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.

[rebelwaclause, ASN, RN]

Originally posted by Youda

It's about what the patient NEEDS.

Guess a story needs to air on 20/20 or Dateline. What if patients started asking their nurses "How many patients are you assigned to, and how many LVN's are you covering", then based on their answers say "I want you to get your supervisor. I want a nurse with less of a load to care for me..."

Hey, with the "Patient Rights Bill" becoming a hot ticket, bet the suits would scramble then!

[rebelwaclause, ASN, RN]

Originally posted by RN2B2005

Apparently students should stick to the 'Student Nursing' corner or risk being flamed.

Actually, you could get flamed there to when you make grandiose, unfounded, generalized statements like:

Originally posted by RN2B2005 Hospitals want to call L.P.N.'s "nurses" because these "nurses" earn a fraction of what a graduate R.N.'s earn. L.P.N's DO have their place...

and this....

Originally posted by RN2B2005 To the uninformed public, especially the older members of the population, any female in any kind of uniform in a hospital setting counts as a "nurse"; hospitals generally fail to educate patients in the roles of various

staff

Continuing...With this:

Originally posted by RN2B2005 Not to denigrate L.P.N.'s, but when push comes to shove, I want an R.N. at my bedside.

Ending the above insults with this:

Originally posted by RN2B2005 If hospitals want to call L.P.N.'s "nurses", fine. Just let them hire TWO L.P.N.'s for every R.N.; after all, an L.P.N's training is one year, half the minimum for an R.N.

...If you assumed LVN's would not be offended by your negative, generalized comments, insinuating an RN could not have made a similar mistake in care because RN's have more training (Of course it has nothing to do with ON THE JOB TRAINING...Just years in school, as you suggest), Then...FINALLY....Every mention of LPN (LVN's in California) has the word nurse in quotations, as if LVN's aren't "nurses" at all....

Then maybe you should stick to the student nursing forum. After all, you really haven't walked in any of the mentioned professions shoes,"Yet", have you? But again, you'll get flamed there to if you choose to insult people or suggest their trade is meaningless.

Duh.

PS...I know, you can post wherever you should feel like, but you made a statement that I addressed.

[rebelwaclause, ASN, RN]

NM...Leave it to you to start a CONTROVERSIAL thread like this!!!!!

Hey...Did you attend the SF hearing? I think I'm going to the Fresno one. PM me!

[NMAguiar]

Rebel,

Hee, hee! Yeah, this thread took some unique turns, but still managed to stay within shouting distance of the subject.

I thought the stories were interesting as other states begin to immulate what California did regarding nurse ratios. I didn't realize what apparent anger exists between LVNs and RNs.

Legally, the issue points out an oversight in the new law big enough to push a gurney through. Time to make changes -- if the changes don't weaken the bill.

[-jt]

It may not have been an oversight at all. I dont remember if the original prososal said REGISTERED NURSE instead of "licensed nurse" - the law was passed in 1999 & the original bill was written by the RN union & submitted well before then. As is the case with every law, it goes thru a process & legislative committees & the final language passed into law is not exactly the same as what the original bill started out as.

I dont think this language was an oversight at all. I think the Governor & legislature bowed to the strong opposing lobbying by the hospital associations & deliberately worded it that way so the hospitals could have the option of using RNs to fill the staffing ratios or choose to fill them with less expensive LPNs if they wanted to. It may have been that the Governor would have refused to sign the law at all if the compromise in the language wasnt done. Theres a very good chance that the legislature deliberately put this vague language there to do exactly what its doing now.

[SKM-NURSIEPOOH, BSN, RN]

originally posted by -jt

thats exactly how it is. and thats why the rns dont want the seius any-nurse proposal that will leave them responsible for the lpns 4 pts as well as their own 4 pts for a total of 8 pts for the rn.

before anyone gets nuts over the rn vs lpn debate, thats not even what this whole thing is about. the issue is the fact that rns have had to be responsible for a dangerously high number of pts. its unmanageable. end of story. 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. 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.

....when rns are responsible for the lpns...i thought it was the "charge nurse" or rn "supervisor" whom didn't have patients whom did the co-signing.

most sbon generally states that lpns come under the direct supervision of rns; i just thought it was those rns in charge. how can they realistically think rns can have a full patient load of their own & also be equally responsible for the lpns' patient workload as well??? how can rns honestly & safely co-sign anyone else's work unless they've witnessed every single thing that was done to the patient???

that's impossible & ridiculous...why haven't rns fought that issue by now??? seems to me...that's a bigger issue here because lpns are licensed by the same sbon & are held responsible for it...why must another license be endangered or threaten should anything happen with the lpn & their patient??? the only thing that rns should be concern with is what advise or orders they've delegated to the lpns & whether or not they do it...not be responsible for the entire staff of that unit - cnas/mas included.

jmho - moe.

