California Ratios

[ANnot4me]

I just returned to California after a 2.5 year absence. I was excited to return after the implementation of the ratios. I have been working agency in an ICU. The ratios have not changed, but from what I understand, the charge nurse can not take patients and one nurse may not cover another nurse's patients while s/he is on break.

I have been working at a hospital where the charge nurse often admits and there is no RN to cover nurses on their breaks. People don't give report when they go on break and many just don't take them. It is a small unit and the patients are safe. Another agency nurse said he has -- on more than one occasion-- been assigned 5 patients in the telemetry unit. I asked another nurse about these practices and why the nurses allow this to happen. She said that the California Nurses Association was not very good about supporting the nurses or enforcing their contract or the law. How disappointing...

What I don't understand is that the nurses don't complain (they admittedly don't). It seems to me that by blatantly ignoring the law and/or not staffing per hospital policy the institution and the nurses involved would be opening themselves up for a huge lawsuit should anything unfortunate ever happen.

I am looking to hear from other California nurses about the practices at the institutions where they work. Is this common?

[Antikigirl, ASN, RN]

Thank goodness I work at a hosptial that typically stays well staffed, has a buddy system for breaks, and will use agency when in a bind for staffing! (I am agency, but work for this one hospital exclusively...I am pretty much on the schedule all the time as is).

It is because thankfully our hospital is basically run by nurse administrators or former nurses! In fact, it is a prereq for employement in those positions. We also have a very tight union that really works well with little trouble! (I don't belong..YET).

The only times this doesn't work well is when we get too many admits from the ER and we fill up and still have surgical patients to place. Happens a few times a month...but then a 'code triage' is called and all nurse managers and admin get together to fix it within an hour to two hours....worked so far, and lots of agency nurses get hours!!! :). Most agency nurses love working at my hospital...so so far so great...nurses typically will come at a moments notice :).....

I was looking at California for a short travel assignment since nurses there get more than I do here...however, I am very leary because of what the OP said and others from Cali have said...I am going there in two weeks on vacation and will check it out...maybe I will find a hospital with the same values as the one I work in now...that would be worth the travel assignment!

[nursebear168]

I just transferred from stepdown unit to tele med surg. I have 5 patients on my own, covering 3 LVN patients and 1 or 2 primary care patients, Team nursing is NOT implement in my new unit and the LVN did absolutely NOTHING for my own 5 patients but if something happen to those 3 LVN patients, I have to call the MD for them, if there are admission, I need to get a report for them. Also I need to carry their orders and check their orders for them. I don't mind to give their IV med. All these are too much for me as a new grad nurse.I feel so overwhleming and frustrated at work. The hospital I am working now, is not union. There are not so much support in my hospital.I have a hard time to communicate to my new manager who seems always in the bad mood. I think that the only solution is that I have to find a new job in a magnet,union hospital so that I will not burn out so quick.

[Genista, BSN, RN]

I work in CA at a union hospital on med/surg. Dayshift RNs get 4 patients, pms and nocs get 5 patients. The acuity can be very high, however (PCAs, drips,TPN, blood sugars, dysphagia 1:1 feeders, PICC draws,isolation,NG/Gtubes,etc.) , and often 1 CNA covers 14-15 patients. We DO complain when staffing is not up to par. It is not swept under the rug at all where I work. The thing is, the union is the nurses. So, if the nurses don't speak up, then the union is weak.

My 1st nursing job (also in CA on med/surg) we had 6-8 patients a piece on pm shift. There was no union at the facility & no support. Turnover was high.

I would ask around. Some facilities are better than others. There are some LVNs where I work, but not as many as a few years ago. Some of the LVNs are top notch, but I have had some bad days where I was responsible for 3-5 patients shared with an LVN, and that was a killer.The total # of patients the RN is responsible for should include those shared with an LVN (but this is not the case, unfortunately).

[pickledpepperRN]

Hospitals will violate the law if they can get away with it. Enforcement is collective action on the unit level because this governor is not supportive of the law and regulations.

No nurse may be assigned responsibility for more than 5 patients in tele or med/surg. The RN "covering" the patients of the LVN was responsible for eight patients. This is unsafe and not allowed.

We dealt with the meal break relief and unsafe staffing by writing that "As a patient advocate in accordance with the California Nursing Practice Act WE are informing you that this assignment places our patients at risk. As a result the hoapital not the nursing staff is responsible for any harm to a patient or incomplete documentation. Under protest we will attempt to carry out the assignment to the best of our ability."

This documentation and our committee that requires management to respond to our recommendations in writing and the fact that we ALL do it result in excellent patient care.

They keep trying but we then fill out a form.

I think the problem is that the nurses don't realize that by accepting a potentially unsafe assignment they could be risking their patients and their license if a patient crashes.