Illinois: "Nurse Staffing by Patient Acuity" bill passes - page 2

the "state" of staffing the illinois nurses association (ina) is celebrating the unanimous passage of the "nurse staffing by patient acuity" bill. while other staffing legislation has failed, ina... Read More

  1. by   locolorenzo22
    This issue is near and dear to me...I work neuro...and the other weekend..this is FEB....3 nurses with 9 patients a piece.....the neurosurgon was TICKED!!!! as well he should be and filing a complaint with the board of directors. I am a may grad this spring, and a current CNA.....
    we have NOT seen a change in levels...and in fact, it shorted tech hours to make up for the supposed "acuity" of the RNs! That's how they get around it....make the CNAs do more with less, and the RNs still have to give the meds, do their jobs, they can't be doing all the first line care!!!!
    I have yet to see any aspect of acuity staffing occuring...they base it on average acuity of patients...well, when most of your patients are hips, knees, backs, and they don't count the total care elderly that come in at 10PM...there's a problem....
    This is silly, and the whole reason why I'm looking forward to being a RN....at least my patient load WILL (because I won't work with it not to be) be manageable....it's a joke....WHEEEEEE!
  2. by   pickledpepperRN
    Quote from Kati2005
    I dont think have a bill will make the staffing situations any better. I have a friend who used to be an RN in California. She said that since that bill was mandated about the ratios, they have taken some tasks away from the nursing assistants and made it solely under the RNs job description. For example, she said one night she had patients that were due for blood glucose checks every hour because they were on insulin drips. The nursing assistants were not allowed to test blood glucoses with a glucometer by law. So after hearing that, I'm not sure how well the ratios would work and if they would assign more tasks for the RN that are not able to be delegated. We should be lobbying for more pay.
    Absolutely!
    I helped work for this law. These were unlicensed and sometimes untrained people assigned to replace the nurses who had been laid off.
    I do NOT want to be forced to administer insulin coverage based on someone else doing the accucheck.

    Shouldn't the same NURSE do the accucheck who gives the insulin? Or glass of juice?
    Or teached the patient and family.
    Thankfully I am not so short staffed that I would even give insulin based on a list of results.

    Here is an explanation:
    http://www.rn.ca.gov/pdfs/regulations/npr-b-29.pdf
  3. by   RN1982
    Quote from spacenurse
    Absolutely!
    I helped work for this law. These were unlicensed and sometimes untrained people assigned to replace the nurses who had been laid off.
    I do NOT want to be forced to administer insulin coverage based on someone else doing the accucheck.

    Shouldn't the same NURSE do the accucheck who gives the insulin? Or glass of juice?
    Or teached the patient and family.
    Thankfully I am not so short staffed that I would even give insulin based on a list of results.

    Here is an explanation:
    http://www.rn.ca.gov/pdfs/regulations/npr-b-29.pdf

    Ok, I don't see anything wrong with an aide taking a blood glucose with an accuchek. The problem is when an RN has two patients with hourly glucose checks. Thats more work for the RN and especially if that RN has four patients. So how is the law helping with acuity?
  4. by   pickledpepperRN
    Quote from Kati2005
    Ok, I don't see anything wrong with an aide taking a blood glucose with an accuchek. The problem is when an RN has two patients with hourly glucose checks. Thats more work for the RN and especially if that RN has four patients. So how is the law helping with acuity?
    Soon after Y2K when the restrictions on UAP practice went into effect I worked registry on a tele unit with six patients. The very kind aide handed me a slip of paper with my four DM patients accuchecks.
    I apologized to my patients explaining that I want to do it myself.
    It seemed to me that the room mate with a very high glucose level had her number written as the room mate with a lower number.
    IF I had given insulin coverage to the wrong patient her brain or kidneys could have been damaged. Seizures would have been likely.
    Sorry but I DO think an invasive procedure to obtain a result used for a potent medication such as insulin is not appropriate for an unlicensed person. It should not be in their scope of practice.

    If you have four patients requiring hourly accuchecks you and your colleagues are understaffed.
    It is wrong for your employer to down substitute an aide for a licensed nurse.
    In California telemetry patients in a STABLE condition must be staffed at four or fewer patients per nurse.
    Patients not in a stable condition must be staffed at three or fewer patients per nurse.

