[gizelda]

[quote=spacenurse]It is NOT considered an emergency if there are empty beds in the ICU, a nurse is cancelled (whether an extra shift or expen$ive regi$try), and ICU patients are held in the ER. Then when patients come in to the ER the nurses have no choice but to care for the ER patients AND the ICU holds.
There is NO excuse to hold patients in the ER when there are beds upstairs.

IN our ICU we have 15 beds. 2-3 nurses on(we have no staff,we have international nurses and travel nurses making up the bulk of our staff).We are maxed at 4-6 patients. Most of the time we have no secretary,no tech, not even an aide. we have empty beds ,but this are no nurses to take care of patients that would be put in them.As a staff nurse at times I am the only staff person their. This means I am in charge I have a 2 patient assignment,I am also the ONLY resource available to the travel nurse who needs to know where everything and who to call and so on. and the international nurse who depending on who it is I cant understand. the doctor cant understand or the pharmacist cant understand so guess who picks up that slack with a 2 patient assignment already and no tech and the phones are ringing off the hook .So I think that would be a reason why the ER needs to hold that ICU patient. WE are in need of a safe patient nurse ratio that also includes ancillary staff to pick up things we cant.

[pickledpepperRN]

[quote=gizelda]

Originally Posted by spacenurse

It is NOT considered an emergency if there are empty beds in the ICU, a nurse is cancelled (whether an extra shift or expen$ive regi$try), and ICU patients are held in the ER. Then when patients come in to the ER the nurses have no choice but to care for the ER patients AND the ICU holds.
There is NO excuse to hold patients in the ER when there are beds upstairs.

IN our ICU we have 15 beds. 2-3 nurses on(we have no staff,we have international nurses and travel nurses making up the bulk of our staff).We are maxed at 4-6 patients. Most of the time we have no secretary,no tech, not even an aide. we have empty beds ,but this are no nurses to take care of patients that would be put in them.As a staff nurse at times I am the only staff person their. This means I am in charge I have a 2 patient assignment,I am also the ONLY resource available to the travel nurse who needs to know where everything and who to call and so on. and the international nurse who depending on who it is I cant understand. the doctor cant understand or the pharmacist cant understand so guess who picks up that slack with a 2 patient assignment already and no tech and the phones are ringing off the hook .So I think that would be a reason why the ER needs to hold that ICU patient. WE are in need of a safe patient nurse ratio that also includes ancillary staff to pick up things we cant.

You are right. Your staffing is not safe. I don't know what it's like in the ER. The patients need to be cared for somewhere.
I was rewferencing a hospital that before ER ratios would call off a nurse who was scheduled to work in ICU. They would make the ER hold the patient all day.
With ratios the ER has to staff critical care patients at 1:2 too. The hospital has to use it's staff. No more calling off expensive registry nurses or those willing to work an extra shift.

Here are the proposed ratios for Massachusetts:
http://www.massnurses.org/safe_care/toolkit/story2.htm

Intensive Care Unit: 1:2
Critical Care Unit 1:2
Neo-natal Intensive Care 1:2
Burn Unit 1:2
Step-down/Intermediate Care 1:3
Operating Room RN as Circulator 1:1
RN as monitor in moderate sedation cases 2:1
Post Anesthesia Care Unit Under anesthesia 1:1
Post Anesthesia 1:2
Emergency Department 1:3*
Emergency Critical care 1:2*
Emergency Trauma 1:1* * The triage, radio, or other specialty registered nurse shall not be counted as part of this number.
Labor and Delivery Active Labor 1:1
Immediate Postpartum 1:2 (one couplet)
Postpartum 1:6 (three couplets)
Intermediate Care Nursery 1:4
Well-Baby Nursery 1:6
Pediatrics 1:4
Psychiatric 1:4
Medical and Surgical 1:4
Telemetry 1:4
Observational/Out patient treatment 1:4
Transitional Care 1:5
Rehabilitation Unit 1:5
Specialty Care Unit, any unit not otherwise listed above shall be considered a specialty care unit 1:4

These ratios shall constitute the minimum number of direct-care registered nurses. Additional direct-care registered nurses shall be added and the ratio adjusted to ensure direct-care registered nurse staffing in accordance with an approved acuity-based patient classification system. Nothing herein shall be deemed to preclude any facility from increasing the number of direct-care registered nurses.

