Pennsylvania Lawmakers Consider Nurse-Patient Ratio Legislation

  1. 2
    Pennsylvania Lawmakers Consider Nurse-Patient Ratio Legislation

    Rest of the story here…

    http://www.rwjf.org/humancapital/digest.jsp?id=9562

    Source: http://www.afscme.org/workers/68.cfm
    missmoe and lindarn like this.
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  4. 20 Comments so far...

  5. 4
    My gripe is that SEIU is trying to make the numbers cut and dried, black and white. The objective of ancilary staff is not being addressed. Yes, I may only have five patients, but there's no aide, one person in pharmacy (for the whole 800+ bed hospital), only one person in central supply and he can't leave to deliver your equipment (Yet, when there were three people earlier when the supplies were ordered, why didn't they send it then? ), no secretary, etc. I still won't be able to provide good care to those patients b/c I'm forced to wear too many other hats. When the hospital has to comply with specific ratios for nurses, they just cut corners somewhere else. Until that issue is addressed, the ratio numbers won't mean a lot and SEIU refuses to aknowledge that.
    Last edit by NurseyBaby'05 on Mar 29, '09
    wonderbee, lindarn, rabbitgirrl, and 1 other like this.
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    Quote from NurseyBaby'05
    My gripe is that SEIU is trying to make the numbers cut and dried, black and white. The objective of ancilarry staff is not being addressed. Yes, I may only have five patients, but there's no aide, one person in pharmacy (for the whole 800+ bed hospital), only one person in central supply and he can't leave to deliver your equipment (Yet, when there were three people earlier when the supplies were ordered, why didn't they send it then? ), no secretary, etc. I still won't be able to provide good care to those patients b/c I'm forced to wear too many other hats. When the hospital has to comply with specific ratios for nurses, they just cut corners somewhere else. Until that issue is addressed, the ratio numbers won't mean a lot and SEIU refuses to aknowledge that.

    Yeah, I think any legistlation needs to be mindful of all that. I also think that ratios should be determined based on acuity. We have functioned without a secretary on nights and we sometimes don't even have an aide or the aide has 21 pts to care for. We may have as many as 3 vented patients with all that goes along with those pts such as isolation, diarrhea, bed sores, tube feedings and our managers seem to have little concern about the ability of one nurse to handle such a load. Another nurse may have 3 patients who are only on our unit because they need monitored beds and are up with bathroom privileges. Something is bad wrong with this, I keep putting it in my comments everytime they give us one of those surveys to fill out, but seems to go unnoticed. I could take care of 3 vented pts with issues if I have good tech support, but if the tech is non existent or has 21 pts to care for, then it is next to impossible. Thank goodness we do have great respiratory support.

    I wouldn't even begin to know how to utilize a secretary because we never have had one.

    Mahage
    lindarn and rabbitgirrl like this.
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    I just finished doing a paper on PA nurse-to-patient ratios for my ethics class. It's interesting how at first ratios seem like such a great idea (especially if you have 8-10 or more patients), but once you realize that they may not be thinking about secretaries, CNA's, or other ancillary staff, you begin to realize there could be problems. I think that in order for a law to be passed that will actually work, there needs to be good input from floor nurses telling Harrisburg that we need our support staff, and we need a flexible ratio (flexible based on acuity).
    lindarn and rabbitgirrl like this.
  8. 4
    prior hb171 introduced in 2007-2008 legislative session introduced by rrp. solobay, never made it out of health and human services (hhs) committee:

