Safe Staffing Law - page 2

~1865~1858854,00.html Article Last Updated: Monday, December 29, 2003 - 5:39:33 AM PST By Rebecca Vesely, STAFF WRITER PATIENTS WHO find themselves at the hospital on New Year's Day probably... Read More

  1. by   pickledpepperRN
    Originally posted by it'sallbueno
    The staffing ratio saga continues:

    Today I had six of my own patients, (med-surg) and covered six of the (brand new, and floated in) LVN's, for a grand total of 12 patients. Census was low, just the 12, so the clerk and the NA floated out.

    I think I may have hope, but not necessarily faith! Please continue to send good thoughts until this is all figured out!
    If that happens to me at my union hospital I will use the form on the
    www.calnurse.org
    web site to inform management that the patients need their nurses available so we must have our CNA to help with lifting and so on, the secretary to enter orders, answer the phone and so on. If the LVN also signs I truly think we will get them back.

    If registry at a non union hospital I will write the possible harm to patients and why the patients need NURSING care.
    If the acuity requires more licensed nurses, aides, monitor tech, or clerk that will be in the letter. It will state,

    "As a patient advocate, in accordance with the Nursing Practice Standards of Competent Performance, in my opinion as a professional registered nurse I am informing you (nursing managers name) that the facility not the nursing staff is responsible for any harm to a patient due to failure to assure sufficient licensed and unlicensed staff."

    Details of treatments, medications, care planning, pain and other assessments, decubitus prevention, and documentation that may not be done in a timely way should be included.

    This may get the help for that shoft. If not it will probably save my license if I am reported to the BRN. It may save my money and home if there is a lawsuit.

    Lots of people are out of work now. A person with good manners can answer the phone. It will take more training and experience for a person to become a competent unit secretary. A certified nursing assistant class is 150 hours. They have had since 1999. There is NO excuse.
    Our job as bedside nurses is to provide nursing care.
    The hospital is responsible for staffing. This law was passed because they were not doing this.
    Unfortunately we as nursing staff must be the police. I say give them the opportunity to do the right thing. When there is NO DOUBT that a manager is disregarding the needs of the patients and disrespecting the nurses it is time to either begin a fight or go to another unit of even another facility.

    Off my soapbox for a while.
  2. by   Hellllllo Nurse
    Excellent post, spacenurse.
  3. by   RNKPCE
    As I have said in other postings where I work on tele our ratios are 5 to 1. Out of the twelve shifts that I know of since Jan1st the ratios have been met on less than 50% of them. The night shift staffing looks so good, last night they didn't meet ratios but all 5 floor nurses had 5 patients and one had 6 and the charge had none and they had 2 cna's. So though just out of complaince by one it looks pretty good. We now have the same staffing on days and evenings and we have met the ratios less often and over by more than just one patient. They are cutting back the cna's on all shifts to accomplish the 5 to 1 on nights. We already had 4-5 patients per nurse on days and pm's and cna's. Now our staffing is worse but even if it meets the ratios it is worse because we have less cna assistance now. That wasn't the spirit of the law. We are writing letters to local papers, administrators, and our union. Also sometime by the end of the month we are opening 16 more beds that will be an annex unit of ours that we are going to have to staff.

    You may think this is odd but most of the people I work with think that having to have someone without patients watch your patients when you go to dinner or the bathroom is rediculous. We all by choice eat dinner in our breakroom and would be avail if there were an emergency the buddy watching our patients couldn't handle. Hey I could be more tied up with another patient
    and not be able to drop everything to check on a patient than I would be in the bathroom. That is what team work is about. What if I had just stuck a patient for an IV and a different pt had a long run of pvc's, the monitor tech would have the nearest nurse check the patient anyways, I couldn't just leave a catholon dangling from a patients arm anyway. I think the break aspect of the law is too rigid. If the ratios are met I don't think having someone cover your 5 or less patients on your 30 min break is a problem.
  4. by   tlynsmith
    My sister was informed today there will be layoffs where she works. They have already begun canceling third shift. She told me her hospital stated they are expected a bus load of nurses to arrive anyday now. Is this crazy or what? I guess its really a great time to become a nurse. Maybe they will look at the nursing programs in CA, too be able to accomodate this demand

    Teresa
  5. by   Spidey's mom
    We've been preparing for months now, using acquities and the new ratios but it is hard to schedule the breaks. I live in a rural area with a real nursing shortage where we do not have such a thing as a "break nurse". The supervisor has to break us, but she is also the ER nurse and what if the ER is busy and she already has her 4 patients? The logistics of this is a nightmare.

