Just venting... I heard a commercial this morning that aggravated the heck out of me. My state will be voting to add safe staffing measures to the upcoming ballot.
The commercial was to the effect of "Don't vote for safe staffing, it will cost healthcare billions, nurses should be allowed to decide safe staffing levels (meaning those that have gone to the dark side as staffing specialists).
As someone who worked on a super busy unit with an avg load of 5 patients, occ. six, and on one memorable occasion seven patients., I can attest to the fact that there was a HUGE difference on the (very) few occasions I had 4 patients. When I had 4 patients I felt I could critically think, thoroughly assess, and provide my patients with a good level of care. Five patients meant running all day and feeling guilty over the lack of time I had for the less needy ones.
Geez, if I had several million dollars I'd make my own commercial. Ok done venting.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Yes, you can mandate anything by law. You can even have a unionized hospital. But management has all day to think up work-arounds and staff nurses have to be prepared for a fight on a DAILY basis. Then you factor in the brown-nosers who feel noble missing breaks, the new grads who are not in a position to rock the boat, the behind-the-scenes complainers who won't speak out or even support the ones who do, the ones who can't be bothered to join the union and pay dues (yes, open shop) and that leaves.....oh, yeah, me. With a chronic target on my back.
I tried to quote someone, but this didn't work out. She was speaking of staffing rations being so strict in California that you might have to miss lunch because no one can take your patients.
On most units, I really feel that this is pretty ridiculous. I would rather eat my lunch when my patients are calm and safe and keep my patient communication device on me at all times until waiting until someone is capable of "relieving" me. Our workplace has recently had a lawsuit over a nurse not having a completely relieved 30 minute break, and now we have to have our buddies watch our patients. I have NEVER been abused with this system and have rarely even had to answer a call. Maybe once every 3 weeks or so? We usually make sure that our patients meds are up to date, they've been rounded on and all is well before passing on to our buddies. I'm all for safe staffing ratios, but they need to make some exceptions when it comes to breaks if it's going to delay my lunch. Hangry is a real thing.
When I worked on a med-surg unit a patient load of 8 was usual and customary. When I worked night shift in a nursing home it was one nurse for 60 patients with 3 aides, if you were lucky. To me it is totally unrealistic to expect one nurse, sometimes not even an RN to provide adequate care and supervision for 60 patients. Intermixed in that 60 were skilled care patients that requried sepcialized care, trach patients, children with trachs, severe diabetics that required night glucose monitoring, and wound care. Never mind the actual physical care, but there was charting, following up on making sure people were turned and cleaned as well as doing the tasks of changing oxygen tubing, neublizer tubings, doing QA on the glucometers and the list goes on. In 36 years of nursing I never had a 5 patient assignment!!!
I tried to quote someone, but this didn't work out. She was speaking of staffing rations being so strict in California that you might have to miss lunch because no one can take your patients.
On most units, I really feel that this is pretty ridiculous. I would rather eat my lunch when my patients are calm and safe and keep my patient communication device on me at all times until waiting until someone is capable of "relieving" me. Our workplace has recently had a lawsuit over a nurse not having a completely relieved 30 minute break, and now we have to have our buddies watch our patients. I have NEVER been abused with this system and have rarely even had to answer a call. Maybe once every 3 weeks or so? We usually make sure that our patients meds are up to date, they've been rounded on and all is well before passing on to our buddies. I'm all for safe staffing ratios, but they need to make some exceptions when it comes to breaks if it's going to delay my lunch. Hangry is a real thing.
In my time on my current unit I can count on one hand the number of lunch breaks I've gotten.
I don't know why we can't all just follow California's lead. Staffing should absolutely be regulated. I refuse to work med-surg full-time for this reason. I've had seven patients on multiple occasions and was forced to sit for about 2.5 -3 hours of my shift. One nurse who I worked with had a full house. She was charge with one other nurses and one tech for 26 patients.
Needless to say, she ripped management a new one.
And it also has to be factored in that patients ard much more acute than they were years ago. These days, and in the span of my career, unless you'rd a self paying plastics patient, you have to be pretty sick to get admitted to a floor
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
I tried to quote someone, but this didn't work out. She was speaking of staffing rations being so strict in California that you might have to miss lunch because no one can take your patients.