    The regulation requires that the hospital must implement a patient classification system for determining nursing care needs of individual patients that reflects the assessment, made by a registered nurse of patient requirements and provides for shift-by-shift staffing based on those requirements.
    The ratios shall constitute the minimum number of nurses 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
    Acuity system requirements 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 must 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.

    Acuity starts on page 7 - http://www.dhs.ca.gov/lnc/pubnotice/...ation_Text.pdf

    On units where the nurses are united in advocating for safe patient care they actually achieve safe staffing.
    There is no need for an unlicensed person to perform critical invasive data collection. You need an LVN/LPN or fewer patients.
  5. by   workingforskies
    Quote from snappy01
    The Illinois legislation stinks...will maintain the status quo and NOTHING WILL CHANGE! RN's in other states WATCH the legislation in your states so you can TAKE A STAND BEFORE IT PASSES.

    Agreed. The fine print seems ambiguous to me. It essentially allows each hospital to define "Acuity" and puts that responsibility upon a committee that has at least 50% of it's members as RN's who do actual bedside care. In practice, all they are going to do is stack their committee with a bunch of either young nurses who will do what they are told, or a-- kissers with an eye for management in their futures.

    How will this be enforced? It's unenforceable. Imagine a nurse trying to bring action against her hospital and then trying to prove that her patients were at a higher acuity than what her bosses defined them as? What a nightmare that would be.

    This legislation is utterly worthless. I agree with 'Snappy01'. Nothing will change. Nurses in Illinois will have the same crappy assignments, the politicians get a gold button they can bandy about to the press, ("We CARE about our nurses and patients here in the Land Of Lincoln"), and the health care machine will continue to grind on in their mission of increasing earnings per share and getting fuel in the ol'e corporate jet with nary a bump in the road.
    Last edit by workingforskies on Feb 19, '08
  6. by   interleukin
    "Imagine a nurse trying to bring action against her hospital and then trying to prove that her patients were at a higher acuity than what her bosses defined them as? What a nightmare that would be."

    If only every nurse had the courage to forcefully state the obvious that many of the previous writers have.

    Any acuity tool which does not consider the enormity of variables and dynamics of patient care and disease processes will be useless. And creating such a valid tool is an undertaking of enormous and scholarly proportion. And unless one is created and enforced we are treading water.

    But, at the heart of all of this is the following: Management's continuing crusade to micro-manage nursing.

    Unless, and until, they cease trying to force nursing into assembly-line models of efficiency, patients will never get the care that research says they can when staffing is based upon not some Utopian model but a model that actually understands the inherent unpredictability of nursing.

    We must at least stop saying that, "We are not able to give proper patient care." Instead, we must say, "They are letting down their patients by not only ignoring the research but also their mission statements."

    Instead of re-assessing budgets according to research, they want shiny new buildings with yet more rooms. perhaps they can manufacture the extra staff out of pipe cleaners.
  7. by   Charles66
    Staffing needs vary greatly according to acuity. The only one who really knows the acuity are those working on that unit at that time. The house supervisor should be able to verify and keep track of what is going on, by speaking to the charge RN on the unit. The problem we face is that there are few, if any, qualified float personnel. The hospitals need to be willing to pay premiums for personnel to come in when needed. Buy using such a system, they will develop staff with a broad set of skills, that can be used on several units. The PRN staff will be rewarded for being available on call.

    I work psych, and we need a mix of staff. We do not need all RNs. LPNs still exist, and should be utilized. Techs are OK too, but should have a psych background, as they do in California. We also need more guards to be available at a moments notice. Not five minutes later.

    One patient can require several staff at any one given time, That leaves all the other patients at risk. It is not uncommon for our patients to wander into another room. Plus the possibility of self harm and suicide.
  8. by   workingforskies
    Quote from interleukin
    "Imagine a nurse trying to bring action against her hospital and then trying to prove that her patients were at a higher acuity than what her bosses defined them as? What a nightmare that would be."

    If only every nurse had the courage to forcefully state the obvious that many of the previous writers have.

