CA staffing ratios evoke anger 'tween RNs & LVNs

Nurses Activism

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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 dispute has broken out between rival unions over exactly who should count as a nurse.

In separate news, testifying hospitals plead for more time, citing the nursing shortage as a hinderence to nurse-patient ratios.

Both stories in entirety are here.

Has the nursing unions who are fighting that all nurses are equal when it comes to staffing ratios demanded that since they are all equal that all nurses should receive equal pay?

If anyone is going to argue that a nurse is a nurse no matter how much schooling, no matter what their licensure, and can do anything anyone else can do, they why not also fight the hospitals for the same pay as RNs. Why make a difference in pay between LPN and RN, between ADN and NP?

If the hospitals are going to talk dollars, then let's talk dollars! Why not turn their own argument against them? Ask the SEIU to answer that question, huh? Why aren't they fighting for equal wages since their fighting for equal status?

By equal status, I mean equal and interchangeable in staffing ratios, to clarify.

Anyone see a problem here?

thinking some more about this . . .

I'm very serious in my above post. I'm not being facetious.

If we are going to argue that all nurses, regardless of schooling, education and licensure are interchangeable when it comes to staffing ratios, THEN WHY AREN'T WE ALSO FIGHTING FOR EQUAL PAY?

To argue one, but think the other is ridiculous is illogical. We give compensation depending on someone's "worth" in this country, by their educational level, by the skills they are able to perform. If the hospitals and the SEUI want to claim that all nurses are interchangeable, then why not fight for equal pay, too? One demands the other!

Not to belabor the point, but to insure clarity, if the argument is that LPNs can be counted equally as an RN in staffing ratios, then why is there a pay discrepancy?

I know this thought will raise some eyebrows and head scratching. But, really think about it. The premise is that any nurse can fill the staffing ratio, negating the recognition that there may be a difference between RNs and LPNs. So, if they want to insist on this premise, why don't they pay the same? If they want to insist that any nurse can fill the ratio, then why do they, then, pay differently? The differency in PAY ASSUMES a difference that they are unwilling to admit to in staffing ratios. So, if they won't admit to a difference between RNs and LPNs in staffing ratios, why are they making a difference in pay scales?

Why do they think that the implications of this position shouldn't be carried out to its fullest reasoning and consequences?

Since I'm the one who provoked much of the craziness in this thread, I feel obligated to clarify a few things.

First, when I put the word "nurse" in quotes, I did not mean that LPN's are not nurses. I meant, the hospitals will call anybody a "nurse" that they can get away with. Patients may not know the difference in ability or scope of an RN vs. an LPN or an LPN vs. a CNA (or unlicenced assistant, or technician), but when things go wrong, it's the RN's licence on the line. Not the LPN, not the CNA, not whoever else.

In addition, it is my PERSONAL belief that a higher ratio of RNs improves the overall quality of the hospital or healthcare setting. This PERSONAL belief, which you may believe to be right or wrong, comes from my individual experiences in multiple health-care settings, both as a patient and as an employee.

Small things--like familiarity with the names and pharmacology of various medications--make a difference in patient-doctor communication when the intermediary is an RN instead of an LPN. The LPN who came on shift after the other LPN had left my urinary catheter in while marking it in the chart as removed not only failed to listen to me as a patient, she failed to communicate my concerns to her supervisor--the RN on duty. The LPN had been trained to do technical tasks, and when the patient (me) complained of something (the catheter remaining in place) that conflicted with the information in the chart (showing that the catheter had been removed), the LPN lacked the critical-thinking skills to address the problem, so she ignored me. The little box in my chart had been checked off, and that was that. The LPN had the same technical skills as the RN who eventually listened to me--the LPN could read the chart and could also have removed the catheter--but her critical-thinking skills differed. She did not think it was possible that the information in the chart could be incorrect.

