[NRSKarenRN]

Found at American Nurses Association California

Article from the Robert Wood Johnson Foundation: Charting Nurses Future

"Facts and Controversies about Nurse Staffing Policy: A Look at Existing Models, Enforcement Issues, and Research Needs"

With the rapid growth of managed care in the

mid-1990s, hospitals faced severe financial pressure.
To save money, many hospital administrators began
to restructure nurse staffing, cutting wages and jobs
of registered nurses (RNs) and hiring lower-paid
licensed vocational nurses (LVNs) and ancillary staff
to fill in the gaps. In response, nurses—especially in

states with shortages, such as California—began to

campaign for policies to improve nurse-to-patient

staffing levels (see fig. 1).

This brief examines state mandated
nurse staffing ratios as a policy model,

including in-depth coverage of California’s ratio

experience, and explores two other staffing models:

patient classification systems and pay-for-performance
concepts. It also presents a diversity of views
from experts; notes enforcement and research needs;
and offers a set of tips for policymakers considering
nurse staffing measures.

[pickledpepperRN]

I did read all 8 pages but this shows the attitude:

With the rapid growth of managed care in the mid-1990s, hospitals faced severe financial pressure.
To save money, many hospital administrators began to restructure nurse staffing, cutting wages and jobs of registered nurses (RNs) and hiring lower-paid licensed vocational nurses (LVNs) and ancillary staff to fill in the gaps.
In response, nurses—especially in states with shortages, such as California—began to
campaign for policies to improve nurse-to-patient staffing levels

http://www.anacalifornia.org/nursingissue5revfinal.pdf

At my hospital 50% of our pharmacists were laid off and 30% of our registered nurses.
All were replaced with unlicensed assistive personnel. NOT lVNs and NOT certified nursing assistants.
Not even people who had chosen patient care at all.
People from the kitchen and housekeeping were suddenly "Patient care Partners" or assistants, or some other title that had never existed before.
With as little as 16 hours of training they were to replace a licensed nurse!

We were told to teach them to do our accuchecks. They couldn't even count a pulse.
The guy from dietary didn't even know how to make a cup of tea. (Last time I saw him he was happy working construction)

They laid us off, told us "the train is leaving the station Go back to school and get a MSN then a PHd. We don't need mear bedside nurses caring for the sickest people in town.
The UAPs can do it for le$$ and not try to tell the CFO about patient care.
One night it was me as the ONLY licensed nurse for 27 telemetry patients. The only person who even knew to measure the urine, take a blood pressure, or walk a patient to the bathroom with an IV.

Then the very same people who laid off nurses claimed there was a shortage!

Some of those are nice people but they are clueless.
They had their agenda before this was written.
Let them care for patient assignments that threaten their soul and their license.
Then I will take their paper seriously.
Hospitals were mandated to implement an acuity system in 1996. They wrote some silly stuff and paid consultasnts to come in with computer software that could have paid for sufficient RNs for years.
And the patients got sicker while staffing stayed bad until WE registered nurses and our LVN and caregiver colleagues began to work TOGETHER to improve conditions that were killing some of our patients and ruining the life of every caring bedside caregiver.

And we succeeded!
Ratios were then needed to make it illegal to saff below a certain minimum level.
All patients deserve a nurse. That could be a platitude without unified action.

[pickledpepperRN]

The Ratio Solution:

http://www.calnurse.org/assets/pdf/r...os_booklet.pdf

[Neats]

I can speak for LTC only as this is where my experience comes from and as an Administrator and student nurse I can tell you when I will be a nurse advocate for nurse staffing ratios.
As an Administrator I can say when the "bean counters" decide upon the staffing ratios it is completed with input from management and nursing staff and using the lowest breakeven ratio (mathmatical equation) that works best for the company this will be the staff/patient ratio. What this means is statictics lie and we as nurses see the end results.
Once locked into these staffing ratios it takes many safety and ecomonic justifications, written reports backed up with more written reports to change a designated staff position. It takes time to complete this your manager can be consumed with just this over the course of a year or longer. Then it must go through the chain of command. Not an easy process. This is why paper work is so important.
I know that when I complete nursing school I will go back into administration but I will make smart decisions based upon sound evidenced based nursing practices thus demonstrating to the decision makers the need to say yes. And if they say no then I will ask them for their medical license because they are making a clinical decision and I want their license number written down not mine.

[forrester]

Amazing how they always found money for million dollar lobbies and executive suites, not to mention PR people and the uncounted funds used to bribe, I mean pay, physician specialists for coverage.

Administrative salaries have skyrocketed, investors need to be paid off, and corporate profits need to be secured.

All on the backs of nurses.

Do yourselves a favor and get mad.

Join the NNOC. It's free, and if nothing else, will scare the bejeezes out of them when membership exceeds that of the ANA.