CA staffing ratios evoke anger 'tween RNs & LVNs

[NMAguiar]

Big news on the California nursing ratios front. As California prepares to carry out its first-in-the-nation law telling hospitals how many nurses they must have on hand for patients, a bitter dispute has broken out between rival unions over exactly who should count as a nurse.

In separate news, testifying hospitals plead for more time, citing the nursing shortage as a hinderence to nurse-patient ratios.

Both stories in entirety are here.

[-jt]

Actually I've had my California license for years, am there for part of every year and work in the UC system then. I dont know what you mean by RNs not having to "cover" for LPNs. The RN is legally responsible for the pts & the care they receive, even for the pts that the LPN is assigned to. And the RN must provide all the care for those pts that is not within the LPNs legal scope of practice. Thats not to say that the LPN is unworthy- just that the RN has double the assignment & responsibility. The issue is about manageable pt loads - not which kind of nurse is better.

DHS may not be a friend of nursing (even with the NY RN they had at the helm as director), but the fact is their proposal gives RNs a ratio of at least 2 pts less than SEIUs. SEIUs plan only will give LPNS the 4 pt ratio. Since they are trying to also manddate that staff on the floor consist 50% of LPNs, the RNs pt load will be doubled that - 8 pts. DHS proposal of 1:6, if applied to RNs, is a better, more manageable ratio for RNs.

Its not about kinds of nurses - its about numbers of pts the RN is to be responsible for & can safely provide for.

It has to be settled before any ratios are implemented, because once the wrong ones get implemented, it will be near impossible to change them. The point is not to just get mandated ratios implemented. The point is to get the right ratios mandated & implemented.

[sanakruz, ADN]

I agree its not about lvn vs rn. Its still dirty pool on CNAs part. As a result we are all stymied,all of us.

[rebelwaclause, ASN, RN]

:angryfire

Sigh...Why is it almost ALWAYS a non practicing nurse - Meaning non-RN or non-LVN making statements that suggest LVN's are worthless?

My comment in this "Here-we-go-again-RN/LVN-bash-fest" thread is:

There's shytie LVN's. There's shytie RN's. There's damn good RN's, there's damn good LVN's. A title doesn't make an individual a good nurse, just means if they're bad - They have more room to seriously f*** somebody up. I'd want a nurse who knows what to do within their scope of practice, regardless of RN or LVN title, because a GOOD LVN would solicit their RN and MD for advanced care out of their scope of practice - JUST AS a good RN would do.

Grrrrrrr.

[Youda]

-jt, this bill really interests me. We've got a similar bill in our state, so I'd like to follow the California bill to see the battles ahead for my state.

ANYWAY, I can't seem to find the California bill number. Can you post it, please? Thanks!

[Gomer]

Youda.......AB 394

Rebel.....You are correct....alot of damn good LVN's!!!!

[Youda]

Are you sure it's AB 394? I'm looking at the California Legislative website and 394 is about dispensing of controlled substances, not staffing ratios. Sorry to be a pest, but could you furnish a link to the actual bill if it's 394?

[Gomer]

If you are looking at http://www.ca.gov site....you need to change the year the legislation was inacted from "2002" to "1999-2000" (the bill was signed in 1999. Hope this helps.

[Youda]

Thanks, Gomer! Yes, it helped to look at the right year. Odd that California would assign the same bill numbers to completely different legislation. Oh well.

That was a very interesting read. The bill as originally submitted went through some very significant changes during committee!

Here's a couple of quotes from the final version:

(d) The basic principles of staffing in the acute care setting

should be based on the patient's care needs, the severity of

condition, services needed, and the complexity surrounding those

services.

and

(a) A health facility licensed pursuant to subdivision

(a), (b), or (f), of Section 1250 of the Health and Safety Code shall

not assign unlicensed personnel to perform nursing functions in lieu

of a registered nurse and may not allow unlicensed personnel to

perform functions under the direct clinical supervision of a

registered nurse that require a substantial amount of scientific

knowledge and technical skills,

This isn't about union vs. non-union. It isn't about LPNs vs. RNs. It isn't about "good" LPNs being better than "bad" RNs. Those arguments are self-serving. This bill was intended to provide the care that the PATIENT needed. I think we can all agree that a mathematical ratio doesn't meet those needs most of the time, whether or not it is LPNs, RNs, UAPs, or a mixture of all. The bill was meant to base care on NEED, not by alphabet.

The sad thing is that the INTENT of the bill has been lost while everyone sits around arguing over who can provide the best care. I'm sure the hospital PACs are leaping for joy.

[rebelwaclause, ASN, RN]

Originally posted by -jt

The issue is the fact that RNs have had to be responsible for a dangerously high number of pts. Its unmanageable. End of story.

What patient to nurse ratio is dangerously high? How is it unmanageable with an LVN onboard?

It does not solve the problem to add more LPNs. That STILL would require the RN to be responsible for the care of too many pts - hers AND the LPNs.

