CA staffing ratios evoke anger 'tween RNs & LVNs - page 8

Big news on the California nursing ratios front. As California prepares to carry out its first-in-the-nation law telling hospitals how many nurses they must have on hand for patients, a bitter... Read More

  1. by   imenid37
    hospitals are so greedy and ruthless. the lpn's may provide fantastic care, BUT the scope of practice dictates what he/she can do. if an rn and an lpn work together and each has 6 pts. the rn then has 12 assessments to do, all the iv push meds to give , etc. cost effective so the suits can keep their six figure jobs, but no good for pt. care. and rotten for the nurses too. these admin. are masterful manipulators pitting nurse against nurse. sick and disgusting, but no surprise.
  2. by   -jt
    when the RNs pointed out that they were responsible for things that they weren't directly doing, but were expected to know what was going on despite having higher patient loads and acuity themselves, an awful lot of LPNs felt that RNs were simply complaining that the LPN was not capable. There was no thought on the part of alot of LPNs that this was not the issue RNs had.

    I just do not get why an LPN would feel that this is appropriate. And I don't understand how an LPN doesn't see how this drives a wedge between two groups of nurses who need each other. Instead what I see, from my perspective, is LPNs that become defensive over whether they are bright enough to do what they are doing.


    It seems we're banging our heads against the wall here because the 2 different groups are talking about 2 different things. We see that having a full pt load of our own & being told that the LPN can also have the same full pt load under our direction does not reduce our total pt load, responsibility or risks to pts & licenses. Its a simple fact, but some are taking it as a personal affront to their abilities cause they see only the number of minutes it takes us to hang their antibx. Apparently some measure the RNs pt load only by the number of technical tasks we have to carry out. Its become apparent that we're just not talking about the same things.


    <<<<if an rn and an lpn work together and each has 6 pts. the rn then has 12 assessments to do, all the iv push meds to give>>>>>>>

    An eye-opener of this thread for me has been that a lot of LPNs dont see this as a problem & dont seem to recognize how it impacts on us. They dont consider it as us actually having 12 pts. But we do. All some of them apparently think is so the RN has to hang my antibx - whats the big deal? They dont want to see that it is a big deal for us to try to manage 2 full pt assignments, even if they are doing some of the hands-on for 1/2 of it. Some jumped to the conclusion that we're BLAMING them for our role & responsibility & they dont want to recognize that this is not the case - all we're asking for is to be able to carry out that role & responsibility with a more manageable number of pts than this "any-nurse-will-do" staffing proposal gives us[.

    I dont understand why some LPNs wont get that the RN objections to these ratios is not about the LPNs abilities at all. Its about the amount of pt load the RN has to try & deal with safely. The fact that the LPN is there helping with the hands-on care for 4 of the pts doesnt change OUR load. Basically, some are telling us that just doesnt matter to them & getting more jobs for LPNs is what counts.

    Nursiepooh - the LPN IS responsible for her actions, her scope of practice and what happens to her pts. She has a license to uphold & IS legally responsible for whatever she does. BUT the RN is also responsible for the LPNs pts & what happens to them. The scope of practices are different. If you make the LPN solely responsible for her pts, she would have to have the scope of practice of an RN - and an RN license. You would be putting LPNs out of existence.
    Last edit by -jt on Nov 25, '02
  3. by   BBFRN
    Originally posted by -jt
    [B]

    Apparently some measure the RNs pt load only by the number of technical tasks we have to carry out. We're just not talking about the same things.

    I dont understand why some LPNs wont get that the RN objections to these ratios is not about the LPNs abilities at all. Its about the amount of pt load the RN has to try & deal with safely. The fact that the LPN is there helping with the hands-on care for 4 of the pts doesnt change OUR load. Basically, some are telling us that just doesnt matter to them.

