why can't nurses get safe staffing laws passed

allnurses Guide · Sep 9, 2017

One of the lobbyists for the Texas Nurses Association told me that hospitals will continue making staffing cuts at bedside until nurses start billing for their professional services like every other discipline does (like PT/OT/speech for example). Once we start making the hospital money, they will start investing in the nursing workforce.

The purpose of a hospital is to provide NURSING CARE.

Anyone not needing nursing care is not admitted to the hospital.

Other disciplines are nor required for each and every patient at all times.

NURSING is the reason the hospital even exists.

All else can be done as an outpatient.

suzil · Sep 9, 2017

Even without a union a group of nurses lobbied their elected leaders and achieved safe ICU staffing in the law:

That is only for the ICU setting. Unfortunately they have nothing for the med/surg and tele floors. The poor nurses in LTC, SNF etc are on their own.

MunoRN, RN · Sep 10, 2017

One of the lobbyists for the Texas Nurses Association told me that hospitals will continue making staffing cuts at bedside until nurses start billing for their professional services like every other discipline does (like PT/OT/speech for example). Once we start making the hospital money, they will start investing in the nursing workforce.

Except PT, OT, and Speech don't bill for their services for inpatients, neither do hospitalists for that matter, those services are reimbursed by IPPS based on DRGs. It's unlikely we'd be better staffed if we directly billed, most likely the reimbursement rates would be set to approximate what we currently make except we would have to also spend time billing, appealing denials, etc, so our hourly pay would likely decrease significantly.

gcupid · Sep 18, 2017

I am a Management RN who has worked as management before becoming an RN. I care about patient safety but am able to look at the whole picture and have information available to me that line staff more than likely do not. I have worked in union and non-union environments.
Developing a staffing model is an art if you will. Most people think only "bean counters" decide how much staff we get.
When I do develop a staffing model I get input from staff. I have provided schedules (no names on it) and times we need higher coverage than others. I have also provided an empty schedule (no times with the caveat of some must have criteria i.e. there must be coverage 24/7)...this one I get my best results and a very creative schedule that with some tweaking success for staff.
I agree with what is written here and patient safety but I really do not think a class action lawsuit is the answer. What I think is the ANA, and any other health profession association band together and submit a Problem, Solution and discussion formation to our Nation leadership. Invite your local congress senator, mayor, governor to your facility for the day at a time when they are feeding, passing medication, putting in bed for a afternoon rest... you know the busy times. I know from being in Long Term Care to have staffing ratios and the reimbursement that goes with it would make a difference in so many lives however I would want this to be made in a thoughtful way because be careful what you wish for once we get government input then our administrative costs', documentation, and everything else we do is so much more than what we bargained for to begin with. I want to see staff busy not overloaded in an unsafe way, I do not want to see staff sitting around because there is nothing to do.
I urge my healthcare profession to carefully think before acting so that any changes are sound and not cost prohibitive.
Bring a solution that includes higher reimbursement form CMS in writing with thousands of signatures not only from nurses but other healthcare staff and patients would be prudent and may work with public pressure in a coordinated, formal and professional way would be refreshing and certainly remembered in that we directed our own path and hopefully worked.
Lastly people often think the companies reap the rewards for profit at the expense of staff, although this may seem true at times I can say in the Long Term care setting profit is not more than 3 percent at most so already they are operating bare bones.

"I do not want to see staff sitting around because there is nothing to do." Are you serious? The last 12hr shift I worked I was running back and forth like a chicken with my head cut off from 7 to about 3:30. I made myself take a seat for 10 min and eat a candy bar so I wouldn't pass out. I wouldn't want to add more stress to my coworkers by becoming an admission or being sent home.

Management, It's okay to see nurses sit. It's not against the law.

Also, I like to sit down and chart. You know document all that stuff that's supposedly required.

labordude, BSN, RN · Sep 18, 2017

I am a Management RN who has worked as management before becoming an RN. I care about patient safety but am able to look at the whole picture and have information available to me that line staff more than likely do not. I have worked in union and non-union environments.
Developing a staffing model is an art if you will. Most people think only "bean counters" decide how much staff we get.
When I do develop a staffing model I get input from staff. I have provided schedules (no names on it) and times we need higher coverage than others. I have also provided an empty schedule (no times with the caveat of some must have criteria i.e. there must be coverage 24/7)...this one I get my best results and a very creative schedule that with some tweaking success for staff.
I agree with what is written here and patient safety but I really do not think a class action lawsuit is the answer. What I think is the ANA, and any other health profession association band together and submit a Problem, Solution and discussion formation to our Nation leadership. Invite your local congress senator, mayor, governor to your facility for the day at a time when they are feeding, passing medication, putting in bed for a afternoon rest... you know the busy times. I know from being in Long Term Care to have staffing ratios and the reimbursement that goes with it would make a difference in so many lives however I would want this to be made in a thoughtful way because be careful what you wish for once we get government input then our administrative costs', documentation, and everything else we do is so much more than what we bargained for to begin with. I want to see staff busy not overloaded in an unsafe way, I do not want to see staff sitting around because there is nothing to do.