"Responsible"...Hmmmm. I have had covering RN's take a peek at my patient charts a half hour before sign-off report, sign their name and write "Agree with course of care" on it. I've had other RN's complain about covering LVN's because they had to take 10 minutes to hang an abx for me. So "responsible" for me is subjective...looks like.

I guess it would additionally depend on what state you work in. For example, I am an LVN in California. I cannot hang ABX, push IV meds or complete initial assessments. Since I CANNOT do those things - I am more than willing to do everything I can, for the RN's that cover me - Accuchecks, wound care, PO Meds, starting IV's, flushing IV's, patient teaching...Whatever it takes to lighten the load of my RN and promote TEAMWORK. RN's where I work take less patients freeing them up for admissions and "covering" me.

Asking for the RNs pt load numbers to be reduced by having enough RNs on staff is not a reflection on or denigration of the LPN. The focus of the issue is getting lost here.

If you have more RN staff, this suggests less LVN staff. this IS a reflection on my livelihood! :chuckle.

We waste so much energy bickering about the RN/LVN thing, instead of coming up with workable solutions. The thing most RN's fear saying is "I do not want an LVN here to 'cover' when an RN could do ALL the work, without the 'covering' ". I've heard some RN's just fess-up and come clean with this, and really...I appreciate them just being real about it, instead of smoke-screening the issue with the excuse of "patient safety" and "work overload". Though these issues are real, it's often used as a catch all "scapegoat".

PLEASE DO NOT GET ME WRONG - I know RN's have a lot of work to do in a shift, and I sympathize with all the work RN's are accountable for. I really do. But I am not the one creating extra work to be done. PLEASE don't degrade LVN's because their scope of practice doesn't allow them to be "self-sufficient". Hospital's have decided to utilize LVN's, so spend more time figuring out how to comfortably work around LVN limitations and put them (me) to work to your advantage.

Because it appears LVN's are here to stay, and not to sound crass or funky - But RN's will have to get over it.

[Youda]

Again, this isn't about how to divvy up the work, RN vs. LPN, etc. It's about what the patient NEEDS. It isn't about LPN bashing. It's about what the patient NEEDS.

Let's take a hypothetical. Suppose you have a med/surg floor with 32 acute care patients. Under this legislation, need is lost and it goes to straight ratios of licensed nurses. Staffing is well above average and there have been no call-ins and the hospital actually managed to hire enough nurses. So, today there are three RNs (1:8), and 3 LPNs to make 6 licensed nurses for a overall ratio of 1:6.

Now suppose you're in an ICU. The same ratios apply. There are 8 patients. One RN, and two LPNs. Simply by the limitations in the scope of practice, not BECAUSE someone is an LPN, the RN is going to have a really heavy load monitoring blood transfusions, monitoring hearts, assessments, IV pushes, monitoring ICP, or whatever. Now, suppose there is a Code, because this happens alot in ICU. The RN is in the code, and the 2 LPNs can NOT do, by law, what the rest of the patients need done. The patient's NEEDS aren't getting met, although there is certainly adequate staffing according to the ratios.

I hope this illustrates a little what the problem is. It isn't about licensure. It's about how the hospitals are figuring out a way to make the most money and still meet the ratios. Please get over the LPN vs. RN issue and focus on what it means to the patient. Please?

[RN2B2005]

Wow, I had no idea I'd get flamed simply by stating that I'd rather have R.N. by my bedside.

I have absolute respect for L.P.N's. Apparently, I wasn't clear on that.

As long as L.P.N.'s are played off of R.N.'s for the monetary gains of a few, some R.N.'s will continue to look down on L.P.N.'s, or see them as threats. This bill in California just throws what has been a private fight into the public view. I never thought L.P.N.'s are less of a "nurse" than R.N.'s--just that the intent of the California Nursing Association was to address R.N. issues, and that an end-run is being made around the intent of the bill because of a loophole in the bill.

By the way, Lois Jean, "litigious" (or, as you spelled incorrectly spelled it, "litigeous") means "tending to engage in lawsuits". Since I declined to sue the hospital or the L.P.N. who provided substandard care, I am NOT litigious. Next time you want to throw around the big words, look it up first.

And yah, I'm not an R.N.--yet. So, feel free to ignore my opinions, since they're obviously worthless. Apparently students should stick to the 'Student Nursing' corner or risk being flamed.

[Jenny P]

Okay, once again I want to say that the reason I have not supported ratios is because of the numbers games that will be played. I still think that ACUITY (or as Youda said the NEEDS of the patients) is the only fair way to staff units: but it will never be done UNLESS ALL NURSES (LPNs/LVNs and RNs) work TOGETHER on this. There has to be a solution to this problem and the media and the lawmakers are causing divisions AGAIN in nursing. Somehow WE NURSES have to take responsibility and control of and for our profession and not let others cause infighting among us. Flaming is not the way to go here.

Youda, I do have a question for you. If the ICU has 8 patients, do you really think that a hospital will staff 3 nurses there? It ould depend on the ratios of the ICUs I suppose, but the fear is that the hospital would only staff a unit wih 2 nurses (1 LPN and 1 RN) IF they could get away from it.