CA staffing ratios evoke anger 'tween RNs & LVNs

  1. 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.
    Last edit by NMAguiar on Nov 20, '02
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  2. 118 Comments

  3. by   sjoe
    Surprise!
  4. by   legsmalone
    Actually just got a letter from my place of employ affirming there promise to me as a nurse (in June of course ) that they support the staff ratios, but of course "We remain concerned with a few of the provisions within the regulations, their practical impact on hospital operatinos and our ability to maintain access for our patients." In other words, we want to do this, but we don't know how in the hell to manage it...
  5. by   Gomer
    What is boils down to is CNA (Calif. Nurses' Assoc, aka union) wants only R.N.'s in the ratio numbers while SEIU (other union) wants R.N.'s and L.V.N.'s (50%) considered in the ratio numbers. Why? L.V.N.'s can't join CNA, but can join SEIU (ergo, more $$$$ in the union pockets).

    Love it when the unions are divided and fighting each other...makes for excellent theater.
  6. by   RN2B2005
    Hospitals want to call L.P.N.'s "nurses" because these "nurses" earn a fraction of what a graduate R.N.'s earn. L.P.N's DO have their place--to assist and carry out the directions of a physician or nurse under the immediate supervision of a graduate R.N. To the uninformed public, especially the older members of the population, any female in any kind of uniform in a hospital setting counts as a "nurse"; hospitals generally fail to educate patients in the roles of various staff. The inter-union bickering just serves the purpose of the hospital's bottom line.

    Not to denigrate L.P.N.'s, but when push comes to shove, I want an R.N. at my bedside. When I was hospitalized after the birth of my son, my urinary catheter bag was changed by a well-meaning but none-too-bright L.P.N. who marked that the catheter had been REMOVED instead of CHANGED. Therefore, the catheter was left unattended for several hours (the bag hung on the side of the bed out of immediate view of hospital staff), backing up and causing a bladder infection. It was only after I brought it to the attention of an R.N. (after telling a C.N.A. and another L.P.N. that the catheter was still in place, and being ignored after they looked at the chart) that the catheter was removed.

    The hospital avoided a lawsuit because a) I recovered without sequelae from the bladder infection and b) I'm not a litigious person. I wonder if other patients who suffer because inadequately trained staff make mistakes will be so forgiving.

    If hospitals want to call L.P.N.'s "nurses", fine. Just let them hire TWO L.P.N.'s for every R.N.; after all, an L.P.N's training is one year, half the minimum for an R.N. This will turn the hospital's "cost-saving measures" on their head.
    Last edit by RN2B2005 on Nov 20, '02
  7. by   -jt
    <a bitter dispute has broken out between rival unions over exactly who should count as a nurse.>

    Thats not new. That has been the problem with that law from the very beginning. The intent of the RN union behind the law in the first place was for one REGISTERED NURSE to a set number of pts. The whole reason for the law was that REGISTERED NURSES had responsibility for too many pts. The INTENT was to fix that with REGISTERED NURSE staffing ratios, but the LANGUAGE of the law that the Governor finally settled for & signed doesnt say "RN" - it only says "NURSE". You can just imagine the Cheshire-cat grins appearing on the faces of all the CA hospital administrators when that happened.

    Of course there is going to be a fight over it by the RNs that first proposed the law & the original intent of it to increase the number of REGISTERED NURSES so RNs had a safer pt load, & who worked so hard for about 10 years to make it an issue and get the state law passed and well there should be a fight. And there has been since day 1.

    Because the LANGUAGE of the law as passed created a loophole for the hospital to get around the INTENT of the law. They can get away with not hiring any additional RNs, staffing with more less costly LPNs, ignore the intent of the staffing ratio law but still technically be following the letter of the law itself by having more NURSES instead of more REGISTERED NURSES.

    And they'll be saving money by doing it. Is it any wonder that the hospitals are taking the side of the LPNs union?

    The loophole could mean a hospital hiring boom for LPNs there, so of course their union is going to fight for it. But while the state gets a staffing ratio law, the REGISTERED NURSE could STILL be left with responsibility for too many pts - her own & the pts of all those LPNs too. THATS why the RNs union is fighting against it. And well they should.

    There are real implications for pts and RNs when the suits try to get around the intent of the law on a technicality in the language. The fight over this law is not merely a union power struggle as some people are going to make it out to be.