On most units, I really feel that this is pretty ridiculous. I would rather eat my lunch when my patients are calm and safe and keep my patient communication device on me at all times until waiting until someone is capable of "relieving" me. Our workplace has recently had a lawsuit over a nurse not having a completely relieved 30 minute break, and now we have to have our buddies watch our patients. I have NEVER been abused with this system and have rarely even had to answer a call. Maybe once every 3 weeks or so? We usually make sure that our patients meds are up to date, they've been rounded on and all is well before passing on to our buddies. I'm all for safe staffing ratios, but they need to make some exceptions when it comes to breaks if it's going to delay my lunch. Hangry is a real thing.
The whole point of staffing ratios is so you can get a proper meal break and your patients still be properly cared for. That means management are supposed to provide extra staff for break relief. Buddying up with someone is still the same system that already doesn't work.
I've had the frequent experience of it NEVER being the right time to get away; someone always needs something urgently. Your buddy is only going to answer your lights and can in no way keep your worksheet current, anymore than you can for your buddy.
If this is what mandated ratios look like, then it's apparent management has found a way to work around that.
When I worked med-surg, I had 7-8 pts every single day. Plus I had to do all of the IV pushes, start iv's, etc., on the LPN's patients. Initial physical assessments and skin sheets had to be done on all admissions, and only an RN could perform them. One day I had 9 pts.
Don't know your state, but having been around hospital practically all my life (not as a nurse, but a patient and/or observer) I can attest to you the best doctors (from neurosurgery, internists, and nurses) I have observed at Lafayette General Hospital in Louisiana. Never thought I would be there, but when my brother had a brain tumor he was passed to three hospitals. The neurosurgeon finished surgery and came to talk to us at 3:30 in the morning. We had 2 neurosurgeons we spoke with, or rather they spoke with us, internist and nurses. Of 30+ years being around this type system I can say this is the best hospital I've been in as far as knowledgeable doctors and nurses. They were also all polite and positive. From NY to FL to CA I would say if you want a good position and a good hospital to work for go to Lafayette, LA. I, in my entire life that is left of it, could not commend these people enough. Excellent.
I remember an incident in acute care where we only had the charge nurse and myself with one nursing assistant for 25 patients. It was not long after this that the safe staffing bill was starting to be implemented. What a relief that was for everyone. I do hope that this could be implemented nation-wide.
It was not ANA that helped with the staffing ratio issues when California fought for this It was our state board (CNA) that helped the California nurses band together to obtain safe staffing ratios. The fight was taken to the families and the patients, appealing to their desire to receive safe nursing care which can only happen with safe staffing ratios. If you type in CNA safe staffing ratios, you can see some reading regarding this issue in Ca. Some of this information may be useful for those fighting for this now.
In LTC and rehab, I have seen up to 40 patients per nurse. It is crazy!! I work evening shift. On my unit, we have 8 to 14 pts per RN, We can have multiple admissions ( which takes 3-4 hours just to get into the system and assessed) This is a short term rehab unit that takes care of patients post surgical, IV antibiotics, dialysis (manual and cycler), TPN, PEG tubes, NG tubes, cardiac rehab, and trach care among other things. I get there and I go, rarely get any break. The only "quiet" time when we can get a break is spent calling doctors about lab results and pt issues. Often I am there 3-4 hours after the end of shift to complete treatments and write notes. God help us if there is a fall or an emergency..and all the documentation that follows. we have to do vitals on all the patients (many LTC only do vitals once a week) and we have to write notes on every patient (most LTC only write when needed). On top of this, there is no building receptionist after 7, so we also answer calls and respond to the door bell. All this, while providing excellent customer service to patients and their families. I work hard, walk about a mile every evening and have a good team to work with. we help each other out as best we can. That being said, admin piles more and more expectations on nursing. we can't keep a unit manager because they see how hard we work and try to help us and get frustrated by the unwillingness of the admin to recognize that. The patients even see how hard we work and tell admin we are short staffed. Per their numbers and the state regulations, we are not short staffed. Changes need to come from the state regulators...staffing based on licensed nurses in the building, including DON, ADON and Unit managers in the building is not accurate when they are in meetings and not actually doing patient care.
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TriciaJ, RN
4,328 Posts
Yes, you can mandate anything by law. You can even have a unionized hospital. But management has all day to think up work-arounds and staff nurses have to be prepared for a fight on a DAILY basis. Then you factor in the brown-nosers who feel noble missing breaks, the new grads who are not in a position to rock the boat, the behind-the-scenes complainers who won't speak out or even support the ones who do, the ones who can't be bothered to join the union and pay dues (yes, open shop) and that leaves.....oh, yeah, me. With a chronic target on my back.
Not that I'm jaded or anything.