[workingforskies]

Originally Posted by interleukin

"Imagine a nurse trying to bring action against her hospital and then trying to prove that her patients were at a higher acuity than what her bosses defined them as? What a nightmare that would be."

If only every nurse had the courage to forcefully state the obvious that many of the previous writers have.

Any acuity tool which does not consider the enormity of variables and dynamics of patient care and disease processes will be useless. And creating such a valid tool is an undertaking of enormous and scholarly proportion. And unless one is created and enforced we are treading water.

But, at the heart of all of this is the following: Management's continuing crusade to micro-manage nursing.

Unless, and until, they cease trying to force nursing into assembly-line models of efficiency, patients will never get the care that research says they can when staffing is based upon not some Utopian model but a model that actually understands the inherent unpredictability of nursing.

We must at least stop saying that, "We are not able to give proper patient care." Instead, we must say, "They are letting down their patients by not only ignoring the research but also their mission statements."

Instead of re-assessing budgets according to research, they want shiny new buildings with yet more rooms. perhaps they can manufacture the extra staff out of pipe cleaners.

What an artfully articulate post! I could not agree more.

[medpsychRN]

About 3 weeks ago, in a general staff meeting, we were told we would be staffing by the numbers NOT acuity. I work in Illinois in a large university hospital and yes the hospital is forming a committee on staffing. I should also mention in I work in Chicago where tradition dictates a "business as usual policy". All the hospital has to do is change the rating of acuity numbers and they will be in compliance using the same amount of staff or less.

I am guessing when I am unable to complete my work assignment in 8 hours, I'll be called to the office and asked about my time management abilities.

I wrote the INA, state rep/senator. There is a federal bill sitting on committee about nurse patient ratios. To protect ourselves from unsafe assignments, nurses need to support this endeavor.

[Michigan RN]

Originally Posted by spacenurse

Absolutely!
I helped work for this law. These were unlicensed and sometimes untrained people assigned to replace the nurses who had been laid off.
I do NOT want to be forced to administer insulin coverage based on someone else doing the accucheck.

Shouldn't the same NURSE do the accucheck who gives the insulin? Or glass of juice?
Or teached the patient and family.
Thankfully I am not so short staffed that I would even give insulin based on a list of results.

Here is an explanation:
http://www.rn.ca.gov/pdfs/regulations/npr-b-29.pdf

I see no reason why a nursing assistant should not be taking a patient's blood glucose as long as they repeat the test if the result is high or low. Any person can walk into a local pharmacy and buy a glucometer and figure out how to use it on their own without having an RN teach them. I'm sorry but I don't agree with your rationale.

[pickledpepperRN]

I will not give insulin to a hospitalized patient based on another person doing the accucheck.
I once was handed a list of room numbers by a CNA.
He had a normal BS for a patient and a very high level for the room mate.
I apologized to the patients when I repeated their accuchecks.

Yes, the high result requiring regular insulin coverage was actually from the patient in bed "A".
The list handed to me stated "B" had a high result.
We must advocate for the best interest of our patients.
The SAME licensed nurse should test the blood sugar and treat the result.

People give their own insulin at home too.
Do you think administering sliding scale insulin should be done by an unlicensed person?

[pickledpepperRN]

Originally Posted by Kati2005

I see no reason why a nursing assistant should not be taking a patient's blood glucose as long as they repeat the test if the result is high or low. Any person can walk into a local pharmacy and buy a glucometer and figure out how to use it on their own without having an RN teach them. I'm sorry but I don't agree with your rationale.

I see a reason every acute care patient needs to be assigned to a registered nurse who is responsible for the nursing process.

Acutely ill hospitalized patients need NURSING care.

[Michigan RN]

Originally Posted by spacenurse

I will not give insulin to a hospitalized patient based on another person doing the accucheck.
I once was handed a list of room numbers by a CNA.
He had a normal BS for a patient and a very high level for the room mate.
I apologized to the patients when I repeated their accuchecks.

Yes, the high result requiring regular insulin coverage was actually from the patient in bed "A".
The list handed to me stated "B" had a high result.
We must advocate for the best interest of our patients.
The SAME licensed nurse should test the blood sugar and treat the result.

People give their own insulin at home too.
Do you think administering sliding scale insulin should be done by an unlicensed person?

Um, I know that no one unlicensed should be telling a patient how to follow a sliding scale.

[Michigan RN]

Originally Posted by spacenurse

I see a reason every acute care patient needs to be assigned to a registered nurse who is responsible for the nursing process.

Acutely ill hospitalized patients need NURSING care.

Please don't imply that I am not a responsible RN and that I do not follow the nursing process. If patients need nursing care then more nurses should be hired not unlicensed personnel.

[medpsychRN]

When the Illinois bill was announced last year we were advised by the hospital to call our state rep/senator and support staffing by acuity. We were told should a nurse/patient ratio bill pass, we would have to do more patient care as support staff would be eliminated. Since I expected to do patient care when I became a nurse, I didn't have a problem with taking this on. BUT, the implication was I'd have to work harder and get my hands dirty.

Well, since the bill passed, I am working harder and getting my hands dirty. In addition I am asked to take on more responsibility because we are working with fewer staff. The budget is a hot topic and they have steadily cut staff in the last three years. Since it continues to be an issue, I am confident they will continue to find ways to eliminate nurses and replace them with lower paying staff.

Taking an accu check doesn't bother me. If I had a patient on hourly accu checks, I'd be doing it anyway.

The issue is safety. Employers will do whatever they can get away with. Nurse patient ratios have worked well in California. This is something we can stand behind to ensure we have some rights and the ability to care for patients as they deserve to be cared for.

[Michigan RN]

Originally Posted by medpsychRN

The budget is a hot topic and they have steadily cut staff in the last three years. Since it continues to be an issue, I am confident they will continue to find ways to eliminate nurses and replace them with lower paying staff.

That doesn't seem right. I thought the whole point of having RN to patient ratios was having more RNs.

I don't care if I'm doing accucheks. I work in the ICU and most of the time we do not have a care partner, so I do my own anyhow. My whole problem was if I have four patients and three of them are hourly accuchecks, I didn't see a problem with an aide taking the blood glucose. This was just something my friend experienced when she worked in California. Just seems like more work for the nurse. What are the aides responsible for then? The number of patients and their acuity should be taken into account when assigning patients to nurses.

[Michigan RN]

I believe they are trying to get RN to patient ratios mandated in Michigan. It was a bit of a hot topic a year ago and then we haven't heard anything about it. I don't think it would be a bad thing, I know a lot of hospital administrators would think so. Some of them have said that the hospital would be losing a lot of money if it were to pass.

I work on an SICU and the other night my friend said she had to take 3 patients, 2 of which were very unstable. They were unable to find another nurse to work that shift. So if the RN/patient ratio laws were to pass, then hospitals would be forced to find appropriate staffing which I don't really have a problem with.