[pickledpepperRN]

If I were in Massachusetts I would be doing some of these activities for my patients, my colleagues, and my sanity.
http://www.massnurses.org/safe_care/index.htm

You Can Help Ensure Patient Safety
The Key to Protecting Your Patients and Your Nursing Practice
House Bill 2663 would establish minimum RN-to-patient ratios on all hospital units and in all departments. All ratios would be the same for all three shifts. These ratios would also be adjusted based on patient acuity, the educational level of the nurse.

Patient safety checklist: What you can do to help pass RN-to-patient ratio legislation
Write a personal handwritten letter to your representative and senator.

Of all the types of communication with your elected officials, personal handwritten letters probably have the greatest impact. Tell them why safe staffing is important for your patients' safety and what type of care you can provide when staffed appropriately.

For legislators' contact information or if you don't know who your legislator is, go to: http://capwiz.com/massnurses/state/main/?state=MA
Write a letter to the representative and senator who represent your hospital and have nurses from the bargaining unit sign it.

Join with other nurses from your bargaining unit and write a group letter. Have as many nurses as possible sign it. Be sure to have everyone include their name and address. Also, remember to make a copy of it before you mail it.

For legislators' contact information or if you don't know who your legislator is, go to: http://capwiz.com/massnurses/
Spread the word!

Talk to members in your bargaining unit and other colleagues about becoming activists with the MNA. Ask them to write letters to their legislators and join you in signing the bargaining unit letter. Let other nurses know about opportunities to contact legislators, volunteer with campaigns, and make their voices heard. Encourage them to check the MNA Web site often to get updates. www.massnurses.com.
Hold a legislative briefing on Safe Staffing in your community.

A legislative briefing is a time for you and other RNs in your community to get together with local legislators and discuss the need for safe RN staffing. MNA staff will help you set up the briefing, contact legislators and provide background and training materials. For more information, please contact Kate at the MNA 781.830.5713, kanderson@mnarn.org.
Meet with your legislators in the district.

Most legislators hold regular office hours in their communities. Call the legislator's state house office (State House main number 617.722.2000) to find out when and where office hours are held.
Write a letter to the editor.

Go to http://capwiz.com/massnurses/ and follow the links to "write a letter to the editor" and personalize a sample letter and email it off. Encourage other RNs to do the same. The public trusts you—make your voice heard!
Buy an ad in your local paper.

MNA bargaining units have purchased ad space in local papers to educate the public about the importance of safe RN staffing. It will get the attention of the public, local legislators and the hospital administration. For sample ads, assistance, and more information, please contact David Schildmeier, 781.830.5717, dschildmeier@mnarn.org.
Get support from non-nurses.

Do you belong to a parent/teacher organization (PTO), a church, a neighborhood group or a town or city committee? Arrange a time to present information on how RN staffing affects everyone.
Invite your PTO to formally endorse the MNA legislation.
Ask your town committee to pass a resolution supporting the Safe Staffing/ Quality Patient Care legislation.
Invite seniors in your community group to get more involved by contacting their legislators.

For more information or for materials, contact Jason at the MNA 781.830.5740 or jsilva@mnarn.org.
Join the MNA Email Network.

Often the MNA needs to communicate with members and legislators quickly about pending bills. Members of the Email Network will be called on to take action and communicate with legislators on important issues throughout the year. Go to: http://capwiz.com/massnurses/mlm/.

[Dave11]

these ratios are useless if the staff doesnt exist. when JAHCO comes around the extra shift bonuses go through the roof. it is unrealistic to expect the hospitals to pay those kind of bonuses year round.
why dont the unions concentrate on the base of the problem, namely the lack of high paying nurse teaching jobs? educators are leaving the field at an alarming rate because they can make considerably more money in the private sector than in colleges and universities. fix that problem and enrollment rates rise and there are more RN's available to staff the hospitals. if you have 10,000 job vacancies per year and only graduating 7500 RN's each year (hypothetical numbers) you will always be in the hole and any number of safe staffing laws isnt going to change the fact there just isnt enough to go around.

[PsychRN03]

Originally Posted by Dave11

these ratios are useless if the staff doesnt exist. when JAHCO comes around the extra shift bonuses go through the roof. it is unrealistic to expect the hospitals to pay those kind of bonuses year round.
why dont the unions concentrate on the base of the problem, namely the lack of high paying nurse teaching jobs? educators are leaving the field at an alarming rate because they can make considerably more money in the private sector than in colleges and universities. fix that problem and enrollment rates rise and there are more RN's available to staff the hospitals. if you have 10,000 job vacancies per year and only graduating 7500 RN's each year (hypothetical numbers) you will always be in the hole and any number of safe
staffing laws isnt going to change the fact there just isnt enough to go around.

