government mandates staff/pt ratio

  1. Hi....I am currently working per diem agency and seen a lot as far as hospital staffing goes......and its looking pretty ugly out there.
    But, I haven't worked in a unionized hospital. And being from Florida, I haven't worked where the government stepped in and mandated nurse/pt ratios either.......I am curious as to which works best for us? Has anyone had the opportunity to experience both?
    I may be a bit naive, but I would think the only thing out there to help our patients receive proper care (and relieve a great deal of our stress) are ratios that are enforced by law.
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  2. 6 Comments

  3. by   Dr. Kate
    As they say, you have to be careful what you ask for. Most of the mandated ratio laws speak about licensed nurses not RNs.
  4. by   -jt
    Theres a loophole in the staffing ratio law the governor passed in California. The idea of the original law was supposed to be for specific RN to pt ratios. What ended up being passed was ratios for "licensed nurses" - which means the hospital could have 1 RN on the floor responsible for all the pts & the rest of the staff could be all LPNs - which doesnt really help the RNs because the whole idea of staffing ratios originally was to not have 1 RN responsible for so many pts. The fight there is now to correct the interpretation of the law back to the original intent of the bill. So the law's implementation is stalled. In the meantime, the unions are trying to get around the problem by negotiating RN staffing ratios into their contracts.

    In my state, we dont have ratio laws dictating numbers. We have that in our New York State Nurses Association union contracts. The RNs at each facility decide the unit-by-unit, shift -by-shift RN ratios that they feel will work for them at their facility based on the acuity of the pts they care on each floor & in each department & that is put into the contract - becoming "law" at that facility (so to speak). Our contracts also stipulate the number of CNAs & LPNs (if any) that are to be on those floors on each shift based on the number of pts. So the ratios for a med-surg unit at a high-acuity trauma/medical center might be different from the ratios RNs themselves at a small, less acute, community hospital decide works for them.

    Our union (our state nurses assoc) has written the safe staffing bill that is currently being sponsored in our state legislature & it follows this concept rather than setting minimum #s of RNs for #s of pts. The idea is that the RNs at each facility should be able to decide their own working conditions as they are the ones who know best what will work for them and the kinds of pts they care for.

    Some of our hospitals have had this in effect in their contracts since the early 1980s.
  5. by   pickledpepperRN
    Here in California the ratio law has not gone into effect yet.
    For about thirty years we have had a ratio law for ICU and CCU patients. "Two or fewer patients per licensed nurse at all times."
    Almost no hospital has used LVNs for the last 20 years.
    This includes lunch breaks.
    Many nurses prefer to work in ICU, not to care for the sickest patients but so they can have the peace of mind that comes from time to care for your patients and time to think.
  6. by   rebelwaclause
    (Hi Spacenurse...A fellow Californian!)

    I'm a LVN that works in a "chain" hospital, med-surg unit, here in the bay area (California). The CNA is negotiating a 1:4 ratio for RN staff, that our hospital has decided to pilot to see how it will work. So far? Its good. The RN's rarely get more than 4 patients, when staffing is low, they may get five patients. I've seen it work well in our smaller (yet chain!) hospital.

    In your post JT, you said:

    Theres a loophole in the staffing ratio law the governor passed in California. The idea of the original law was supposed to be for specific RN to pt ratios. What ended up being passed was ratios for "licensed nurses" - which means the hospital could have 1 RN on the floor responsible for all the pts & the rest of the staff could be all LPNs - which doesnt really help the RNs because the whole idea of staffing ratios originally was to not have 1 RN responsible for so many pts. The fight there is now to correct the interpretation of the law back to the original intent of the bill. So the law's implementation is stalled. In the meantime, the unions are trying to get around the problem by negotiating RN staffing ratios into their contracts.

    Can you tell me where I could reference this? I'd like to be more educated on this initiative. Thanks!

    ...Normally, our RN's will refuse to work without another RN and a LVN, for obvious reasons (I wouldn't want the responsibility either!), But when census is low, most RN's are comfortable working with just me because they trust my skills and are willing to "cover" the things I can't do....But I make sure I've maxed out my scope up, down and around before soliciting my RN.

    Take care all!
  7. by   -jt
    <Can you tell me where I could reference this? I'd like to be more educated on this initiative. Thanks!>

    It was discussed in a presentation by members of the American Nurses Association-California at the national RN labor union convention of the United American Nurses in Philadelphia this past June. It has been written about in many news articles which I dont have links to but you might be able to find in an online search. I think I saw one in a San Diego newspaper & several in the Sacramento Bee. It is also detailed info on the California Nurses Assoc website which might be the easiest source to search.
  8. by   pickledpepperRN
    Look at:
    www.calnurse.org
    click on the "ratios Announced" link

    The CNA is of the opinion that the MINIMUM ratios be RN only and the LVN will be assistive to the RN.
    Most ICUs do not use LVNs.
    It makes a huge difference when working with a skilled LVN whose abilities are known. When working with an unknown LVN the RN must assume this nurses knows only what was taught in school.
    In addition I will float to an unfamiliar unit and assist an RN who is experienced in that specialty. It would be unsafe for me to work with an LVN as the only other licensed nurse in an area where I have no competence nor orientation.

    PS: Hi rebel! I am glad it is working well. How is retention of staff? Is the facility advertising for nurses based on these ratios?
    I would work on a telemetry or medical-surgical unit with such ratios, especially with a good LVN too! ((But not move away from my family).

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