    hb 171 amends the health care facilities act, further providing for purposes & duties of the dept. of health, for admin & licensure; for public disclosure of staffing requirements; for license standards; & for medical assistance payments. sets specific patient-to-nurse staffing ratios based on the type of care needed in a particular hospital or care unit. ratios would range from 1:1 in emergency trauma room and or; 1:2 in critical care, pacu and l+d units; 1:3 ed; 1:4 med surg/ acute psych; 1:5 rehab, up to 1:6 in postpartum and well-baby nursery units.
    solobay’s legislation includes grant programs to encourage more students in nursing education programs.
    hb 147 health care facilities act, again referred to hhs committee.
    the staffing plan must incorporate, at a minimum,
    the following direct-care nurse-to-patient ratios:
    (i) one nurse to one patient: operating room and
    trauma emergency units.
    (ii) one nurse to two patients: all critical care
    areas including emergency critical care and all intensive
    care units, labor and delivery units and postanesthesia
    units.
    (iii) one nurse to three patients: antepartum,
    emergency room, pediatrics, step-down and telemetry
    units.
    (iv) one nurse to four patients: intermediate care
    nursery, and medical/surgical and acute care psychiatric
    units.
    (v) one nurse to five patients: rehabilitation
    units.
    (vi) one nurse to six patients: postpartum (three
    couplets) and well-baby nursery units.
    (vii) for any units not listed above, including
    psychiatric units in facilities other than acute care
    hospitals, the direct-care nurse-to-patient ratio as
    established by the department.
    (3) the ratios set forth in paragraph (2) shall
    constitute the maximum number of patients that may be
    assigned to each direct-care nurse in a unit during one
    shift. a nurse, including a nurse administrator or
    supervisor, who does not have principal responsibility as a
    direct-care nurse for a specific patient shall not be
    included in the calculation of the nurse-to-patient ratio....


    appropriate license required.--for purposes of
    compliance with the minimum staffing requirements standards set
    forth under section 806(h), no nurse shall be assigned, or
    included in the count of assigned nursing staff in a nursing
    department or unit or a clinical area within the health facility
    unless that nurse has an appropriate license under the
    applicable registered nurse law, received prior orientation in
    that clinical area sufficient to provide competent nursing care
    to the patients in that area, and has demonstrated current
    competence in providing care in that area. hospitals that
    utilize temporary nursing agencies shall have and adhere to a
    written procedure to orient and evaluate personnel from these
    sources to ensure adequate orientation and competency prior to
    inclusion in the nurse-to-patient ratio....

    2/26/09, pasnap press release
    state senate introduces bill to protect pennsylvania's patients and nurses,
    herring_RN, jpRN84, rabbitgirrl, and 1 other like this.
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    to bad the legislation here in good ole mississippi don't seem to care about this issue unless it's their family member in the unit. But it wont affect them, cause the hospital will be pulling nurses and techs,clerks etc.. from all over to make a strong showing.
  10. 0
    Wow, we currently have 1:15 on our acute care psych unit. That would send shivers up my facility's spine to have a 1:4 ratio.
  11. 1
    Quote from RNKittyKat
    Wow, we currently have 1:15 on our acute care psych unit. That would send shivers up my facility's spine to have a 1:4 ratio.
    I know psych is different than the medical setting but 1:15?!? Wow, that is too many
    herring_RN likes this.
  12. 2
    Nursing by acuity seems a good idea , but who assesses the acuity of the patients , my experience is that although the bedside nurse inputs the scores , if the floor management , thinks they should be different , they change the scores and amazingly , always so that there is a lower number of bedside RN's .

    Who sets the Acuity tool parameters ? , again on this if the acuity tool doesn't provide the staffing numbers management want to pay for ,the tool is changed . Again so that a lower number of RN's are needed .

    Whether you use a acuity based system or a Staff Ratio law to set staffing levels , management will use it to manipulate staffing , to their benefit . If management feels in either system that the nuring budget is too high , they will cut nursing hours . If you do not have a staff ratio law they can and will cut both RN's and ancillary staff . If you have a ratio law they cannot reduce the RN hours to unsafe levels .

    Although I would prefer that no staff was cut , I believe it is better for patients to be cared for by RN's , if I have to accept that a few more tasks are directed at me , it is part of the bargain , because on balance it is my experience I have more time to care for my patients , also my total workload is not as bad , as prior to ratios.
    Chico David RN and herring_RN like this.
  13. 0
    "Wow, we currently have 1:15 on our acute care psych unit."

    Now, thats crazy! Does this include the administrators that think that's an OK ratio?


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