[gwenith]

Originally Posted by kathi yudin

this is a reply to all who have posted.. while i understand the importance of nursing ratio's and how important they are.. we are all missing a very important fact.. we are in the midst of a major nursing shortage!!!.. there are not enough nurses to fill the open slots needed to be filled with a 1:5 ratio let alone a 1:4!!!.. i applaud governor shcwarzenagger for his wisdom.. we first need to solve the shortage dilemma.. and then work on the ratio's.. there are too few teachers.. 125,000 that can't get into nursing school at the moment..and even with that number.. it is still short what is needed.. i work in a skilled nursing facility.. my nurses have 32 residents each that they are responsible for at any given time!!.. i would love to have more nurses.. i can't get them.. they are not there!!!.. so.. how do we meet the ratio when there is no one there to fill the slots??.. those wanting to lower the ratio.. please tell me how we can deliver care when there aren't nurses to do so...

Trouble is - it is a self fullfilling prophesy. You can't get staff because no one wants to work 1:32 and you can't improve the odds because you can't get staff. We have a nursing shortage here in Australia too but we are more unionised. Our Critical care ratios are 1:1 1:2 only on meal breaks and only in some facilities. If we do not have the staff we simply close beds. Delay some surgical cases until we DO have the staff. It is AMAZING how much support you get then.

[Spidey's mom]

Originally Posted by stevierae

There is no nursing shortage---that is simply a myth, in my opinion, manufactured by management who want to lay guilt trips on nurses to work mandatory overtime and do more with less---nurses are simply dropping out of bedside care because they are mad as he** and not going to take it anymore....there are actually plenty of nurses, we just won't put up with delivering suboptimal care in order to hand fat bonuses to administrators..

With all due respect, kathi, you work in Southern CA---your wages are FAR less than what we are paid in NORTHERN CA--especailly the San Francisco Bay Area, where I'd say MOST RNs are CNA---that's where I work---

1:6 is the ratio for med-surg. It should be 1:5, if the governor does not have his way. In ICU, it is 1:2; in telemetry, I beleive it is 1:3 or 1:4. THESE ARE RN to PATIENT RATIOS, and they are mandated by LAW--AB 394. One CANNOT use LVNs as a substitute for RNs--they are not allowed to assess. However, management in some CA hospitals tries to get around the law by doing just this.

They also, as punishment" for nurses who demand that they adhere to the law, fire all the nurses' aides and housekeeper--in a sense saying, fine, you've got your RN ratios in place--but NOW you will have to do MORE work instead of taking optimal care of your patients.

Are these the type of people you really want to work for? I don't, and I won't. If you see hospitals not obeying the safe staffing ratios, call the BRN--because the BRN ssupports those ratios, and will NOT allow substitution of LVNs for RNs in safe staffing ratios. It's the LAW, and has been since Jan 1, 2004.

We GOT those ratios because we were radical enough to speaK OUT--long ago, early in the '80s--and go on strike as needed--to DEMAND better patient care and better working conditions.

Hi Stevierae - Actually, I'm in Northern California and you are in Central California At least that is how those of us who live north of Sac feel. Most of us think of the Bay Area as not part of rural Northern California.

Rural nursing in California has its own special needs and trying to comply with the 1:6 ratios has been tough but I think my management and our nurses have done a very good job. We have not fired the CNA's or ward clerks. I work with another RN and at least one CNA and usually two (when our other day CNA gets back from maternity leave).

The California Nurse's Association does not speak for me and it IS a special interest group and the Gov was right to call them that although I don't think he should talk about them as if they are not legitimately representing SOME nurses . . .and special interest is not a dirty word. I have no problem with people organizing to make changes (CNA). Just don't say you represent me. Because you don't.

I don't believe that this is an either/or situation. It isn't black/white . . good guy/bad guy. The more we portray hospitals and administrators as evil, the less work we will get done to advance our patient's well-being and safety. And hospitals/administrators need to not portray nurses in a bad light either.

I think Music and Kathi make some very good points.

I know my DON and our little rural hospital works very hard for the nurses. And they need more time to implement the ratios. There are bugs galore . . .

steph

[kathi yudin]

i have to say for those that believe that there is NO NURSING SHORTAGE get your heads out of the sand!!!.. there IS a nursing shortage..!!!.. living in southern california there is a huge pool to draw upon.. problem???.. there are NO NURSES TO DRAW UPON!!!!...i can advertise and advertise for nurses and get NO responses..!!.. while money is always an issue.. it is not a reason not to hire... i have an administrator that would hire because.. like the acute.. the long term care facility has ratio's.. based upon nursing hrs.. they can not be met because there are NO NURSES OUT there!!!.. for years.. nurses have attempted to be considered professionals.. as long as they act unprofessionally.. they will not be considered professionals.. thank you for having already stated this steph... we all want the best care for our patients.. we would not have gone into nursing otherwise.. we certainly won't get rich from it.. but.. the job we do is important.. and heartwarming most of the time.. however.. we can not give good nursing care when there are not enough nurses available to deliver the care.. no matter what the ratio is!!.. we have to change our outlooks.. work on why nurses are not going into nursing.. get more nurses to teach so that we can educate more in the field of nursing.. and then.. work on the ratios.. i am well aware of the law that states what the ratios are and will be..i am also well aware that they can not be met as long as men and women don't enter the profession..!!!.. as for those who insist lvn's can not assess.. they have to because there are not enough rn's to do it all.. and the lvn plays a very important role in the nursing profession...as long as we are divided we will not be able to affect any changes.. we must stand together.. and work on the cause before we work on the effect.. then.. we can affect change...