    Was this in response to my comment about how the LPN's have more pt's? Because the point I was trying to make was not a complaint about RN's having less patients- they still have just as much or more work than we do at times. I never felt that the objections to the pt load was related to LPN abilities. It sucks for ALL of us. And I side with the RN's on this type of staffing- I feel that is IS a way to get around having more RN's on the floor. It DOES affect pt care- dramatically IMHO. If this was in response to my last post, please re-read it because I don't want to come across as having blamed this type of staffing problem on the RN's and griping about their patient load. I'm going to be put in this position myself after I receive my RN, as all RN's on nights on my floor are required to do charge shifts- even new RN's who haven't been LPN's before.
  4. by   -jt
    <Was this in response to my comment about how the LPN's have more pt's?....I never felt that the objections to the pt load was related to LPN abilities.>

    No! Your comments hit the nail directly on the head. Your gave an excellent & clear explanation of the problem.

    I was referring to no one in particular - just the many defensive posts from LPNs throughout this 5 page thread who dont seem to recognize what you described so well. Some of them have pretty much missed the points you & others have made about the RNs job & they basically just keep saying what are the RNs "complaining" about having to "cover" the LPNs pts for --- it only takes 5 minutes to hang an antibx & a second to "sign off" a chart.

    Some honestly just dont get it that what we are objecting to is state law staffing ratios which do nothing to reduce our pt load.

    This thread was about factions in California now trying to use the new staffing law to reduce the LPNs pt load by hiring more LPNs, while leaving the RNs pt load still at unsafe levels -- using that same law to replace vacant RN positions with less expensive LPNs, rather than doing what they have to do to improve working conditions & make their facility a place where RNs want to work. Its disgraceful that a patient safety staffing law is being used & manipulated like this to keep their bottom line profit margin up to par & their pockets filled.

    But a lot of LPNs here dont seem to want to understand the RNs who are saying how that will affect the RN & her license, instead they changed the focus to defending their LPN abilities - which havent even been questioned by most of the RNs posting.

    Some people here dont get that our objection to the staffing plan is not an objection to LPNs or a put-down on their abilities. Its about being able to do our jobs the way we're supposed to be doing it & being able to manage it safely.

    The debate here has been clouded by emotional responses and defensiveness.
    Last edit by -jt on Nov 25, '02
  5. by   rebelwaclause
    Originally posted by RN2B2005
    Finally, to those who attacked me--feel free to e-mail or call. After all, I am sure that all of the critical-thinking and writing courses that you took in preparation for your career as an LPN left you ably equipped to convince me of the error of my ways. Oh, wait, only RN's--who have an Associate's Degree or a Bachelor's Degree--receive such a broad-based education. Silly me.
    I'll PM you on this one. And, I urge anyone else to PM any flames. I'd hate to waste a perfectly healthy debate on one poster's - yet again...Unarticulated ignorance.

    ...But I do have to ask..."Feel free to...CALL?" Hahahahahahaha...Where's the phone number?
    Last edit by rebelwaclause on Nov 25, '02
  6. by   rebelwaclause
    Originally posted by -jt
    Some of them have pretty much missed the points you & others have made about the RNs job & they basically just keep saying what are the RNs "complaining" about having to "cover" the LPNs pts for --- it only takes 5 minutes to hang an antibx & a second to "sign off" a chart.
    Aiyyyy.... I guess that would be me then, JT? Funny, you quote me but disclaimer "No one in particular". What can I say? An RN said if it takes longer than 10 minutes to hang an ABX...WORRY ABOUT THAT RN! And I do hear RN's complaining about covering LVN's. what else is new? LVN's complain about RN's too.

    I think I've said in prior posts "I understand", "I get it".....My GAWD...I GET IT!

    You guys carry on. I bow out for now. This just won't get resolved here, and I DO agree a lot of emotions have replaced vision and understanding. I throw myself in that boat. I also haven't heard a solution that would satisfy California CNA and SEIU on Wednesday when the final meeting takes place in Fresno. I'm going.

