Bill would squeeze nursing staffs at Citrus Memorial Hospital

[Advocator2014]

It is Septemer 10, 2014. I have found this article and quote by Citrus Memorial Hospital administration over 3 years ago to be a fabrication of their patient care model. Patient to nurse ratios are more often 6 to 1 all day. The patient to patient care tech ratio is more often 15 to 1 during the day with 8 to 1 at night. It has been a very stressful experience working there and having to handle all of the patient care with very little support from staff.

When there are only 2 PCT's on a 35 bed floor we get our vitals signs done q4h(late) and are left to handle everything else. This makes it impossible to give some patients the attention they need. When I was hired I was told I would have 6 patients with 4 PCT's for the floor of 35 patients. I was also told we were the "brains" behind the PCT staff and that we supervise them. That does not happen. They disappear from your room if they don't want perform a requested task or complain to the manager who is actually the only one who hires, fires, and supervises them.

When it is discovered that a task did not get done we get personally browbeaten by a manager in front of peers and patients. Any mention of workload as a factor gets the standard reply of "you must get better at planning your day". Meanwhile, we are presented with added online documentation tasks on a weekly basis.

I am currently looking for another hospital unless things improve. HCA health care takes over soon as well. I am hearing it will be status quo.

Is this the way it is everywhere? Any Central Florida people out there want to share or vent? Make sure you don't use info about yourself that can reveal your identity to your employer

Bill would squeeze nursing staffs

CMHS authority: We'd have to hire more nurses

By Chris Van Ormer

Saturday, March 19, 2011 at 9:27 pm

If the Florida Legislature passes a bill to mandate a higher ratio of nurses to patients, Citrus Memorial hospital would need another 35 nurses.

The proposed staffing level also comes at a time when the United States as a whole needs 300,000 nurses.

Linda McCarthy, chief nursing officer at Citrus Memorial Health System in Inverness, discussed the bill Monday with the Citrus County Hospital Board. McCarthy advised the trustees about the ways the bill would affect nursing care at CMHS, and got right to the bottom line: "I would need to find 35 nurses."

Florida Hospital Patient Protection Act is sponsored by Rep. Cynthia Stafford, D-Miami.

"It's a pretty extensive bill," McCarthy said. "It's not the first time it's hit the floor. It's a little different each time."

The bill calls for more registered nurses rather than licensed nurses.

"It defines a direct patient care provider as a registered nurse," McCarthy said. "Previously, it could be a licensed nurse, it could have been any of those support people but this is a direct care provider. They have not stipulated yet in this document the level of education required."

As chief nursing officer, McCarthy would need to use a staffing plan based on the severity of the patients' conditions. This is known as the acuity system of the patients' needs.

Another difference in practices would be that minimum staffing levels would be mandated at all times, including meal times and other breaks.

"It has a mention of prohibition of mandatory overtime and it uses the nursing process inclusive of assessment, diagnosis, planning, intervention and evaluation that only a registered nurse can do at this point," McCarthy said. "It also asks that the nurse look at the assessment of orders. She must check for appropriateness, whether it's licensed by a licensed practitioner and whether the order itself is within the nursing scope of practice."

The registered nurse may decide if the order is inappropriate.

"She has the ability to refuse to implement this order without ramifications, so she needs to be able to accurately assess the order that the physician writes and make sure it's appropriate," McCarthy said. "If she disagrees with it or a patient disagrees with it, she is acting as the patient's advocate and must speak on behalf of the patient."

McCarthy described some of the issues with the bill.

"The nursing shortage itself is huge and they project it will be more than 300,000 by the year 2015," McCarthy said. "We are seeing a slight decrease of the nursing shortage because of the economic times we are living in. Many of the nurses who are currently at retirement age have decided to hang on a little longer to build up funds."

When the economy turns around, it could increase the shortage of nurses as more decide they can afford to retire. McCarthy did not have numbers for the nurse shortage in Florida, but she said the "opening rate" or potential vacant positions across the state stood at 23 percent.

With so many nurses not retiring, the average age of nurses has increased.

"We're also looking at the aging population," McCarthy said, "not just of the patients, but that of the nurses. The average age of a nurse right now at Citrus Memorial is 49.6 years old and I have at least 65 nurses who are at or are eligible for some type of retirement program at this time. Should the economy turn around, those could be immediate losses."