    Somebody didn't think this out very well.

    steph
  6. by   RNKPCE
    mztrixi,
    Was that layoffs of nurse aides? I hope it wasn't RN's. I hate to see anyone in healthcare lose there jobs when our patients need all of us.

    All,

    As I told you in my earlier posting today I don't agree with the break nurse aspect of the rule. Well I wrote the California Hopsital Association(CHA) that I agree with some aspects of their suit regarding the break nurse thing and they want myself and some of my other co- workers along with the support of our hospital to be interviewed and quoted as saying we support the ratios but not the break nurse rule.

    I will let you know what happens.
    Last edit by RNKPCE on Jan 5, '04
  7. by   PEACE1
    CAN WE ALL LVN/RN JUST GET ALONG, WE ARE ALL NURSES, HUMANS AND WE ALL NEED A JOB. UNITY IS WHAT BRINGS QUALITY AND PEACE. LETS ALL BE SMART AND PUT OUR SELVES IN THE OTHER PERSONS SHOES.
  8. by   PMHNP10
    Originally posted by PEACE1
    CAN WE ALL LVN/RN JUST GET ALONG, WE ARE ALL NURSES, HUMANS AND WE ALL NEED A JOB. UNITY IS WHAT BRINGS QUALITY AND PEACE. LETS ALL BE SMART AND PUT OUR SELVES IN THE OTHER PERSONS SHOES.
    Huh?????
  9. by   ainz
    The staffing ratio laws will bring to light some things that I don't think the CNA really thought through, or perhaps didn't care to, not sure.

    Why does there have to be such an "us versus them" mentality about all of this. Like a war between administration and nursing. My current hospital began staffing according to the new laws back in the summer in order to prepare and see the finanical effect it would have. The care hasn't improved, the nurses still complain and whine about being too busy, nothing has changed.

    What was CNA thinking when this thing was pushed through? Kind of like saying, well let's see, there is already a nursing shortage so let's just make it worse and force the hospitals to hire even more nurses they can't find. The end result will be closing beds and cutting back services. Again, who loses in the end----the PATIENT.
  10. by   PMHNP10
    ainz
    The staffing ratio laws will bring to light some things that I don't think the CNA really thought through, or perhaps didn't care to, not sure. ...
    My current hospital began staffing according to the new laws back in the summer in order to prepare and see the finanical effect it would have. The care hasn't improved, the nurses still complain and whine about being too busy, nothing has changed.

    What was CNA thinking when this thing was pushed through? Kind of like saying, well let's see, there is already a nursing shortage so let's just make it worse and force the hospitals to hire even more nurses they can't find. The end result will be closing beds and cutting back services. Again, who loses in the end----the PATIENT.


    Knowing nothing about where you work--eg. what changes actually occured after 1/1/04 (on your unit)--I can only assume from your post that the nurse to pt ratio HAS decreased on your floor. I am also reading that on your unit YOU don't believe care has improved and you hear the same nurses complain as before the ratios. So I can fully understand...Are you saying your care has not improved either and you continue to complain about being too busy regardless of getting to care for fewer patients? I'm not saying this to call you out as a poor nurse, but rather to emphasize that while these ratios aren't the perfect answer, they are certainly better than what was going on in many settings before the implementation of the laws. Let's say you had 8 pt's pre ratio laws, and now you have 6. There is no way you could convince me that this is not a better situation for YOU as a nurse and more importantly, for the patient, unless YOUR ability to care truly hasn't improved. Granted I don't know you, but I find this hard to believe.
  11. by   ainz
    Good questions psychrn03. I am no longer doing direct patient care. I am now in hospital administration and am looking at this thing from a hospitalwide perspective. I am a chief operating officer for a hospital in California. Part of my job includes reviewing the patient and employee satisfaction surveys, handling incoming comments from the medical staff (both positive and negative), seeing all of the financial data, and reviewing the quality data.