    While I was working last night...There was a total of 4 staff nurses, 2 RN's and 2 LVN's. We had 12 patients. The RN's where assigned 2 patients each, we (LVN's) had 4. We all worked together as a team, we checked in with each other, asking if help was needed. One of my patients had abx ordered at midnight. The other three had IV pushes PRN (Morphine, Ativan, etc), I monitored the NS, as licensed to do. I volunteered to do things ("tasks"....Sorry - That argument made no sense. If you're honest, at some point EVERYONE is struggling to make sure all the "tasks" of the shift get done - Be it RN, LVN or CNA?....Sigh.....) that I could do in my scope of practice. We didn't have a CNA, so we all pitched in to make sure all patients where cared for, REGARDLESS of assignment. The RN's I work with are stellar, and I don't tell them that as often as I should. But they know if they ever needed something - Up to and including protesting in Fresno on Wednesday - I'd be there for them.

    Someone mentioned "Trust has nothing to do with it". For the argument of this thread - Maybe not. But to get through some of the perceptions about LVN's, to possibly look at ways to lighten your load of worries, Yes it does.

    If I have proved that I know what to look for in a post-op appy, what low H&H values mean in an anemic patient, the difference between a bronchovesicular breath sound versus a vesicular breath sound, teaching implementation on a 60 y/o patient with a who has just came back from an echo with an ejection fraction of 20, or what is a peak and trough lab draw is for.... Maybe if my RN who is worried about handling her load can relax a wee-bit when it comes to trusting that I will not jeopardize licensure in that manner - Maybe we can take a small step toward working around this difficult ratio situation - Until something better comes along. No, I do not think I can function as a RN, nor do I believe I can. (Said before). But I can be competent enough that if you where overwhelmed with your patient load and totally forgot to do anything with one of my patients that you are covering me - You could sign the chart at the end of the shift and confidently know I would've informed you of any changes. I cannot believe that doesn't lighten the burden in some small way. I know it does - I've seen it work.

    However, I have seen RN's that are so scared and frightful of the responsibility thing (Not to make light of it) - That they don't trust anything and would rather burn out by not opting to delegate what can be handled and trust that staff member that it gets done or notified if it doesn't. The above scenario wouldn't work for them, and ONLY an RN in place of me would. The hospital's will probably not favor adding more RN's, as much as replacing LVN's or offering an internal fast track LVN to RN option, as they did a few years back when this same topic surfaced.

    Perhaps I'm naive and spoiled to working in a smaller facility. We do not deal with 1:8 patient ratios EVER! We probably never will. We (RN's and LVN's alike) get indignant when we have 5 patients and 1st up for an admission. To sympathize with some of the situations I've heard on this thread - I'd run to a smaller facility. No, it doesn't solve the big picture, but it takes...care....of...you!

    I respect ALL of you! (OK...Well most all of you minus one! ).
    Last edit by rebelwaclause on Nov 25, '02
  7. by   BBFRN
    Well put, Rebel. Here, here!
  8. by   BBFRN
    Originally posted by RN2B2005


    Finally, to those who attacked me--feel free to e-mail or call. After all, I am sure that all of the critical-thinking and writing courses that you took in preparation for your career as an LPN left you ably equipped to convince me of the error of my ways. Oh, wait, only RN's--who have an Associate's Degree or a Bachelor's Degree--receive such a broad-based education. Silly me.
    Ok, I really tried to stay away from tis one, and I don't want to perpetuate this ugly course, but RN2B, I'm not too sure you have any idea WHAT courses are taken in preparation for an LPN career. And am I mistaken in assuming (mainly because of your BB name) that you are another 2 years away from receiving your RN? Your point is mute (in regard to critica-thinking and writing courses)if you're referring to Rebel or myself, as I think we are both closer to our RN degrees than you are. On another note, I already have a Bachelor's Degree in Fine Arts with a minor in English, so I think that personally I just may have taken more classes in the afforementioned areas than you might have been privy to. Please don't judge us solely on our titles- you're showing your naivete. Peace.
  9. by   NRSKarenRN
    Been away having fun with my family, return to check at the BB only to find the deterioriation of this thread.

    Why is is that people can't express themselves without always deteriorating into she said...he said .....she said and starting flame wars.

    KEEP OUT the personal attacks and the desire to respond back.

    Closing this thread for a couple of hours to cool it off.

    Please go back and re-read your posts. Is it truly what you think/feel, want the world to see??? Is the post on topic or just a lashout of emotions. Want or need to edit?