Adding to the crisis of the nurse shortage is the lack of nurse educators.

"The problem most immediate with nurse education is that there are no nurse educators," McCarthy said. "There is a minimum qualification that you must be master's prepared to be a nursing instructor, so there are a minimum number of nursing instructors. Even if there were people wanting to take nursing programs, there are very limited supplies of educators."

Nursing today competes with many other career choices for women.

"At one time, nursing was considered a woman's profession and she could do very well there," McCarthy said. "Now we have many opportunities. We can all go to be an astronaut. We can be engineers; we can do all those things. So we have minimized the people who are even getting exposure to the nursing profession."

If the bill becomes law, CMHS has to have a plan to comply with it.

"We need to implement an automated patient acuity system," McCarthy said. "We currently have an acuity system that is based on each one of the nursing floors and the type of patient that they care for. We have a number system we apply to each patient based on the number of IVs and the number of medications and the type of treatments they need. Most of the more intellectual processes involve adding the data out of an electronic document which loads immediately in and calculates an acuity score for the patient. That would be one of the first things we would be looking at."

Another option would be primary care nursing, McCarthy said. It is a method of nursing practice that emphasizes continuity of care by having one nurse provide complete care for a small group of patients within a nursing unit.

"As the R.N. is going to be the only one to implement or really, truly assess and take care of the patients, we may go back to a primary care nursing," McCarthy said.

Primary care nursing has not been in practice for 15 to 20 years.

"It failed miserably because it is a lot of work for one nurse to take care of two to three to four patients at one time, taking care of all their requirements," McCarthy said. "That's bathing, medication and then treatments."

The nurse shortage and the workload could repeat the experience in California, McCarthy said. California enforced higher nurse-to-patient ratios in 2004. Subsequently, hospitals in California have been unable to meet the staffing standards. The new staffing law also has been blamed for longer wait times in emergency departments because of the nurse shortage.

"The worst-case scenario about what happened in California was the closure of beds," McCarthy said. "They actually closed many hospitals because they did not have the number of nurses that were necessary to provide this level of service. So that paints a pretty sour picture for us, but we need to be prepared for it. I can tell you that I've already been working on some of these things. I'm already very close to a patient acuity system at this time."

McCarthy outlined current nurse to patient ratios at CMHS.

"In obstetrics, we have one nurse to two patients," McCarthy said. "That's for a laboring patient. The ratio for a postpartum is a 1:4. For nursery, it can be up to 1:6. But OB is what we primarily look at and House Bill 305 indicates 1:1 for labor and 1:3 for the ante partum. So we're not really too far off on that."

The women's center is 1:5. The bill proposes 1:4.

"Pediatrics is 1:2," McCarthy said. "They want 1:3, based on the acuity. So we really could go a little heavier. The issue at Citrus is our average daily census for the pediatric floor is two patients. We really don't see a whole lot of pediatrics. It's usually for dehydration and nausea. Maybe some upper respiratory, so not a whole lot."

For the second and third floors, McCarthy said the current model is 1:5, stretching to 1:6 at night. The bill proposes 1:4.

A problem with the higher ratios is the continuous coverage and scheduling a nurse to take over for breaks.

"When a nurse goes to lunch or break, currently, in almost every system in Florida, somebody covers for her," McCarthy said. "This bill and the California bill require that you have somebody who is able to step in and take care of those patients. Where she is during the day and all the other hours, nobody really can define that."

The strict staffing rules would be a challenge to the way hospitals need flexibility to handle the unexpected.

"They want 1:4 around the clock, 24/7, for lunch and breaks regardless of any crisis that's happening in the hospital," McCarthy said. "You can call an emergency situation, but it needs approval like a state of emergency, a hurricane, a flood or something like that."

Chronicle reporter Chris Van Ormer can be contacted at [phone] or [email protected].

[lifelearningrn, BSN, RN]

Wow- there goes that whole 'nursing shortage' myth again. The managers sure like to make it sound like it's the shortage that makes it impossible to staff, and not them wanting to squeeze profits with as little staffing as possible.

[APRN., DNP, RN, APRN, NP]

Am I the only one who saw the title of this thread and immediately thought “Oh....Lemonade!!”?