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.

[Youda]

Jenny P, I was being incredibly optimistic that the suits would staff an 8 patient ICU with 3 nurses under the ratio law.

We've got an "acuity" based bill in our state. I doubt it will pass in the 108th. The biggest opposition to that legislation is the hospital PACs are claiming that it would take too much "time and paperwork" to document acuity and adequate staffing on acuity. The PAC is also fighting it on the argument that it would take too much money to implement that could be going to patient care.

How do you like that reasoning?

[NannaNurse]

Like I've said for quite some time......there will NEVER be an end to this RN vs LPN thing......NEVER!!

Where I work, large hospital....I do my OWN work. I sign my OWN charts, care for my OWN patients. The only time I need one of my fellow nurses who is an RN, is to assist when initiating blood or and IV push med.....which is not very often and they are always ready to help.

The most patients I will have is 7-8....sometimes I get the 8 and the other 2 nurses get 7 each. Sometimes it's an RN and LPN sometimes it's 2 RN's.....we all work as a team. I work under the direction of our medical director and our clinical director. I carry my own weight and I must admit, my patient care is often times better than that of my fellow nurses who are 'the almighty RN'.

Canada...you can't really cover up your 'true' feelings by stating in a later post that you have nothing but respect for LPN's.....damage already done dear......I once worked with an RN who stated that she changed a pts foley (changed every 3 weeks & prn) for 3 different times......she didn't change it at all for almost 4 months!!!! This same RN retreived a coat hanger from the closet, un-wound it and used it to unclog a G-tube, she also stated she hung $1250. bags of IV ATB.....they were still stapled in the bag that was brought from the pharm..

I've also worked with LPN's whom I wouldn't let care for my ex-husband.........now that's pretty bad.

There are good nurses and there are bad nurses...........I'm proud to say that I'm one of the GOOD ones. Take pride in my ability to provide quality nursing care to my patients. I finish school in 18 months........sometimes I wonder if I'm making the right educational choice.........teaching sounds good.

[ERN]

NannaNurse

I'm happy to see another Buckaroo Banzai aficionado.

[Teshiee]

Originally posted by RN2B2005

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

Because you literally imply because this person was a LVN that rendered this individual incompetent.

I was a LVN for 4 years and nurses like yourself had always assume that because I didn't have RN behind my name we were inferior. I am not ashamed of being a LVN, in fact it was the LVN training that set my foundation to become a RN. Those who never been a LVN really are clueless. LVN/RN can work together. Unfortunately what the nurses practice act states divides us further. You have a right to prefer someone with a title of RN at your bedside but don't go by that alone. One day you may get your feelings hurt.

[KarenKidsRN]

Originally posted by 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.

I totally agree acuity is the ideal way to staff but unfortunately the nurse at the bedside who is most qualified to make the decision on acuity and staffing needs is totally ignored and the decision is made by some pencil pusher staffer or administrator who hasn't seen a live patient in years (if ever.) The law was an attemt to improve nurse patient ratios by FORCING the hospitals to at least address the issue and set some minimum safety standards, and we see how the hospitals have fought it. Imagine if it was a was that madated staffing by acuity, the lobbyists and the powers that be with the most money would once again spread rumors of shutdowns and limited access and it would most likely fail becuase it all comes down to whoever has the most money has the most power and influence.

Regarding ICU staffing I believe most of them are all RN staffed anyway and generally at a 1:2 ratio, but I personally have seen way too many shifts where out of 8 ICU patients 6 of them were unstable and requiring 1:1 or even higher staffing and that is something that administrators just can not or will not try to understand. They think 4 RNs for 8 ICU patients should be plenty, but just one unstable, coding all shift, bleeding, open the chest case can throw the whole staffing mix off requiring 3 RNS just to maintain one patient, and then some of the patients will still be on "ignore" until the situation stabilizes.

My fondest wish for the administrators making these decisions is that they be a helpless patient in bed needing care and pain relief and not getting it for hours because the nurses are all too busy with higher acuity patients. But even then I doubt that they would "get it", they would just complain and raise hell and get the responsible nurse in trouble, even if she was priortizing as best she could in an unsafe and unmanageable situation.