    Please think about how others view what they see spewing from your coputer and posted under your name ----not intended for any specific person but a pause to refelect.

    When thread reopened, if flaming continues will be permanently closed.

    Karen
  10. by   -jt
    Back to the topic: Safe Staffing ratios

    <<There was a total of 4 staff nurses, 2 RN's and 2 LVN's. We had 12 patients. The RN's where assigned 2 patients each, we (LVN's) had 4.>>

    That seems to be the way LPNs are looking at it. But from the RNs corner, those RNs were assigned 6 pts each, and each RN had an LPN to assist her with the care of 4. I know some LPNs will disagree because theyll feel they had more hands-on time with those 4 pts and the RN "didnt do much" in their eyes - but its true. In that example the RNs in your unit had 6 pts each --- not 2. Still that sounds like good staffing.

    The RNs in your unit had a better staffing ratio with the 6 pts each than California hospitals are trying to force on them statewide now. You said you havent seen any solutions proposed but the RNs union is proposing the very same 1 RN:6 Pt ratio that your RNs had last night.

    You seem to be happy with the staffing in the example you mentioned. Youre an LPN & that ratio seems to have worked for you as well as the RNs. Yet the LPN union, SEIU, is strongly opposing those very same ratios. They are fighting against RNs having less than 8 pts each, while they want the LPNs to just have 4. Go figure.





    <<<Perhaps I'm naive and spoiled to working in a smaller facility. We do not deal with 1:8 patient ratios EVER! We probably never will>>

    Well that explains it then. Hard to imagine then what RNs & LPNs everywhere have been dealing with or what those RNs in California will be facing if it becomes law that all med-surg RNs may be assigned 8 med-surg pts every single day if youve never had to do it yourself.

    Other RNs would drool over the same 1:5 ratio your RNs get indignant over.... but they have already been denied those manageable ratios by the state. They are even being refused the same 1 RN to 6 pt ratio that worked so well for you last night. They will not even have the same low pt numbers assigned to them that the LPNs will enjoy, but the LPNs union & the hospitals are actively fighting to prevent RNs from having lower pt numbers too. Yet we are criticized for our objections to that & are told we're just "complaining about covering LPNs" - like it should be no big deal.

    Running to another facility is not going to help California RNs because its a state law and the state is mandating the ratios for all acute care hospitals. That means its the same for all. Once the law goes into effect, the hospitals legally only have to provide the ratios that the law says it has to. They dont have to offer any better ratios than what the state mandates, & most wont. That concerns me because I have a California license & work there part of the year.

    Your smaller facility gave the RNs in your unit better staffing than what the state is mandating, better staffing than the SEIU wants RNs to have, and better staffing than the hospitals wanted any nurse to have. Theyre lucky. Hope it stays that way. Many facilities will provide only the minimum amount of staff to be in compliance with the law.
    Last edit by -jt on Nov 26, '02
  11. by   rebelwaclause
    jt...Your post's are saying the same thing over and over again, getting longer and longer with a point that everyone has acknowledged over and over again......

    Are you READING what others (including myself) are saying?

    No need to respond...I dare not ask.

    I fully understand now. You have to WORK in California to SEE how it could work (not just read about it from CNA and SEIU's standpoint, who most California nurses love to hate).
    Last edit by rebelwaclause on Nov 26, '02
  12. by   -jt
    <<<<<< You could sign the chart at the end of the shift and confidently know I would've informed you of any changes.>>>

    If I dont know whats happening with the pts & am just assuming, Im cutting professional corners just so I can deal with an unmanageable load of pts. Id rather have a more manageable load of pts to be able to do my job correctly the way Im supposed to do it. Delegating is not the problem. As you have seen, it works well when the staffing ratios are manageable, as yours have been. Too many pts to care for, keep up with, & be responsible for at once is the problem.

    About trust,

    There is a practice act, hospital policy, legal & professional standards to adhere to, & responsibility to know that what we are signing to is fact. We can trust each other to the moon but we cant be so cavalier & unprofessional with our licenses, disregard the standards, & ignore policies & regulations just because we trust each other.

