why can't nurses get safe staffing laws passed

  1. Why does it seem that nurses here in the USA cannot get safe staffing laws passed. Only California has been able to do this
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  2. 58 Comments

  3. by   LessValuableNinja
    $: summed up in one character, but AN makes me provide >5.
  4. by   llg
    The political clout of the groups against (American Hospital Association and others who own health care facilities) is greater than the clout of nurses because they invest more time, effort and MONEY into lobbying against such legislation than nurses are willing to invest.

    Basic change theory
  5. by   hppygr8ful
    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
  6. by   Tippyrn
    I heard new York passed laws also but I don't know the details.
  7. by   herring_RN
    Quote from hppygr8ful
    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
    Oops. It was not Arnold.
    More info later.
    Pro life people need to watch this video because RATIOS SAVE LIVES!
  8. by   herring_RN
    I think it will be achieved if enough nurses and others continue the work.
    We can't give up. How about struggling FOR something good?

    We assigned nursed to each and every statewide elected official and visited them or their staff. We made cards with our title (RN), phone number, and later email.
    We answered their questions explaining what a Foley Catheter is, the difference between systolic and diastolic BP, and just about any question your friends and family members ask.
    We listened to their hospital stories.
    We explained our frustration at our patients being forced to share us with too many other patients.

    We let them know that all night, every holiday and weekend the sickest patients in town were cared for by nurses. Patients are admitted to the hospital because they need nursing care. That is the only reason.

    We worked on the campaigns of those who promised to support our safe staffing legislation.
    We interviewed candidates for office and ONLY supported those who promised to support safe nurse staffing for hospitals.
    Nurses 12 year campaign for safe staffing ratios:
    http://www.nationalnursesunited.org/...fight-0104.pdf
    Here is the law Governor Davis signed:
    ftp://www.leginfo.ca.gov/pub/99-00/b...chaptered.html
    Here are the regulations enabled by the statute:
    View Document - California Code of Regulations
    Please enjoy this video even if you don't read any of the above:
  9. by   herring_RN
    Quote from Tippyrn
    I heard new York passed laws also but I don't know the details.
    The New York State Assembly passed the Safe Staffing for Quality Care Act.
    The Yew York State Nurses Association continues their work to pass the bill.
    I hope all nurses and supporter in New York contact their legislators and tell them they was safe nurse staffing.
    NYSNA 217 Lobby Day: Tuesday, April 25 | New York State Nurses Association
  10. by   NurseSpeedy
    Mandated numbers would be a nice start but it will never take into account the workload of a specific assignment. My facility does a pretty good job of not going over a given number of patients per nurse (we are always full). However, even if you discharge all the patients that you started with in the morning, expect to be reassigned those beds with transfers or admits as soon as the room is clean.

    Also, just because a patient meets criteria for a specific floor does not mean that a given number of patients would be safe. I've had days where everything went haywire and I couldn't keep up even within our given number, not getting out until almost three hours after my 12 was supposed to be finished. I didn't even chart until after giving report. It's impossible to say that a certain number will provide safety. I definitely could see administration using it as a way to justify that there is enough staff if there was a law. IVs/inserting and maintaining tubes/pain med frequency/confused patients that are constantly trying to get out of bed-better not fall/declining patient status/phone calls/doctors/families-the list goes on and it's impossible to determine prior to the beginning of a shift what will happen since there is no crystal ball seeing into the next 12 hours. I've had the exact same group one day when everything will go okay for the most part and then the next day it's a total crap shoot. The only thing that would have helped would be another nurse to jump in to give meds and do tasks-but I have rarely seen a facility that will bring on another nurse who doesn't have a patient load assigned.
  11. by   herring_RN
    Quote from NurseSpeedy
    Mandated numbers would be a nice start but it will never take into account the workload of a specific assignment. My facility does a pretty good job of not going over a given number of patients per nurse (we are always full). However, even if you discharge all the patients that you started with in the morning, expect to be reassigned those beds with transfers or admits as soon as the room is clean.

