[bukko]

Originally Posted by talaxandra

So how does this translate in practice? Have you had any problems staffing when demand increases? Also, it may just be that my eyes were starting to glaze over (I could never be a lawyer!) but I couldn't see an objective acuity assessment tool there, either.

If I may comment at this late date, I'd like to give another perspective about how California's ratio law works in practice. Space, who's always got a lot of detailed information at her fingertips to forward, posted the law, but it is tedious to read. Here's my take on how it is at the hospital where I work.

Unlike Space's place, the bosses at my hospital start each shift with MORE nurses than they need to comply with the ratio law. They realize we will get admissions. I'm on a cardiac unit where by law, each RN can only have five patients. We usually start with four. It's similar in the med-surg and oncology floors I float to. This is a management decision -- they're not trying to do things on the cheap.

The charge nurse does not take any patients and is not counted in the ratio number. My hospital also has a "resource nurse" who goes from floor to floor to relieve staff for breaks, do admission questionnaires, perform special procedures, etc. This person is not counted in the ratios. Licensed professional nurses, a lesser-trained category who cannot do as much as RNs (I don't think you have that classification in Oz) ARE part of the ratio. Usually the charge nurse "covers" them, hanging the IV antibiotics and doing other tasks the LPNs are legally forbidden to do. But overall, the administration at my hospital does not try to game the ratio. It sounds like hospitals in your province do.

As for acuity, when I started working there, we were instructed about a computer program which evaluated how much care each patient would need. That was supposed to tell the bosses how to plan the staff assignments. Our union made them accept the computer program during contract bargaining. But the program was not working when I started there, and has never been used during my time. The union could make an issue of it, but you can't fight everything. At least not in the U.S. I've heard the unions in Aus are more militant.

The American medical system is more fragmented than I think it is in Australia. Instead of a national or province-wide health system with across-the-board standards, each hospital here has its own culture. I work for a hospital run by the Catholic church, which is not as money-conscious as those run by corporations that are trying to make a profit. So my experience is not universal. But I love the ratio law. By the way, the ratios are the same on midnight shift as they are on day shift, so the owls get a break!

I'm always interested in reading about nursing in Australia. We might be moving there if George Bush steals another four years in office. (My wife favors New Zealand because of the climate, but the Kiwis I've known tended to be more priggish than you bonzer Aussies.)

[talaxandra]

Hi Bukko,
I agree that it's interesting to see how different places practice. We staff to open beds, rather than to patient numbers, to allow for admissions, and in any case a vacant bed rarely stays that way for long. In fact, in the last week or so, we've tried to close beds because my hospital is over its WIES (the government allocates a certain amount of money per patient, treatment, condition etc, and if we're over the WIES then the hospital isn't reimbursed for treatment), but have had to keep opening them as Cas keeps going on by-pass.
Where was I?! Oh yes, how things are done differently. So a 20-bed general unit in an acute hospital has five RNs (division 1 or 2 - I think div 2's are the rough equivalent of an LPN), plus a resource nurse (an ACN or other senior nurse), plus a NUM (on the AM), regardless of actual patient numbers. We also have an ADON for every couple of floors, and out of hours a clinical coordinator (who organises bed assignment, sick leave replacement, ICU transfers and general dramas). Night duty is 1:8, including resource nurse, with no div 2s.
The union here is opposed to an acuity program, primarily because of moves to have it replace, rather than augment, the ratio system.
If the commander in thief does regain office we'd love to have you - although our own PM isn't that different! If your wife's concerned about the climate, tell her that there's a climate here to suit everybody, from the desert to the mountains to the coast! NZ is beautiful, though, and I wouldn't use 'priggish' to describe the NZ'ers I know!

[pickledpepperRN]

Thank you both. I am VERY glad to hear your hospital does'nt try to "game" the system Bukko.
Talaxandra:
It is good to get one nurses perspective. We were reading about heaven when your down to earth struggle goes on.

GLAD to have ratios!

Does anyone know this?
I was told flight attendants have ratios based on the number of seats on the plane, not the number of passengers.
TRUE?

[penguin2]

Someone told me that an LPN in Australia functions as an RN does here in the US. If this is true, what do Australian RNs do??

[talaxandra]

Just like in the US, what nurses do differs on the clinical area and scope of practice of the individual nurse. Where I work (a thirty-two bed mixed medical specialty unit in a tertiary metropolitan trauma hospital) our thirty-six ward staff includes five division two nurses.

All the Div 2's can: assess patients, monitor and record vital signs and BSL's, liaise with allied health, check lab results, remove drain lines/IVs/vascaths etc, write notes, suction, insert NGs, perform CPR, call MET calls...

Four of them are medication endorsed, which means they can give regularly-prescribed oral medications, including narcotics; they are in the process of being endorsed for subcut and IM injections.

Div 2's cannot: single check injectable or schedule 8/11 (narcotic/potentially addictive) drugs, take phone orders, insert IVs, act as a primary nurse, act as in-charge, nurse initiate drugs, prescribe peritoneal dialysis regimens, give telephone advice to patients...

That's a start, anyway. I certainly seem to find enough to do to fill my shifts...