[-jt]

Yeah but in real life thats not how it works. For example:

RN working in the nursery - in the back room admitting a newborn tells the aide to take the babies out to the mothers for feeding. 30 minutes later 2 mothers discover they have the right cribs but the wrong babies in them. (They think its funny & not a problem - babies had the right bracelets on - just in each others cribs). Babies had been taken out of cribs during the shift to be fed, examined, changed, etc. Aides, LPN & MDs all were in the nursery during the shift. Babies were handled by lots of different staff. Anyone could have put the baby in the wrong crib. The RN was in another room with another pt & had nothing to do with it, but the RN was held responsible for the mix up because "shes the professional with the license", according to our VP of Nursing.

The RN wasnt even in the room when the aide took the babies to the mothers. There is no policy that says she must be there before the babies leave or that SHE had to check the cribs before they left the nursery. It says the person leaving the nursery with the babies has to. The aide didnt follow procedure & check the ID bracelt with the crib tag before leaving the nursery nor did she check the mothers ID bracelet with the babies when handing them over as she was required to do.

How did administration solve the problem? The aide got transferred to another unit. The RN got suspended for one day more than a full week - without pay - & then transferred to another unit. It was her fault even though she didnt violate any policy, she didnt do it, and wasnt even there. All she did was delegate to the aide to bring the babies to the mothers, but she ended up being held responsible for the aide not doing it correctly.

Of course we filed a grievance with the union & got the whole thing reversed for the RN, cleared her record & reinstated her pay, but it took a month after the suspension & pay loss to get it all resolved. The RN was told by her manager that she was a failure & not wanted back on the unit. Even though she won her grievance, the whole thing stressed the RN out so much, she refused the position that she had won back & went to work someplace else.

If we were not in a union, this whole incident would have been left as the RNs fault & failure, the suspension would have remained on her record, & she would be out more than a weeks pay for something she didnt do, and had no control of because she couldnt be in 3 places at once.

This is the kind of crap we're dealing with. Any wonder RNs dont want any part of hospitals anymore?

[-jt]

another example:

hospital Oncology unit - eve shift

1 experienced RN (and shes assigned to be in charge, too)

1 new grad RN

2 LPNs

1 aide

32 pts

The nurses all get 8 pts each. But the RNs also have to provide certain hands-on care & all responsibility for the LPNs pts as well. So the LPNs have 8 pts each to help with. The 2 RNs really have 16 pts each. (and one of those RNs is a new grad, 2 weeks post orientation)

BTW, the charge RN was mandated to work ot that night..... 10 minutes before her first shift ended.

[SKM-NURSIEPOOH, BSN, RN]

originally posted by -jt

another example:

hospital oncology unit - eve shift

1 experienced rn (and shes assigned to be in charge, too)

1 new grad rn

2 lpns

1 aide

32 pts

the nurses all get 8 pts each. but the rns also have to provide certain hands-on care & all responsibility for the lpns pts as well. so the lpns have 8 pts each to help with. the 2 rns really have 16 pts each. (and one of those rns is a new grad, 2 weeks post orientation)

btw, the charge rn was mandated to work ot that night..... 10 minutes before her first shift ended.

...taking the ultimate responsibility for other "licensed" nurses' & "certified" nas/mas' actions. i still don't understand why the rns even tolerate that??? why not make that the issue...if you could be releaved from having to "co-sign" for lpns caring for patients within "their scope of practice", then lpns could be counted as nurses on the floors. i think that the hospitals have been allowed to bully the rns into taking on this responsibility simply because the sbon generally or broadly says that the rns supervises the lpns. if rns could fight to only have the "charge nurse" supervise the lpns, cnas, & mas without being made to also take patients assignments...then that would be idea...yeah???

it's absolutely ridiculous for the hospital in the above post to hold the rn responsible for what the mds/nps do within the nursey as they also have licenses...seems there should've been at least one rn in that part of the nursey at all time anyway...it was wrong for that particular hospital to have treated the rn in that fashion. the cna should've been written-up...if not suspended or worse...not the rn. the cna was oriented to the policy of the nursey & should've been held accountable for her actions. i'm not so sure as to report it to the sbon...but if some harm had of came to either of the infants...then i suppose she should've been report to them.