On a more empirical note, multiple studies have been done showing that nosocomial infection rates and overall morbidity and mortality rates drop in direct relation to the number of RN's on staff REGARDLESS of the number of non-RN's per patient. Clearly, it is in the best interest of the patient to have a higher number of RN's on staff. This does not mean that LPN's are less important; it simply means that adding LPN's does not improve overall patient outcomes, whereas adding RN's does.

The intent of the California bill was to increase RN-to-patient staffing. The intent of managed-care providers, hospitals, and other entities is to deceive the public into believing that there is NO DIFFERENCE in the quality of care provided by an LPN when compared to that provided by an RN. For all of the LPN's who were so strident in arguing that they are able to do everything an RN does, do you honestly believe that the hospitals will not one day argue that a CNA should be able to do everything an LPN does?

And I agree with those who say that if the unions really believe that LPN's are 100% interchangeable with RN's, then why aren't the unions arguing for the same licencing burdens and pay rates?

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. :rolleyes:

And I agree with those who say that if the unions really believe that LPN's are 100% interchangeable with RN's, then why aren't the unions arguing for the same licencing burdens and pay rates?

I sure agree. The entire problem will be resolved for all the day the unions start demanding, and the hospitals willing to give, the exact same legal responsibilities, licensure, and wages between all groups of nurses. When this idea entered my little pea-brain, it amazed me that no one has seen the pure logic of it, by forcing the hospitals to live by their very words and position!

This is to RN2Bin 2005- I take it you are in school, that is wonderful because we need more nurses! Maybe you could ask some one what the "N" stands for in LPN? It is for Licensed Practical Nurse, not Licensed Practical "Nurse". Just my 2 cents here!

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
Originally posted by Youda

And, that is the problem with this messing with the law that was passed. rncountry is quite correct. The hospitals are trying to lump EVERY nurse into the same category, under the big umbrella called "NURSE" and refusing to recognize that one nurse is not the identical twin of another.

A lot of LPN's see this as a problem, too. Not only is it adding to our workload, but it's allowing for hospitals to get away with things such as having only 1 RN on a floor with the rest of us being LPN's. What this means is a heavier patient load for the LPN, because the RN spends her entire shift (and they obviously have to be charge) pushing all of our IVP's, and hanging our blood (which happens a lot, because we are a trauma floor), and training new staff,as well as any charge duties that are there. That used to bother me, but now that I am closer to receiving my RN, the thought of being the only RN on the floor scares me. I have talked to a few of my RN friends who are in this position on my floor, and the picture is a scary one. I wholeheartedly agree that the scope of practice should be held as different. I also would never work on a Unit, or in Recovery. My LPN program was of an RN preperatory nature, so I was taught things like heart/lung sounds, etc. BUT, I have to say that it IS a good thing to have an RN there to help me when I need a more educated evaluation of something. To say that an LPN can do anything that an RN can do is not valid. I know this because I am furthering my education, and I have learned a lot since LPN school. I didn't take Micro in LPN school for example. And when I took it a few semesters ago, it opened my eyes to a lot! It gave me a much broader understanding of patient care, and I didn't pay much attn. to labs before (except for hgb's, htc's, etc.). I think it would be great for hospitals to require their LPN's to go to RN school, but then they would have to pay them all RN pay when they graduated.

Somewhere way back someone said that LPNs should be concerned about this, too, because soon the hospitals will be saying that CNAs can do the same things an LPN does.

That is already happening. The hospitals here, rather than hire an LPN (let alone an RN), hire a CNA and train them to be a "patient technician" or some such title. What they train the CNAs to do is put-in and take out catheters, DC IVs, etc. Take notice that it is NOT because RNs or LPNs are not available as MANY LPNs are turned away because "we don't have any openings for LPNs."

If it's happening here, it's coming soon to a hospital near you.

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.

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.

>>>>>>

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.

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
Originally posted by -jt

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.

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.

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. :rolleyes:

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?

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