    Also, just because a patient meets criteria for a specific floor does not mean that a given number of patients would be safe. I've had days where everything went haywire and I couldn't keep up even within our given number, not getting out until almost three hours after my 12 was supposed to be finished. I didn't even chart until after giving report. It's impossible to say that a certain number will provide safety. I definitely could see administration using it as a way to justify that there is enough staff if there was a law. IVs/inserting and maintaining tubes/pain med frequency/confused patients that are constantly trying to get out of bed-better not fall/declining patient status/phone calls/doctors/families-the list goes on and it's impossible to determine prior to the beginning of a shift what will happen since there is no crystal ball seeing into the next 12 hours. I've had the exact same group one day when everything will go okay for the most part and then the next day it's a total crap shoot. The only thing that would have helped would be another nurse to jump in to give meds and do tasks-but I have rarely seen a facility that will bring on another nurse who doesn't have a patient load assigned.
    The California regulations attempt to address this in several ways.
    One is to require additional staff to meet the needs of each patient.
    ... In addition to the requirements of subsection (a), the hospital shall implement a patient classification system as defined in Section 70053.2 above for determining nursing care needs of individual patients that reflects the assessment, made by a registered nurse as specified at subsection 70215(a)(1), of patient requirements and provides for shift-by-shift staffing based on those requirements.
    The ratios specified in subsection (a) shall constitute the minimum number of registered nurses, licensed vocational nurses, and in the case of psychiatric units, psychiatric technicians, who shall be assigned to direct patient care.
    Additional staff in excess of these prescribed ratios, including non-licensed staff, shall be assigned in accordance with the hospital's documented patient classification system for determining nursing care requirements, considering factors that include the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan, the ability for self-care, and the licensure of the personnel required for care. The system developed by the hospital shall include, but not be limited to, the following elements
    1) Individual patient care requirements.
    (2) The patient care delivery system.
    (3) Generally accepted standards of nursing practice, as well as elements reflective of the unique nature of the hospital's patient population...
    View Document - California Code of Regulations
    Also the charge nurse is not to be counted in the ratio. At my hospital charge nurses are often very helpful.
    Charge nurses are allowed to take over a nurses assignment during a break, but my hospital eventually hired nurses for break relief. Often they work for five or six hours in the middle of a 12 hour shift. Often the break relief nurse will stay to admit one or more patients.
    From Title 22 of the California Code of Regulations:
    Nurse Administrators, Nurse Supervisors, Nurse Managers, and Charge Nurses, and other licensed nurses shall be included in the calculation of the licensed nurse-to-patient ratio only when those licensed nurses are engaged in providing direct patient care.
    When a Nurse Administrator, Nurse Supervisor, Nurse Manager, Charge Nurse or other licensed nurse is engaged in activities other than direct patient care, that nurse shall not be included in the ratio.
    Nurse Administrators, Nurse Supervisors, Nurse Managers, and Charge Nurses who have demonstrated current competence to the hospital in providing care on a particular unit may relieve licensed nurses during breaks, meals, and other routine, expected absences from the unit.
    View Document - California Code of Regulations
    Please watch the short video. You will understand that nurse's working conditions and patient lives and comfort are worth the years of hard work we put in. New York nurses are doing it now.
    State by state, and the country by country safe staffing will someday be the standard expected for those who need nursing care.
  12. by   SobreRN
    @ hppygr8ful, I remember it well and it was not Schwatrzenegger who signed staffing ratios into law 1999, it was Democratic governor Gray Davis.
  13. by   herring_RN
    Quote from SobreRN
    @ hppygr8ful, I remember it well and it was not Schwatrzenegger who signed staffing ratios into law 1999, it was Democratic governor Gray Davis.
    Governor Arnold Schwarzenegger tried to eliminate the safe staffing ratios for med-surg and emergency departments with executive action. We had to take him to court. He was defeated three times before he gave up.
    Schwarzenegger Abandons Court Fight Against Nurses
    Gov. Arnold Schwarzenegger has given up a yearlong legal battle with the state's nurses union, among his most ardent critics, over a state law that requires more nurses in hospitals...
    ... A judge in Sacramento ruled in March that Mr. Schwarzenegger, a Republican, had acted illegally, but the governor's office appealed the decision. Late Thursday, the state attorney general's office withdrew the appeal on Mr. Schwarzenegger's behalf, state officials said on Friday....
    http://www.nytimes.com/2005/11/12/us...st-nurses.html
  14. by   Wlaurie
    These bills never include ltc. That can be very unsafe. At times I was left with 54 patients and I worked 2nd shift not midnights. Then they want to tell me I don't have good time management. One night I had a doctor wanting to give me orders, a patient's daughter on the phone complaining about care, meds I still had to pass, phones ringing off the hook, another patient at the desk making a phone call, mysteriously no cenas around to help. Then I got called in the office at a later date and was told I don't have good time management skills. Their solution was to make the doctor wait, pass my meds and take the portable phone with me to answer calls while I pass out meds.....right. Nothing unsafe about that. How about an extra nurse, that's what I would tell them now. Patient care is first priority. Answering the phone is not at the top of my list but it was theirs. People were complaining bc they couldn't get ahold of their loved ones....geesh.

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