It's clear you still have the full-on management mindset that hours and/or "busyness" has a direct link to productivity and quality. While I understand that some specialty areas have different workflows and processes, the notion that one sitting down is not being productive is ludicrous. Busy is a rarely a sign of anything good. Actually, if you feel your staff is sitting too much, take the opportunity to lead them for the future. Find out how they want to grow and let them use that time do it. Idle minds are worse than idle hands.

I'll save my ANA disagreements for another thread.

Daisy Joyce · Oct 16, 2017

I have to disagree that having staff moving around all the time is a good metric for staffing.

Patients don't stay the same. They have good days and bad days. Maybe one day they have several loose incontinent stool that need extra cleaning. Maybe they get sick and need extra care. Maybe there are family members on the floor who need emotional support. Maybe there are admissions. Maybe there are discharges. Maybe there are deaths.

Having some down time for staff means that there is a built-in cushion of time, for when it all hits the fan. And it will.

jadedRN04 · Nov 19, 2017

There is no nursing shortage...just a shortage of good nursing jobs that don't totally burn out nurses.

BedsideNurse · Nov 20, 2017

Ratio laws are meaningless in MA. The hospitals use bogus acuity tools and nurses in ICU get tripled up all the time. If there is a way hospitals here can wiggle out of ratios they will and they do and it sucks. I was so happy when the law passed and now it's clear it doesn't mean anything here. The nurses union has helped zero with enforcing staffing ratios. Very disappointing for nursing and most of all for the patients.

neuron · Nov 23, 2017

Nurses in California formed a powerful lobby back when Arnold Schwarzenegger ran for Governor. They helped him get elected and he in return signed a safe staffing bill into law. It was a big deal back when it happened. Still there are significant exclusions to the law and it only covers acute hospitals.
Hppy

If I remember correctly, I believe the nurses went on strike and refused to work. The hospitals had to rely on temp staffing. In Cali, I believe you can strike for anything.

Kooky Korky, BSN, RN · Nov 24, 2017

I think it's a matter of persistence and of not expecting other nurses to lead the way.

It's being willing to take the lead, to stand up and keep standing. Again - not expecting

someone else to lead the way.

allnurses Guide · Dec 3, 2017

If I remember correctly, I believe the nurses went on strike and refused to work. The hospitals had to rely on temp staffing. In Cali, I believe you can strike for anything.

Arnold did NOT sign the bill. He tried to eliminate med-surg and ER ratoos with an executive order.

Please read about how we achieved the ratios.

Lives have been saved and nurses can better care for our patients:

https://allnurses.com/nursing-activism-healthcare/why-cant-nurses-1097375.html#post9403843

Jtoddrn74 · Feb 18, 2018

Just wanted to ask, did they decrease the ancillary staff when the law passed? Our hospitals nurse pt ratio for days/eves on med surg is 4 to 5 and nights is 5 or 6 with 3 aides on a 36 bed unit. I dont think this is too bad and I KNOW the staff has told me time and again they would rather have an aide than an extra nurse (ie when an aide calls in and noone will come in to fill the sick call). I am very very mindful of this when considering voting in a LAW to mandate that each nurse on every shift has 4 pts. I know they will cut ancillary staff to accomodate the cost of increased nursing staff and sadly, with some nurses not wanting to toilet patients or ask other nurses to help them out but having NO issue asking the aide staff, I fear the patient care aspect of their stay will suffer. I also feel it will cause ED backups and increased ED wait times if ED staff is forced to hold admits. I just cant fathom how a LAW is a good idea....I do want sage staffing but not at the expense of good care for all patients. I think what our staffing guidelines now works and is safe and fair. I wouldn't want my loved one or myself to have to sit in a waiting room for HOURS or board for days in the ED because the floor cant take pts due to having to cap the unit because the hospital doesnt want to break the law.....that to me is poor care and alot worse!!