Originally Posted by stevielynn

Hi Stevierae - Actually, I'm in Northern California and you are in Central California At least that is how those of us who live north of Sac feel. Most of us think of the Bay Area as not part of rural Northern California.

Rural nursing in California has its own special needs and trying to comply with the 1:6 ratios has been tough but I think my management and our nurses have done a very good job. We have not fired the CNA's or ward clerks. I work with another RN and at least one CNA and usually two (when our other day CNA gets back from maternity leave).

The California Nurse's Association does not speak for me and it IS a special interest group and the Gov was right to call them that although I don't think he should talk about them as if they are not legitimately representing SOME nurses . . .and special interest is not a dirty word. I have no problem with people organizing to make changes (CNA). Just don't say you represent me. Because you don't.

I don't believe that this is an either/or situation. It isn't black/white . . good guy/bad guy. The more we portray hospitals and administrators as evil, the less work we will get done to advance our patient's well-being and safety. And hospitals/administrators need to not portray nurses in a bad light either.

I think Music and Kathi make some very good points.

I know my DON and our little rural hospital works very hard for the nurses. And they need more time to implement the ratios. There are bugs galore . . .

steph

[Spidey's mom]

LVN's . . .

We have an awesome LVN who fills in for us when someone is sick - which leaves us VERY shortstaffed. Just one person calls in sick and we are in trouble. Anyway, she is very skilled. I have no problem working with her. We all go into the room together at 4 a.m., the CNA for vitals and the LVN and me. I assess the pt. with everyone right there. I write the initial assessment. Then the LVN takes up to 6 patients and I take up to 6. We don't admit over the ratio. I trust her ability to care for the patients the rest of the day. We communicate during the day. I'm well aware of what is going on with all the patients as the CNA and the LVN keep me informed.

I think LVN's definitely have a role to play in the ratios.

steph

[kathi yudin]

the lvn's most certainly do.. they do a job.. and for the most part do it very well.. i have been in california for 6 yrs.. in ny.. i worked med surg.. icu/ccu.. telemetry.. coming to california.. i started working in long term care..(ltc)... i can advertise for rn's from today until doomsday.. i get lvn's.. they are better then most of the rn's i have had working for me.. my lvn's assess.. call the md's .. are in charge of the cna's.. do admissions and treatments.. they write care plans or plans of care.. they are an essential part of the workings in the nursing profession... and.. they fill my nursing hours.. they do serve a role and a purpose.. when the lower ratio's came out.. i needed to send a resident to a geropsych unit.. this resident was a danger to him/herself and the other 90+ residents in the facility... i had difficulty transferring because that one extra patient.. was over their ratio and they could not admit..!!... ratio's have a purpose.. but.. again.. the problem is that there are not enough nurses to fill the ratio's.. one of the problems with our profession.. and why new nurses get discouraged??.. we "older" nurses have a tendency to as the old adage goes.."eat our young!!".. we do not give the new nurses a chance... we expect them to come out running.. and they can't.. baby steps are needed...lets work at the problems from within.. make nursing a profession that others want to go into.. teach our young.. work with them.. work on the shortage.. then... the ratio's.. we can't have ratio's that can't be met.. lets be realistic.. until we get nurses into the profession.. the baby boomers are retiring.. leaving a huge void.. it is not a figment of administrations imaginations that there is a shortage.. it is a reality!!!...

Originally Posted by stevielynn

LVN's . . .

We have an awesome LVN who fills in for us when someone is sick - which leaves us VERY shortstaffed. Just one person calls in sick and we are in trouble. Anyway, she is very skilled. I have no problem working with her. We all go into the room together at 4 a.m., the CNA for vitals and the LVN and me. I assess the pt. with everyone right there. I write the initial assessment. Then the LVN takes up to 6 patients and I take up to 6. We don't admit over the ratio. I trust her ability to care for the patients the rest of the day. We communicate during the day. I'm well aware of what is going on with all the patients as the CNA and the LVN keep me informed.

I think LVN's definitely have a role to play in the ratios.

steph

[immigrant1956]

!.. i applaud governor shcwarzenagger for his wisdom.. we first need to solve the shortage dilemma.. and then work on the ratio's..

AAAAAAAAAAggggghhhh! Please don't tell me you really believe that. Long time nurse here will tell all of you her opinion of what has happened to nurses. We have not stood up to the abuses in our profession by not only administration and physicians, by regulatory agencies. But the most important factor is for us to conduct ourselves with professionalism, courtesy and pride. The public only sees what is portrayed on the news. My opinion of the CNA is guided by the propoganda, thrust at me in the parking lot of my hospital. 1960's union tactics have no place in this time. I think time and money are better spent becoming part of the solution.