    I can trust you with my life too, but I still have to be in there & know whats going on with your pts & whats happening. I can trust you but I still have to follow the rule book, you know? But when we dont have staffing ratios like yours & I have a pt assignment from hell of my own, how can I also be ontop of whats going on with all of your pts too & stopping with my full assignment to provide the RN care/tasks/interventions to your full assignment at the same time?

    I cant - but I am still expected to, required to, and held accountable for it. Crossing my fingers and trusting while Im trying to manage an unsafe number of pts is just flying by the seat of my pants everday & hoping for the best. I trust you - but you know what? I still have the assignment from hell & too many pts to care for and cover so what next?

    I need a safe number of pts. Bottom line. RNs need safe staffing ratios. Eight pts on a med surg floor is not it. I dont even know why LPNs are arguing this with RNs. Dont they want safe staffing ratios for everybody or only for LPNs? I dont see their union offering to have LPNs take 8 pts while they keep telling RNs its no big deal for us to do it.

    No...... LPNs will be restricted to just 4. So what the heck are they doing fighting for RNs to be required to be responsible for at least 8?
    Last edit by -jt on Nov 26, '02
  13. by   -jt
    After reading about your own excellent staffing ratios & your confession that you have never even worked with unsafe staffing numbers, I see how it might be difficult for you to visualize what its like for the rest of us & why this is a topic that is being debated. Its impossible. Its why RNs are bolting out the door in the first place.

    Remember that youre seeing things from the standpoint of someone who does have safe staffing, so youre seeing it work well. But it works well because it is a safe staffing ratio for you. Your ratios are not the reality in most other places so for those nurses, it doesnt work the way youve experienced. Imagine being the lone RN on a busy urban med surg unit with just 3 LPNs & 36 pts or even be one of the LPNs in that situation. Its shouldnt be too hard to see what the RN is talking about when she expresses strong concern over not being able to safely manage her own pts PLUS "cover" for all the LPNs pts and still adhere to the professional standards her license requires of her & holds her accountable for.

    I would be terrified to be that RN - and not because I didnt trust the LPN. How can it be so difficult for LPNs to see this? I would also be terrified of the LPN (and RN) who didnt recognize the problem with this kind of staffing. But this scenario of having less RNs covering for more LPNs is what the SEIU staffing ratio will do to us all.

    Some people suggest we cut professional corners in order to deal with unmanageable pt loads. RNs are saying NO to that! Dont tell me to just hand off more of the job to someone else. Give me manageable pt numbers so I can do my job the right way.

    Delegating helps lighten the burden but it does not remove it or relieve the RN of her job or her responsibilities as dictated by her profession, her license, her state licensing board, or her employment job description.

    SEIUs 1:4 "any-nurse" proposal really means 1 RN to 8 pts with 1 LPN to help with 4 of those pts. The RN unions proposal is 1 RN to just 6 pts, with as many LPNs as the hospital wants to add to that. SEIU's fight to ensure that LPNs have a safe pt load limited to just 4 pts will also require that the RNs own pt load not be less than 8. Thats the problem.

    You have worked with the RN unions staffing ratio 1 RN:6 pts & with better than that from the impression of your post. And have seen that it works well. Maybe you'll tell them that at the Fresno meeting because, until you have tried to work as an RN with the ratios that the hospitals & SEIU want the RNs to work with, you have no idea how good you have it with your 1 RN to 6 pt ratios. We're fighting for all med-surg RNs there to have the same ratios youve had!

    If I have a safe ratio of manageable numbers, delegating and following that up will not be a problem. You have seen how well it can work because your RNs already have safe staffing ratios - the same ones that the hospitals & SEIU are trying to deny all other med surg RNs in the state. If I have a safe manageable number of pts, doing my job the way its supposed to be done is not going to burn me out.

    This is not a union issue for me because, even though I work in California for part of every year, I am not a member of any union there. This is an RN/pt safety issue, plain & simple.

    Yes, I read what you wrote. I tried to defuse the emotion, & address your points from the RNs angle. Obviously to no avail. Maybe someone else can. Im done.
    Last edit by -jt on Nov 26, '02

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