    The theory of fewer patients for nurses to care for would tend to make one think it is a good thing. I think it is a good thing but there are so many more factors to consider besides just the number of patients assigned to one nurse. It is early in the game with all of this and I think we should really take an objective view and do an thorough risk/benefit analysis. The ratios will help only if other things are addressed as well. With the current situation in healthcare and the shortages of various disciplines, this has the potential to have a disasterous effect. Closing beds and reducing services is just about the only alternative a hospital has if they can't find the nurses or the hospital could face the consequences of violating the law. Our hospital has already budgeted about a million more dollars for salary expense in order to meet the ratio. The nurses are just not there to pay at this time. We are already having to turn patients away because we do not have the staff and I am not willing to sacrifice quality just to keep the census up either.

    This law is taking an already difficult situation to manage and making it worse. There needed to be some other basic issues addressed along with the ratio. If the ratio laws fail, and there is a good chance they will (what I mean by fail is being repealed) then the CNA and nursing in general will have a serious credibility issue and this will be seen as validation that nurses really have no concept of financial management and managing a huge complex business in general. It could really be bad for nursing if this thing blows up. Just my thoughts.

    By the way, I am very PRO-NURSING, always have been, always will be, and I work very hard to advance our profession. I just want to see us do it right and be taken seriously and be heard.
  12. by   wjf00
    So if hospitals "close beds" because they can no longer staff using ratios of 10:1 or 12:1 we are to believe this is a bad thing? If you can't provide adequate staffing to assure good patient care then by all means shut down a unit. I am very tired of adminstrators complaining about having to shut down beds because they can no longer staff like before. Why don't these adminstrators get it through their heads that they can no longer stretch the nursing staff to any lengths just to keep the census up. Where does good patient care figure into their calculations? What is the ratio that administrators think is safe? Do we simply divide patients by nurses on any given day and that becomes the safe staffing ratio of the day? Try as they may, these adminstrators will never convince me that the "nursing shortage" gives hospitals licence to stretch ratios to any number that fits.
  13. by   pickledpepperRN
    The hospitals were saying too many licensed nurses were working in hospitals at the time we nurses with the CNA began the 12 year process that lead to the implementation of the ratios.

    I remember RNs & LVNs being replaced by people with 16 hours of training who had been in dietary the week before.

    Please read the entire article to understand the excerpt.
    http://www.revolutionmag.com/newrev2/engineering.html
    "To accumulate the cash needed for their expansion, and to pay off the staggering debt load they incurred, hospital corporations increasingly turned to squeezing labor costs - and nursing care in particular, their main source of expenditures.
    At the bedside, management consulting firms like McKenzie, Booz Allen & Hamilton, American Practices Management (APM), Andersen Consulting and the Hunter Group, were paid hundreds of millions of dollars to implement work redesign models.
    Carrying pleasing-sounding names such as Patient Focused Care or Population Based Care, the re-engineering was premised on models first introduced in the manufacturing sector of the economy and forced onto the health care workplace and direct caregivers.
    The emphasis was on "just-in-time" production techniques that cut staff to dangerously low levels and only provided care for patients when they reached the periphery of crisis and presented a legal liability if they were not treated.
    At their core, the redesign plans were intended to deskill and disempower direct caregivers. Most of the models featured the carving up of the care process into assorted "tasks," and shifting RNs away from hands-on patient care to serve as "team leaders" of unlicensed assistive personnel who would perform the tasks. It would mean replacing direct care RNs with unlicensed staff and RNs with advanced degrees who would supervise them."

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