This was the same argument from CHA. They threatened that med floors, ERs, and entire hospitals across the state would have to close because there simply aren't enough nurses to staff them. The reality is that a majority of all CA hospitals that had to close, if not all that have closed didn't do so because of the ratio law. In fact it's interesting that somehow they managed to find a few million lying under the carpet to fight the ratios.

Overall CA has done quite well with the ratios, bringing in 50,000+ more nurses to the bedside whether from another state or non-bedside nurses returning to the bedside.

While you are absolutely correct about the nurse educators, bringing more nurses isn't mutually exclusive to improving working conditions. Nurses leave the profession as quickly as they enter it because of the working conditions. So train new nurses until you turn blue in the face; once they hit the bedside and realize what real world nursing is like they leave the bedside like birds flying South for the Winter.

[gizelda]

Originally Posted by Dave11

these ratios are useless if the staff doesnt exist. when JAHCO comes around the extra shift bonuses go through the roof. it is unrealistic to expect the hospitals to pay those kind of bonuses year round.
why dont the unions concentrate on the base of the problem, namely the lack of high paying nurse teaching jobs? educators are leaving the field at an alarming rate because they can make considerably more money in the private sector than in colleges and universities. fix that problem and enrollment rates rise and there are more RN's available to staff the hospitals. if you have 10,000 job vacancies per year and only graduating 7500 RN's each year (hypothetical numbers) you will always be in the hole and any number of safe staffing laws isnt going to change the fact there just isnt enough to go around.

WEll ,
In my hospital they are paying hundreds and thousands of dollars to use an agency nurse or an international nurse. They also use things like 10,000 $ sign on bonus. But they do nothing for staff retention. I have said this in a million meetings with the staff and our manager.I also add Why are we working on recruitment when we have HUGE issues on retaining.If we don't fix the problem there these nurses do their 6 months and go running. What a waste of money and our recourses. Do you even realize how much money time and effort goes into orientation?
Then with the understaffing (as in my unit) The money spent on infection control,VAP in particular,or errors and so on just adds to the blown out cost of taking care of the patient. We need the safe staffing bill to pass. We have already thwarted off the MHA bill( patients first ya right).. We rallied. Administration actually had the b**** to send in unit managers dressed as floor nurses to look like "floor nurses did not want the MNA bill to pass and how they supported "MHA patients first"
I have written the MHA after my own father was admitted to a surgical floor (I think that post is around somewhere) I demanded to know "How my father could be safety cared for by a nurse who had something ridiculous like 17 patients that she had transfered,admitted,discharged thru out her 12 hour shift.I have yet to here back from them.
RATIOS work and save lives and money. look at the studies.
Oh I will also add as you are looking at the studies and they are numerous in various journal including the AJM . BEDSIDE NURSES would return to bedside nursing if working conditions and ratios improved to a more manageable level.
I personally no 3 nurses who no longer work in nursing at all. And at this time I am out of leave, unsure if I will be going back to nursing And if I do I believe I will be leaving my job of 10 years in my community hospital to a bigger Boston hospital were I here the ICU is a bit more manageable. Who knows I burnt out .At this point I cant even begin to look at my options. But I do know that my being out right now does nothing for my ICU. We have huge staffing problems and work in the most stressful area with no ancillary staff I cant handle that any more. So now they are paying the travel nurse OT to cover me because they work in any condition. An example of this is one travel nurse works 6 - 12 hour night shifts in a row since his contract has started and he continues to work that and "will stay in this !#@$^%$ hole until they cant pay him any more. ""(his words) I ask How safe is that ,and further How cost effective is that?

[gizelda]

[quote=spacenurse]Safe Staffing Ratios for Massachusetts? I support Massachusetts nurses 100%!

I have been thru your postings and would just like to add this
:hatparty:
I appreciate your advocacy. Thank you

[gizelda]

Originally Posted by Dave11

these ratios are useless if the staff doesnt exist. when JAHCO comes around the extra shift bonuses go through the roof. it is unrealistic to expect the hospitals to pay those kind of bonuses year round.
why dont the unions concentrate on the base of the problem, namely the lack of high paying nurse teaching jobs? educators are leaving the field at an alarming rate because they can make considerably more money in the private sector than in colleges and universities. fix that problem and enrollment rates rise and there are more RN's available to staff the hospitals. if you have 10,000 job vacancies per year and only graduating 7500 RN's each year (hypothetical numbers) you will always be in the hole and any number of safe staffing laws isnt going to change the fact there just isnt enough to go around.