However, I wish the governor had been more explicit about who was badgering him, my family from the rest of the country thinks he doesn't like nurses.

Maybe we could try the Southwest Airlines approach, and invest in what we do. We vest our souls in our jobs every minute we are there, let's own our profession, not the unions.

[SmilingBluEyes]

Make the work environment safe, attractive and well-paid, treat them like the valued part of the medical team, and quit letting doctors, managers and patients/family members run rough-shod over them, give them the equipment and tools that WORK to do the job, quit expecting nursing to cover lab, housekeeping, cardiopulmonary, dietary and others--------- and they will come. Oh,yes, they will. I would go to a place that did all that, even if the pay was not more than I make now. Do all this, Especially in urban and suburban areas.....(I know rural situations are unique, having been there), and they will come.

The trouble is, most hospitals don't want to affect their "bottom line" (or their fat bonuses for their administrators) or alienate their much-admired and needed doctors to do so. And they are left wondering "where the nurses are"..........

HELLLOOO they are right under your NOSE! You just can't see the forest for the TREES.

[dazzle256]

Originally Posted by kathi yudin

i have to say for those that believe that there is NO NURSING SHORTAGE get your heads out of the sand!!!.. there IS a nursing shortage..!!!.. living in southern california there is a huge pool to draw upon.. problem???.. there are NO NURSES TO DRAW UPON!!!!...i can advertise and advertise for nurses and get NO responses..!!.. while money is always an issue.. it is not a reason not to hire... i have an administrator that would hire because.. like the acute.. the long term care facility has ratio's.. based upon nursing hrs.. they can not be met because there are NO NURSES OUT there!!!.. for years.. nurses have attempted to be considered professionals.. as long as they act unprofessionally.. they will not be considered professionals.. thank you for having already stated this steph... we all want the best care for our patients.. we would not have gone into nursing otherwise.. we certainly won't get rich from it.. but.. the job we do is important.. and heartwarming most of the time.. however.. we can not give good nursing care when there are not enough nurses available to deliver the care.. no matter what the ratio is!!.. we have to change our outlooks.. work on why nurses are not going into nursing.. get more nurses to teach so that we can educate more in the field of nursing.. and then.. work on the ratios.. i am well aware of the law that states what the ratios are and will be..i am also well aware that they can not be met as long as men and women don't enter the profession..!!!.. as for those who insist lvn's can not assess.. they have to because there are not enough rn's to do it all.. and the lvn plays a very important role in the nursing profession...as long as we are divided we will not be able to affect any changes.. we must stand together.. and work on the cause before we work on the effect.. then.. we can affect change...

There are nurses out there. Just because they don't respond to your multiple adds don't mean they aren't there. I know personally several RNs that are working in other fields. Just off the top of my head some of the nurses I know don't work as nurses is a Real Estate Agent... another works for an insurance company and yet another works as a dog groomer . There is another nurse I know that isn't even going to renew her liecense doesn't know what she is going to do... she just knows it isn't nursing. I've made a decision myself after the first of the year to look into other avenues...I'll stay a nurse but will not work in acute care again.


I do agree that we do need to stick togeth and work on the cause. Nothing is being done to keep nurses.

[stevierae]

Originally Posted by kathi yudin

i have to say for those that believe that there is NO NURSING SHORTAGE get your heads out of the sand!!!.. there IS a nursing shortage..!!!.. living in southern california there is a huge pool to draw upon.. problem???.. there are NO NURSES TO DRAW UPON!!!!...i can advertise and advertise for nurses and get NO responses..!!..

BECAUSE YOU DON'T PAY ENOUGH IN SOUTHERN CA!!!!!!!

That's why you can't attract nurses, and that's why you must use travelers!!!!!!!

I have taught IV nursing at both Sharp and Scripps in San Diego. Seemed like all the RNs there were travelers. The ones who weren't were interested in doing a job like I did---teaching at different facilities.

I've worked with STAFF from Scripps and Sharp who take their time off to fly into the Bay Area and work per diem here and there--there is ALWAYS work in SF, and it pays well.

[SharonH, RN]

Originally Posted by SmilingBluEyes

Make the work environment safe, attractive and well-paid, treat them like the valued part of the medical team, and quit letting doctors, managers and patients/family members run rough-shod over them, give them the equipment and tools that WORK to do the job, quit expecting nursing to cover lab, housekeeping, cardiopulmonary, dietary and others--------- and they will come. Oh,yes, they will. I would go to a place that did all that, even if the pay was not more than I make now. Do all this, Especially in urban and suburban areas.....(I know rural situations are unique, having been there), and they will come.

The trouble is, most hospitals don't want to affect their "bottom line" (or their fat bonuses for their administrators) or alienate their much-admired and needed doctors to do so. And they are left wondering "where the nurses are"..........

HELLLOOO they are right under your NOSE! You just can't see the forest for the TREES.

Thank you!

Enough SAID