    Any acuity tool which does not consider the enormity of variables and dynamics of patient care and disease processes will be useless. And creating such a valid tool is an undertaking of enormous and scholarly proportion. And unless one is created and enforced we are treading water.

    But, at the heart of all of this is the following: Management's continuing crusade to micro-manage nursing.

    Unless, and until, they cease trying to force nursing into assembly-line models of efficiency, patients will never get the care that research says they can when staffing is based upon not some Utopian model but a model that actually understands the inherent unpredictability of nursing.

    We must at least stop saying that, "We are not able to give proper patient care." Instead, we must say, "They are letting down their patients by not only ignoring the research but also their mission statements."

    Instead of re-assessing budgets according to research, they want shiny new buildings with yet more rooms. perhaps they can manufacture the extra staff out of pipe cleaners.

    What an artfully articulate post! I could not agree more.
  9. by   medpsychRN
    About 3 weeks ago, in a general staff meeting, we were told we would be staffing by the numbers NOT acuity. I work in Illinois in a large university hospital and yes the hospital is forming a committee on staffing. I should also mention in I work in Chicago where tradition dictates a "business as usual policy". All the hospital has to do is change the rating of acuity numbers and they will be in compliance using the same amount of staff or less.

    I am guessing when I am unable to complete my work assignment in 8 hours, I'll be called to the office and asked about my time management abilities.

    I wrote the INA, state rep/senator. There is a federal bill sitting on committee about nurse patient ratios. To protect ourselves from unsafe assignments, nurses need to support this endeavor.
  10. by   RN1982
    Quote from spacenurse
    Absolutely!
    I helped work for this law. These were unlicensed and sometimes untrained people assigned to replace the nurses who had been laid off.
    I do NOT want to be forced to administer insulin coverage based on someone else doing the accucheck.

    Shouldn't the same NURSE do the accucheck who gives the insulin? Or glass of juice?
    Or teached the patient and family.
    Thankfully I am not so short staffed that I would even give insulin based on a list of results.

    Here is an explanation:
    http://www.rn.ca.gov/pdfs/regulations/npr-b-29.pdf
    I see no reason why a nursing assistant should not be taking a patient's blood glucose as long as they repeat the test if the result is high or low. Any person can walk into a local pharmacy and buy a glucometer and figure out how to use it on their own without having an RN teach them. I'm sorry but I don't agree with your rationale.
    Last edit by RN1982 on Mar 8, '08
  11. by   pickledpepperRN
    I will not give insulin to a hospitalized patient based on another person doing the accucheck.
    I once was handed a list of room numbers by a CNA.
    He had a normal BS for a patient and a very high level for the room mate.
    I apologized to the patients when I repeated their accuchecks.

    Yes, the high result requiring regular insulin coverage was actually from the patient in bed "A".
    The list handed to me stated "B" had a high result.
    We must advocate for the best interest of our patients.
    The SAME licensed nurse should test the blood sugar and treat the result.

    People give their own insulin at home too.
    Do you think administering sliding scale insulin should be done by an unlicensed person?
  12. by   pickledpepperRN
    Quote from Kati2005
    I see no reason why a nursing assistant should not be taking a patient's blood glucose as long as they repeat the test if the result is high or low. Any person can walk into a local pharmacy and buy a glucometer and figure out how to use it on their own without having an RN teach them. I'm sorry but I don't agree with your rationale.
    I see a reason every acute care patient needs to be assigned to a registered nurse who is responsible for the nursing process.

    Acutely ill hospitalized patients need NURSING care.
  13. by   RN1982
    Quote from spacenurse
    I will not give insulin to a hospitalized patient based on another person doing the accucheck.
    I once was handed a list of room numbers by a CNA.
    He had a normal BS for a patient and a very high level for the room mate.
    I apologized to the patients when I repeated their accuchecks.

    Yes, the high result requiring regular insulin coverage was actually from the patient in bed "A".
    The list handed to me stated "B" had a high result.
    We must advocate for the best interest of our patients.
    The SAME licensed nurse should test the blood sugar and treat the result.

    People give their own insulin at home too.
    Do you think administering sliding scale insulin should be done by an unlicensed person?
    Um, I know that no one unlicensed should be telling a patient how to follow a sliding scale.

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