[Youda]

My SBON Newsletter arrived today. Consider the following reasons that nurses lost their license:

1. Administered Coumadin without checking labwork; did not administer blood in a timely manner. (Was this a shift from hell?)

2. Did not accurately document all assessments and treatments on her assigned patients. (Was this a shift from hell?)

It doesn't matter what the staffing mix is when there's an error. If there are errors reported to the SBON, you can lose your license. And, it isn't just the SBON, it's the lawyers and the courts you have to worry about. The RN is always considered the last line of defense against errors, anyone and everyone's errors. This law could have helped protect the patients as well as the nurses (both LPN and RN). When you're stretched too far, you're gonna make mistakes. When those mistakes happen, the RN AND the LPN will go down.

[SKM-NURSIEPOOH, BSN, RN]

the thing that bothers me is that rns are fed-up with having to co-sign for the lpns' work...as rightfully so...both are licensed nurses that have their own scope of practice in which they have to follow. there are only a few things that the lpns can't legally do under their scope of practice that supposed to separate them from the rns right??? then why not have the rns do those things only for those patients & everything else that the lpns do is on them??? it really irritates me to read post suggesting that lpns can't do this or that because they're not "educated enough" to understand what it is they're doing...in other words...they have no ability to critical think. that's sooo absurd...if lpns can learn basic pathophysiology, med/surg & nursing fundamentals for their scope...why wouldn't it be possible to teach the rationales behind them as well...instead of letting many just go about the task of it. that'll definitely free-up a lot of rns.

trust me, i'm not trying to make this out to be about rns vs. lpns at all. i'm just looking at other ways of coming-up with solutions to a very old problem...one that should've been addressed years ago...when lpns were first introduced into the nursing profession.

just a thought - moe.

[Youda]

Aw, heck, SKM. I don't wanna get flamed. I don't want to turn this thread into an LPN vs. RN debate! But, I'm afraid if I open my big mouth, that's exactly what will happen just for saying what I believe. So, everybody who wants to flame me, would you please just count to 10 and realize that I'm speaking MY opinion and it doesn't have to be taken personally?

OK. Disclaimer out of the way. I was an LPN for over 20 years. The difference in education *is* the difference between an LPN and an RN. We do teach LPNs the rationale behind doing things. The technical skills performed correctly isn't the issue. It's all the training and knowledge behind it that's important. When I started my RN, I thought it would be a cakewalk, because I'd been an LPN for so long. It wasn't a cakewalk. Trust me, it was no cakewalk. If you'll excuse the immodesty, I consider myself a fairly bright, intelligent and articulate person. As an LPN, I always read on my own and studied nursing, and completed CEUs even though my state doesn't require them. Heck! I just didn't know what I didn't know. When I look back, it scares the crap out of me some of the things I did routinely as an LPN that I didn't have the faintest clue what I was doing! LPN is a vital and important role. Quite frankly, as an LPN I knew more of the technical side of things, even intuitively knew what to do, than a lot of the RNs I worked with. Some were just plain idiots and I have no idea how they managed to pass clinicals and the NCLEX. Still don't. As an LPN I worked in LTC where I was almost always the only licensed person in the building. I learned to think independently, problem solve, think critically, assess my residents, and almost always was the first nurse to know when something was going wrong with my residents. I will defend to the death anyone who says that an LPN can't out-perform an RN and anyone who believes that an LPN isn't just as capable of doing the job! But, the clincher is just that being an RN is so much more, with such a better foundation. My skills improved, my assessments improved, my problem solving improved, I became even a better nurse. I just didn't know what I didn't know. Working on my RN humbled me to my knees when I began to realized what I didn't know. Now, it still scares the crap out of me sometimes because there's just so many factors that go into patient care. I still cry about a little lady that went into CHF and died before we could get her to the hospital. I was an LPN in school for my RN at the time. The very next week, we were doing heart sounds and I KNEW that if I'd have just known those heart sounds a couple weeks earlier, I would have HEARD that she was getting into trouble long before she reached a crisis stage. But, to even understand what I was hearing, I had to learn the physiology, the route of blood, the different valves, and practice listening to the sounds . . . You just don't know what you don't know. Oh heck. No one reads long posts anyway.