HEY dave here is a link to start your research on what safe ratios can do
http://www.massnurses.org/safe_care/...ng/medical.htm

[Dave11]

cool

thanks

[auntieflo]

It has been said that we learn much from the west coast of this country... and no doubt massachusetts nurses need to be educated, I know because i am one who found a leader in rep. christine canavan who not only is a nurse but legislator fighting for patient safety.
and the ole useless argument that patient safety could not be accomplished 'cuz their ain't enough of us to achieve it'
Well why did so many of us leave?
And wouln't some of us come back if we had safe staffing implemented?

You are a breath of fresh air space nurse to many nurses who live in fear.

sincerely,
When I left staff nursing,..it was then I had my babies..........

Originally Posted by spacenurse

If I were in Massachusetts I would be doing some of these activities for my patients, my colleagues, and my sanity.
http://www.massnurses.org/safe_care/index.htm

You Can Help Ensure Patient Safety
The Key to Protecting Your Patients and Your Nursing Practice
House Bill 2663 would establish minimum RN-to-patient ratios on all hospital units and in all departments. All ratios would be the same for all three shifts. These ratios would also be adjusted based on patient acuity, the educational level of the nurse.

Patient safety checklist: What you can do to help pass RN-to-patient ratio legislation
Write a personal handwritten letter to your representative and senator.

Of all the types of communication with your elected officials, personal handwritten letters probably have the greatest impact. Tell them why safe staffing is important for your patients' safety and what type of care you can provide when staffed appropriately.

For legislators' contact information or if you don't know who your legislator is, go to: http://capwiz.com/massnurses/state/main/?state=MA
Write a letter to the representative and senator who represent your hospital and have nurses from the bargaining unit sign it.

Join with other nurses from your bargaining unit and write a group letter. Have as many nurses as possible sign it. Be sure to have everyone include their name and address. Also, remember to make a copy of it before you mail it.

For legislators' contact information or if you don't know who your legislator is, go to: http://capwiz.com/massnurses/
Spread the word!

Talk to members in your bargaining unit and other colleagues about becoming activists with the MNA. Ask them to write letters to their legislators and join you in signing the bargaining unit letter. Let other nurses know about opportunities to contact legislators, volunteer with campaigns, and make their voices heard. Encourage them to check the MNA Web site often to get updates. www.massnurses.com.
Hold a legislative briefing on Safe Staffing in your community.

A legislative briefing is a time for you and other RNs in your community to get together with local legislators and discuss the need for safe RN staffing. MNA staff will help you set up the briefing, contact legislators and provide background and training materials. For more information, please contact Kate at the MNA 781.830.5713, kanderson@mnarn.org.
Meet with your legislators in the district.

Most legislators hold regular office hours in their communities. Call the legislator's state house office (State House main number 617.722.2000) to find out when and where office hours are held.
Write a letter to the editor.

Go to http://capwiz.com/massnurses/ and follow the links to "write a letter to the editor" and personalize a sample letter and email it off. Encourage other RNs to do the same. The public trusts you—make your voice heard!
Buy an ad in your local paper.

MNA bargaining units have purchased ad space in local papers to educate the public about the importance of safe RN staffing. It will get the attention of the public, local legislators and the hospital administration. For sample ads, assistance, and more information, please contact David Schildmeier, 781.830.5717, dschildmeier@mnarn.org.
Get support from non-nurses.

Do you belong to a parent/teacher organization (PTO), a church, a neighborhood group or a town or city committee? Arrange a time to present information on how RN staffing affects everyone.
Invite your PTO to formally endorse the MNA legislation.
Ask your town committee to pass a resolution supporting the Safe Staffing/ Quality Patient Care legislation.
Invite seniors in your community group to get more involved by contacting their legislators.

For more information or for materials, contact Jason at the MNA 781.830.5740 or jsilva@mnarn.org.
Join the MNA Email Network.

Often the MNA needs to communicate with members and legislators quickly about pending bills. Members of the Email Network will be called on to take action and communicate with legislators on important issues throughout the year. Go to: http://capwiz.com/massnurses/mlm/.