[-jt]

Its the link on the 2nd line of this page - under the heading

'Latest DHS Information'

http://www.dhs.cahwnet.gov/

>Get the Facts about the Proposed Nurse-to-Patient Staffing Ratio Regulations (R-37-01) - Read More! Scroll down this DHS page for links to all the info on the regulation:

http://www.applications.dhs.ca.gov/regulations/search.asp?REGID=R-37-01&advanced=yes&c2=@filewrite&o2=%3E&q1=&EMERGENCY=&submit1=Begin+Search

[-jt]

Nurse staffing debate heats up

Union and hospital representatives disagree over proposed regulations on minimum nurse-to-patient ratios

CONTRA COSTA TIMES

http://www.bayarea.com/mld/cctimes/4562645.htm

>>>>

contact DHS in writing with your opinion: [email protected]

California Department of Health Services

P.O. Box 942732

Sacramento, CA 94234-7320

[-jt]

First of all your livelihood was not what the law was about. But LVNs are not going to lose their jobs if more RNs are hired to fill the ratios. There arent enough RNs on staff now. The law was intended to have hospitals fill their vacant RN positions. In order to do that, the hospital would have to make itself a place where RNs want to work. And to do that, they would have to spend money, invest in making workplace improvements that attracted RNs back to the bedside. This law was a way to force an improvement in working conditions. The hospitals latest tactics in challenging who can fill those vacant RN positions is just an attempt to avoid having to do that.

They wont be in compliance with the law if they dont find RNs to fill their vacant positions. They wont find RNs to fill those vacant positions until they make the job at their facility more attractive (better compensation, better benefits, better environment). They dont want to spend the money to do what they have to do, so they are trying to find a back-door way to fill the ratios without RNs & still be in compliance with the law. Fighting to be allowed to meet the ratios by filling vacant RN positions with LPNs is a way to do that. And SEIU is helping them do it.

But if the law applied only to numbers of RNs, the RNs to be hired would be an addition. They wouldnt be pushing you out of your job - theyd be filling the 13% of RN hospital positions in California that have been left empty.

[-jt]

Secondly, this is not an RN vs LPN thing. Its a pt thing. There is no need for LPNs to get their backs up. Keep a focus on what the law is about. In the argument over staffing mixes, nobody is denigrating LPNs. They are just saying that the way SEIU wants the law to be implemented (LVNs filling vacant RN positions) does not improve RN staffing, does not reduce the pt load or responsibility for the RN, and will not draw RNs back to the bedside. And in that case, there might as well not even be a staffing ratio law.

Somehow the point of obtaining this law in the first place seems to have been forgotten. It was supposed to be about safe patient care, safe, manageable patient loads, increasing RN staffing up from skeletal levels, improving working conditions to draw enough RNs back to the bedside, stemming the tide of the RN exodus & filling all those vacant RN positions -- because dangerously high pt loads that prevent the RN from doing her job the way it should be done has been a major cause driving RN away from the bedside & why so many RN positions are left unfilled.

What RN is going to run back to the bedside to fill those empty RN positions for the promise of caring for at least 8 pts?

The SEIU plan of a 1:4 ratio is a farce on the public. YOU will have only 4 pts. The RN will have her own 4 PLUS your 4. There is much more to that than just technical tasks like hanging your pts antibx. There are a lot of implications for me & the pts when Im trying to monitor your pts blood transfusions, manage your pts IVs, hang all your pts antibx, assess all your pts for changes and problems, keep ontop of whats happening with the full pt load that youre assigned to, and what you are doing, while Im trying to manage my own full pt load at the same time. What I do & what happens to my pts is my responsibility and my license. What you do and what happens to your pts is both your license and mine. I cannot safely manage a double assignment on a busy hospital floor, but for some reason a lot of LVNs focus on just the task & dont get the point about the problem it causes RNs (like inferring that its no big deal - the RN only has to take a second to sign off the LPNs chart). Theres much more to it than that but some LPNs dont understand that. (I didnt either when I was an LPN.)

Also, recent studies have proven that pts have better outcomes when there are more RNs caring for less pts. Death & complications rates were less. Pts did better when their RN was assigned 4 pts than when she was assigned 8. In fact, when an RNs pt load increased to 8, her pts had 31% more complications. The number of LPNs & aides in the mix had no effect on the outcomes. Im sure that will be another point people argue over, but to fill those vacant RN positions with LVNs changes nothing for the RN, does not reduce her pt load to a safer number, will not bring them back to the bedside, short-changees the pts, especially in view of those latest studies, & defeats the purpose of the law.

But there you have it - like you so honestly stated - JOBS - the whole reason behind SEIUs current effort to undermine the intent of the RN staffing ratios & replace vacant RN positions with LVNs. Except the point of mandating staffing ratios had nothing to do with getting LVNs jobs.

[Cascadians]

Nutz.

Very simple.

In a hospital, never more than 4 pts per RN.

LPNs & CNAs help too, but staffing MUST include AT LEAST 1 RN: 4 pts.

Recent study proved 4 pts is boundary of safety zone.

If hospitals want to save $$$ they can axe all those suits and managers who do nothing to improve patient care or outcomes.

[NannaNurse]

ERN.....could you please elaborate on your comment?????

I have a feeling it wasn't meant to be some type of compliment(????)

[Nurse Nevada, RN]

I agree jt. The other day on med-surge I was assigned 9 patients and had to cover an LVN's 8 patients. It was extremely stressful.

Nurse Nevada

http://users.lvcm.com/nursenevada