor. What is the going rate for experienced icu rn in souther CA compared the the bay area? What about doing per diem with a hospital (ie UCSF, UCSD)?


    I don't know if there's really such a thing as a 'going rate' for nurses in the Bay Area. People I've talked to when I was working up there tell me that how much you are able to get depends on how much experience and training you actually have. When I was working registry there I was making $605 per shift (including the time and a half rate after 8 hours). I knew people who were working per diem staff there who told me they were making more, and I believe it. The Bay Area is one of the highest paying area for nurses in the country, and the reason is probably because it costs a bundle to live there. If some Bay Area hospitals are paying new grads in the 70s per year to start, then its reasonable to believe that experienced unit nurses will make more.

    Pay in the southern part of the state is less, but, depending on where in SoCal you are, the cost of living is cheaper than it is in the Bay Area.
  5. by   SherBearRN
    I work in San Francisco and I was hired about 1 1/2 years ago as a new grad making more than $40/hr. Per diem rates at my hospital (I've heard) can go as high as $70/hr. We have several per-diem nurses from Texas and Colorado who work two week stretches and then go back home for a month.

    Depending on where you live can be expensive. I did live in Pacifica, CA right on the ocean. My one-bedroom, 632-sq. ft. apartment cost me more than $1,600/month. I moved to the East Bay area of Concord, and my rent is approximately $900 for a larger apartment. It's also in a safe neighborhood (unlike parts of Oakland). I commute on BART and it is reasonable.

    I think wherever you decide to live in California you will make it just fine on the nursing salary. If you want more specific information on my hospital, feel free to PM me.

    To NurseguyFL: I agree with you about HCA facilities. HCA is a for-profit hospital chain that is only concerned about their bottom line than their employees. Before moving to SF, I worked for one in Kansas. Not all hospitals in CA operate like what you experienced, though. If you travel again, ask for UCSF, Stanford, or my hospital, CPMC. You will have a more positive experience!
  6. by   DeeS
    Hi, I am new to this site and I am getting ready to travel out to CA to work. What hospitals in the Bay Area are the best? Do you know of any good companies to work for that provide RN's with Per diem work. I'm not ready for a 4 or 8 week contract. I will be in Livermore, CA in a few weeks visiting and thought I would checkout some hospitals and agencies. Any help is greatly appreciated.

    Thanks,
    DeeS
  7. by   Merced
    I think the "ratio requirement" is a huge step forward for delivery of quality care from RNs. Even when the hospital tries to bend the law by abuse of the "emergency" definition, the notion of what is a safe RN to patient ratio is still enshrined in state law and cannot be labeled as "nurses are just complainers".

    I would like to know the rationale for any nurse not seeing the benefit. Just because they are not a panacea (no such thing as a panacea in Health Care, when you're dealing with ill people, there's going to be difficulty and unhappiness involved, guaranteed).

    However, for nurses to whom it is important to hold their heads up because they can now provide quality care & go home feeling they have done their job well, I am unable to visualize a scenario that would make me "not a fan of ratios".

    (Unless I was an administrator trying to make $$$ by providing "just in time" staffing, or whatever the latest management jargon is for cutting workers to the bone).
  8. by   LadyNASDAQ
    Calif is one place where pay rates are crazy. The Northern end pays up to $80/hr! Can you believe that? Factor in the housing and you just squeak by.

    LA is perfect to work local agency. It is almost impossible to get cancelled. Such a busy place! If I worked there year around, I would be working local agency and have them supply my insurance for medical and dental. You'd be making around $40/hr. with ot available.
  9. by   GoodAsGoldRN
    Quote from jeff a
    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 wondering what is thry typical pay in california for a starting r.n.... i have seen everything from high twenties per hour to 40 per hour in that thread. is there really that drastic of a fluctuation from one place to the next?
    in the bay area, the pay will be approximately low 40's. of course, you will likely be starting out on the night shift as a starting rn.

    be prepared to take care of up to 5 patients total care, as there are several hospitals that have taken away the cna from the night shift. some floors will even lack a ward clerk/csa/transcription clerk/order entry cna.

    the higher acuity level the patient, the more likely there is to be a cna on the floor to help with the patient load. if a med/surg nurse experience is what you seek, that's probably not going to be the case.


  10. by   GoodAsGoldRN
    Quote from nurseguyfl
    i don't know if there's really such a thing as a 'going rate' for nurses in the bay area. people i've talked to when i was working up there tell me that how much you are able to get depends on how much experience and training you actually have. when i was working registry there i was making $605 per shift (including the time and a half rate after 8 hours). i knew people who were working per diem staff there who told me they were making more, and i believe it. the bay area is one of the highest paying area for nurses in the country, and the reason is probably because it costs a bundle to live there. if some bay area hospitals are paying new grads in the 70s per year to start, then its reasonable to believe that experienced unit nurses will make more.

    pay in the southern part of the state is less, but, depending on where in socal you are, the cost of living is cheaper than it is in the bay area.
    i did marketing and recruitment for a local agency for awhile last year. (i have one favorite agency that i work for every once in a while as an rn.) i can tell you from personal experience that the hospitals have gotten smart in their staffing practices.

    it used to be that you made more money as a traveler/agency nurse than as a staff nurse. not anymore. it pays to find a hospital to get hired on with versus working for an agency in this neck of the woods.

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