    This could turn out to be a case of the RNs fighting for pt safety, making real progress, and then getting the rug pulled out from under them.
    Last edit by -jt on Nov 20, '02
  8. by   Gomer
    Sorry, jt, but the legislation was developed and written by CNA, not the governor. If the Calif. Nurses's Association doesn't know the difference between "RN" and "nurse", how do you expect the politicians to?
  9. by   -jt
    Its not contract negotiations. The Gov doesnt ask the RNs to ratify the final draft before he signs it. This bill, like all others, had so many changes made to it as it went thru the process that the law which finally was signed by the Governor was not exactly the same as the bill first written & submitted by the RN union.
    Even so, there such a thing as INTENT of the law and the intent was about RN staffing.

    The issue was that REGISTERED NURSES have had the responsibility for a dangerously high number of patients. The law was supposed to rectify that. It solves nothing to obtain this new law with that intent and then apply it to LVNs, leaving the RN with responsibility for her own patients plus the LVNs patients. The RN STILL gets the responsibility of too high a number of sick people to care for safely.

    If the intent of the law is going to be ignored, might as well have saved the time, money, effort and aggravation it took to get this law passed in the first place.
    Last edit by -jt on Nov 20, '02
  10. by   Gomer
    Maybe the union should have been more "awake at the switch". Isn't that what the members pay their dues for....representation?
  11. by   BadBird
    I remember a long time ago when there was a LPN on the unit that a RN had to co-sign her charts & orders, which meant that we supervised her and signed off that the care was given, all treatments were done properly. Now when you have a full patient load yourself you do not have time to follow another nurse around, you just have to take their word that everything was done correctly, very scarey !!! Does that mean that the ratio for RN's would decrease because actually we would be assigned to her patients too? I haven't done floor nursing in a long time so I don't work with LPN's anymore, I don't know how they are managed and if a RN has to sign off on them anymore, does this still happen? By the way, some of the best nurses I worked with years ago were LPN's, I am not dissing them at all I just don't know the legal ramifications. Should be interesting to see what evolves from this mandatory patient to nurse ratio, at least it is a step in the right direction. What do you all think?
  12. by   -jt
    Gomer youre just trying to bait people. Nobody was "asleep at the switch". Everybody knew what the law was about - RNs. They all knew they were talking about RN staffing ratios. They knew what the intent of the law was and laws do not exist in language alone. Intent means something no matter what words are used to describe it. RNs werent out there fighting for more LVNs to be hired. The whole thing was about RNs staffing from the beginning. The Gov signed into law what he wanted to sign - not exactly what the RNs first proposed.

    Now other people are throwing in monkey wrenches purposefully to cause a delay in implementation, hoping to weasle out of having to provide the staffing ratios for as long as possible.
    And others have jumped on the bandwagon, taking advantage of an opportunity to secure jobs for their own through the back door.

    The RNs did the work & accomplished something real. Now the feeding frenzy off their backs begins. And the hospitals that were livid over having lost the fight against the staffing ratio law are grasping at any other angle they can to try & stop it from being put into effect. Theyre probably making some legal consutlant rich too. Challenging the law, causing confusion, and an argument over who the law applies to is the perfect smokescreen to hold everything up indefinitely or at least make it cheaper for them.

    Surely you arent so naive as to not see that.
    Last edit by -jt on Nov 20, '02
  13. by   Gomer
    As you said jt.....

    "Now other people are throwing in monkey wrenches....."

    One of those "other people" is the other union SEIU who stand to gain alot more than the CNA if LVN's are considered "nurses".
    (If I didn't mention it, SEIU is in favor of LVN's being included in the ratio)

    And, no, I'm not trying to bait anyone. I just find this a perfect example of what unions are all about....getting members' $$$$$$ (in SEIU's case) and once they have the $$$$$ not really representing the members (as in CNA's case for not fighting for the word RN rather than nurse in the legislation).
  14. by   Youda
    Originally posted by Gomer
    Maybe the union should have been more "awake at the switch". Isn't that what the members pay their dues for....representation?
    If I may interrupt the debate for a moment . . .

    The union had no control over the bill once it was introduced. Although I haven't researched this particular bill, I can at least tell you in general terms that it was discussed in committee and changes were made there. In committee, compromises in language were more than likely made at the pressure of the hospital PACs! So, it is VERY likely that this language was manufactured and inserted by the PACs who didn't want the bill in the first place and so created the loophole to benefit themselves. This problem isn't the union's doing, in other words. Please take the time to review "How a Bill Becomes a Law." No disrespect to your viewpoint intended.

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