California mandatory ratios don't work?

[coginthemachine]

So apparently the body of reserach post ratio law in California shows that patient outcomes have not improved.  I'm still sifting through the research to be fair (Current graduate student).  Could you California nurses provide some insight why this may be?  After the ratio laws did they cut back on CNA numbers and limit their scope?  

In my one travel nurse job I did in California I noticed, yes the lower ratios did not seem to help.  I noticed at least at the one Kaiser hospital I was at, CNAs were very limited in what they were allowed to do.  They were  not allowed to get blood sugars or vital signs!  Further, there were no charge nurses in the sense I am used to.  They had "Assistant Nurse Managers"  who wore white coats and were very much on a ivory tower and disconnected from the unit.  In my expereince, charge nurses are involved in patient care and will help you turn, wipe a bottom, help with a difficult patient/visitor, etc.   I AM NOT ABOVE BASIC NURSING TASKS.  Don't start that pile up.  I am a big beleiver in doing all tasks.  Any insight is much appreciated.  Thank you!

[mdfog10]

The Science of Ratios

https://www.nationalnursesunited.org/science-of-ratios

[lilRN16, ASN, BSN, RN]

On 7/30/2021 at 12:51 PM, coginthemachine said:

So apparently the body of reserach post ratio law in California shows that patient outcomes have not improved.  I'm still sifting through the research to be fair (Current graduate student).  Could you California nurses provide some insight why this may be?  After the ratio laws did they cut back on CNA numbers and limit their scope?  

In my one travel nurse job I did in California I noticed, yes the lower ratios did not seem to help.  I noticed at least at the one Kaiser hospital I was at, CNAs were very limited in what they were allowed to do.  They were  not allowed to get blood sugars or vital signs!  Further, there were no charge nurses in the sense I am used to.  They had "Assistant Nurse Managers"  who wore white coats and were very much on a ivory tower and disconnected from the unit.  In my expereince, charge nurses are involved in patient care and will help you turn, wipe a bottom, help with a difficult patient/visitor, etc.   I AM NOT ABOVE BASIC NURSING TASKS.  Don't start that pile up.  I am a big beleiver in doing all tasks.  Any insight is much appreciated.  Thank you!

Maybe that's a Kaiser thing, I've heard many awful things about that organization in regards to working there. In dignity, LA County and providence facilities the ratio does indeed make a difference. One of the reasons I will never work as an RN outside of California. Since the CNAs aren't in our scope of practice, you may have to read the legislation on how they are impacted by ratios. 

[Cloud9RN, BSN]

I currently work in one of the hospitals in LA right now and have previous work experienced from out of state. I am in awe when CNA's have limited work to do here. In my previous state CNA's can do accuchecks, do bladder scan etc.... Here in California all they do is to take Vitals and most of them are very lazy just playing on their phonesa nd sometimes have the nerve to tell Nurses to do this and that. Im like are you serious? They don't even answer call lights... 

[mdfog10]

sounds like a management problem. Managers need to be clear with job expectations for all staff and follow up when job requirements are not met. 

[Nursetom1963, BSN]

Been doing this about 30 years and just thought I'd chime in.  The ratios are supposed to provide for nurses to give better care, but there are so many factors and variables involved; it is impossible to really say whether it does any good or not.  Availability of meds, availability of (working) equipment, CNAs, or other helpers, The acuity of the patients (and I have never seen a good way to measure this) My hospital, it causes patient to sit in ER for 24, 48 or more hours waiting for a bed, because we don't have the staff to put them in a regular bed.  We run less than half theoretical capacity at most, but no nurses. On the other hand, I haven't had a day off in the last two years that they didn't text me offering time and a half, double time or more (I've made lots of money, but Im burnt, and the rest of my life takes a hit too)  I could take care or more patients (sometimes do when we go out of ratio) easily if I had the backing and resources.  (but that's a whole 'nother thread.  )