Nursing Rally 2/12 in Arizona

pererau · Jan 28, 2009

Oh poo! One more step closer to unionization. The nursing will really go in the toilet.

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Mandates Minimum, specific RN-to-patient staffing ratios based on acuity and not by numbers

Whistle blower protection for RNs who report unsafe hospital conditions or for refusing unsafe patient care assignments

Legal recognition of the right of the RN to act as an advocate for their patients rather then for the economic interest of their hospital employer"

I like the idea of safe patient ratios, but mandates - especially unfunded mandates that require laying a lot of money out - are rarely effective as desired and often have very unintended consequences. In this case, a lot of hospitals which are already facing sharply declining income would have to severely cut back in other important areas to address this mandate. Perhaps instead a carrot could be held out for facilities that take steps to ensure safe ratios.

Some day, I'm going to have to have somebody explain to me how refusing an "unsafe assignment" actually helps patient safety. You feel that 5 patients is too much for you, so you refuse. The result is that someone else has to pick up your slack and take those patients or the patients do not get care at all. Besides, who determines which assignments are unsafe? In my experience, the ones who would take advantage of this are the ones who will complain over anything not going exactly according to what they wanted. Maybe it is just because I'm an ER nurse and we don't get the cushy rules that floor nurses get - in the ER anything and everything comes at you and you don't have the luxury of saying no.

Finally, who determines where the line is between what the patient needs and what the bottom line of the hospital is? Again, the nurses who would take advantage of this are the whiny ones who aren't willing to flex as the situation requires.

Don't get me wrong, I think that patients will have better outcomes and less errors if there is a lower ratio, and I think that nurses shouldn't be walked over by management, and patient safety should not be endangered to save a buck; but remember that healthcare is very expensive and administrations are facing smaller profits and higher costs.

How about instead of unfunded government mandates and unionization, someone put together a website where nurses can indicate what the staffing ratios are at their facility as well as any patient safety concerns that they see - you know, kind of a hospital compare site, except this one would actually mean something. If we were able to see ahead of time what hospitals are good to the nurses and make efforts toward patient safety, then the market would work itself out. We would all flock to the hospitals that are good and leave the ones that are bad. If the bad ones want to stay solvent, they would have no choice but to improve. This is how the free market system works. The government mandate system works by loopholes. The hospitals look for what they can do to technically comply without actually making improvements, and without the ability to be flexible in applying safe practices to the idiosyncrasies of each particular hospital or unit.

How about telling the California Nurses Association to get back in California and ruin hospitals there instead of trying to infest Arizona with their poison.

dorimar, BSN, RN · Jan 29, 2009

Unfortunately, minimum mandates are sometimes necessary, and I think this will prove more so in this economy. As we are made to feel "lucky" to have a job in this market, we will be expected to sacrifice more and more. I am not whiny. I've worked the bedside for 24 years and probably would work circles around you. I actually did house supervisor for 1 year and was appalled at that administration's true attitude toward it's nursing staff. They did just look at numbers. That was what the staffing grid was based on. We had hell to pay if we deviated from it. I left that job out of principle and have stayed at the bedside ever since. I have worked in numerous places and they all do accuities now, but I have yet to see them truly utilized. Minimum ratios do not mean that accuities are not addressed. On the contrary. It states a minimum ratio (despite accuity), and if the accuity of the patient requires more nursing than that is also mandated. I have only refused one assignment in my 24 years at the bedside. I know this was the right thing to do for the sake of my patients. They payed the money to bring an extra nurse from the outside in, and it was for the best--period. It did not go unpunished, but I would do it again in the same situation, no doubt.

pererau · Jan 29, 2009

"They did just look at numbers. That was what the staffing grid was based on."

And that is exactly the problem. You are concerned that they only looked at numbers. That will only get worse when the law only requires them to look at the numbers.

I agree that something needs to be done when nurses are being abused, but that something is not unfunded mandates from above.

dorimar, BSN, RN · Jan 29, 2009

No... The law in CA speaks to MINIMUM ratios. As I stated, accuities are considered also. If the accuity requires MORE nursing than that is mandated as well.

Kindly do not quote bits and pieces of my posts and leave out other important statements that ultimately change the meaning of what i stated.

pererau · Jan 29, 2009

I understand what you are saying about what the law mandates and that is my problem - mandates only inspire people to look at numbers. It also inspires acuities based on staffing and not on acuity. How does the law define acuity, anyway? What acuity is a patient who has chest pain that is responding well to NTG? What if the 18 hour labs come back positive? Does the acuity change? What about the post-appy patient who is healing well, but then starts to show signs of infectin? What about the patient who you can't find anything wrong, but they get a little sundowners and lean on the call light? What about the TIA patient who is at risk for CVA but show no neuro deficit but requires hourly neuro checks?

Who determines what staffing level each of these require? What is the formula? You'll get your staffing ratio with some magic number for some formula-driven acuity level, and the management will see it even more as a numbers game and stick even more coldly to the minimum staffing ratio.

Mandates are not the answer.

cardiacRN2006, ADN, RN · Jan 29, 2009

Some day, I'm going to have to have somebody explain to me how refusing an "unsafe assignment" actually helps patient safety. You feel that 5 patients is too much for you, so you refuse. The result is that someone else has to pick up your slack and take those patients or the patients do not get care at all. Besides, who determines which assignments are unsafe?

For me, refusing an unsafe assignment means that my manager or house supervisor must watch the other patients until they find some kind of replacement.

And it's funny how a nurse magically shows up when the manager taking patients....

I determine if my assignment is unsafe. Unsafe for me and my license and unsafe for all the patients in my team. For me in the ICU, I will never accept that third pt. If they want to give it to me then too damn bad. And if they want to transfer it to me then too bad.

Staffing, pt safety and the protection of my license are all the priorities here. I could care less if the Hospital has to eat agency nursing costs. Maybe next time they will learn that we won't break acutities, and they need to start looking for more nurses EARLIER.

Chico David, BSN, RN · Feb 16, 2009

My experience is that management will always spend/provide the least they can get away with. Staffing ratios at least put a minimum floor under that "least". Some years back I used a corner of a larger office space at my hospital. Part of the same space was used for the daily staffing meeting where the charge nurses and house supe met to figure out staffing for the following shift. The hospital had a sort of crude "low/med/high" acuity system. Many times I heard a statement something like this: "By the acuities, we need two more nurses than we have, we have to change some of these high patients to medium". Minimum ratios aren't perfect, but you get something a lot closer to safe.

Our cardiac stepdown floor opened in 1980 with a standard ratio of 1:3. Over the coming years the patients got sicker, the procedures more complex and the ratio was gradually increased to 1:5 - have to control costs you know. Nurses were drowning. turnover was high and morale was in the toilet. Then the ratio law went into effect, and now it's back to 1:3 again and slowly rebuilding in the direction of being a decent place to work.

As an aside, I get a little tired of the term "unfunded mandates" which only seems to be applied by conservatives to mandates on businesses. If you are in the business of providing patient care, providing safe patient care is a basic part of the business. Don't see any reason why the government should be required to pay companies extra to actually do what they claim to be doing anyway - providing safe and adequate nursing care.