California RN union (CNA) presence in Texas?

gauge14iv, MSN, APRN, NP · Oct 7, 2006

Heh - I got that too. I tore it in half, shredded it, tore up the shreds and then lit them on fire in the driveway. I washed the ash into the dustpan with bleach...

well...that's how *I* feel about it :)

I dont think ratios are all they are cracked up to be. They can mandate anything - but if they don't enforce it, then what good is it? So they mandate all these ratios. And people file grievances when they arent adhered to. Nothing is done. Just like now.

The most effective ratio would be one set by nurses - nurses who leave jobs where they are expected to carry unsafe loads. Vote with your feet.

Sheri257 · Oct 8, 2006

I dont think ratios are all they are cracked up to be. They can mandate anything - but if they don't enforce it, then what good is it? So they mandate all these ratios. And people file grievances when they arent adhered to. Nothing is done. Just like now.
The most effective ratio would be one set by nurses - nurses who leave jobs where they are expected to carry unsafe loads. Vote with your feet.

Sorry but, you're dead wrong about this.

As a student I've done clinicals in over a dozen hospitals in California and I've also worked in two of them. I always make a point of checking to see whether the facility is following the ratio law when I'm there. And, I always ask the RN's if the ratios are followed.

When I've personally been in these facilities the ratios were always followed. When I've asked the RN's if this was the case all the time, the overwhelming answer was yes. I was told of only two instances where ratios were broken. In both cases the RN's complained to management that the law was being violated and in both cases the situation was corrected immediately.

Ratios are, in fact, followed the vast majority of the time. Why? Because the unions will pitch a fit, file complaints and the hospital will lose state and federal funding if they don't comply with the ratio law. The unions have even set up hotlines where RN's can complain about ratio violations and report them.

Remember: Medicare and MediCal requires compliance with all laws and regulations ... and that includes the ratio law. That's why a ratio law, rather than voluntary ratios that can disappear at any time ... is so effective. When it's the law, it can cost them millions if they don't comply.

But, don't just take my word for it ... I also invite you ask any veteran California RN who's worked here before and after the ratio law was passed what kind of patient loads they had back then versus now ... because I've literally talked to dozens of them.

Virtually all of them will tell you they typically had eight patients, minimum (and often a lot more than that), before the law took effect. The only exceptions I know of was ICU nurses (who, of course, already had mandated ratios) and Kaiser (which was way ahead of other hospitals in implementing ratios).

Other than that, none of them had patient lower patient loads until the law took effect.

I also invite you to talk to travellers who've worked in both California and other states. It's always the same story, even today. In other states they typically get eight to ten patients minimum. Only in California do they get only five patients. Every traveller I've talked to says the same thing.

Feel free to ask them yourself. There's a reason travellers are now flooding the California market and, travel rates have actually gone down in some cases. Many travellers prefer California over other states because of the ratio law.

In my experience, the only RN's who say the ratio law isn't working are managers who, of course, don't want to staff properly and, people who have never actually worked here and seen it for themselves.

:typing

RN34TX · Oct 8, 2006

Heh - I got that too. I tore it in half, shredded it, tore up the shreds and then lit them on fire in the driveway. I washed the ash into the dustpan with bleach...
well...that's how *I* feel about it :)
I dont think ratios are all they are cracked up to be. They can mandate anything - but if they don't enforce it, then what good is it? So they mandate all these ratios. And people file grievances when they arent adhered to. Nothing is done. Just like now.
The most effective ratio would be one set by nurses - nurses who leave jobs where they are expected to carry unsafe loads. Vote with your feet.

I Did vote with my feet. As an LVN for 7 years, I had few options outside of med/surg.

But after getting my RN, I left med/surg and Dallas and refuse to go back to either because the employment conditions are so horrid at every hospital I ever worked in DFW.

The problem was, my coworkers were so spineless and kept taking the 7-9 patient loads with little or no support staff so I was often the only one complaining.

So of course then it just looks like I'm the problem because everyone else seems to handle the patient loads just fine.

Why don't more nurses vote with their feet and start refusing such unsafe patient assignments?

I don't know. But in DFW, too many were afraid of losing their jobs (as if nursing jobs in Dallas aren't a dime a dozen).

I'd quit one job, and start two the next day in that town yet others acted as if their current positions were gold and that they didn't want to rock the boat and upset management by complaining about working conditions.

Thank you for your insight/opinion on unions/CNA.

RN34TX · Oct 8, 2006

The only exceptions I know of was ICU nurses (who, of course, already had mandated ratios) and Kaiser (which was way ahead of other hospitals in implementing ratios).

Which is where I'm at now so any new ratio law wouldn't affect me because 2 patients is strictly enforced in ICU and PACU at my current employer.

But who's to say that couldn't change over time?

In addition, it still bothers me that nurses on the floors are taking big patient loads, it affects all of us in many ways, and I'd like to see that changed.

I have floated to ICU's as an LVN in Dallas where the ICU nurses were taking 3 patients each. That's insane but not uncommon in some hospitals in Texas.

Thank you for your info and insight on CNA and mandated staffing ratios.

I just didn't think that any of that organizing/collective bargaining would be possible here with Texas laws designed to protect the employer/big business.

Sheri257 · Oct 8, 2006

Thank you for your info and insight on CNA and mandated staffing ratios.
I just didn't think that any of that organizing/collective bargaining would be possible here with Texas laws designed to protect the employer/big business.

And it may not be possible if there's not a lot of support from RN's, which seems to be the case in Texas. If people don't want a union in Texas, that's fine.

But you also raised some interesting points ... I do think there are different nursing cultures in both states. In California I've personally seen RN's refuse to take even five patients when they felt the acuity of their four patients was too high ... even though management could legally give them five. And this was at a non-union hospital.

RN's tend to be very assertive here ... whether they're union or not. I'll never forget the day there was a ratio violation that happened on a different floor (not ours). Nevertheless, word spread like wildfire and the RN's pitched a fit ... even RN's who weren't affected directly complained to management that they were violating the law and that they better stop it right now.

Needless to say, management corrected the problem immediately.

:typing

gauge14iv, MSN, APRN, NP · Oct 8, 2006

I happen to know a number of CA nurses myself - some very EXPERIENCED CA nurses in fact.

ah never mind....

unsubscribe thread

Nancyebg · Oct 8, 2006

I'm with GaugeIV on this one. I trashed it myself as did most everyone I have spoken to. I've heard plenty from both sides of the fence in California--they aren't consistently enforced, they diminish the professional judgment and common sense of staff ("at all times" standard makes little sense) along with the possible positive aspects. There are good employers and bad employers in every state of the good ole USA. If you are in a bad situation, vote with your feet. There are plenty of opportunities in the better employers...without having to pay dues or give up your indepdence or your professional voice or your chance to be viewed on the merits of your own work.

Unions are about one thing: creating as much divisiveness as possible in the workplace in an effort to gain dues paying members.

Sheri257 · Oct 8, 2006

Unions are about one thing: creating as much divisiveness as possible in the workplace in an effort to gain dues paying members.

If that was true, why get the ratio law passed in the first place? Why defend it in court multiple times?

Eighty percent of California RN's don't belong to a union. If all the union cared about was dues paying members, why pass a law that benefits every RN in the state .... including anti-union RNs? Why not just negotiate ratios in contracts that only benefit their own dues paying members?

But they didn't. They passed a law that benefits everyone. If you or any other RN moved to California, you wouldn't have to join a union to benefit from ratios. You've got to give them credit for that.

I'm not saying that unions are all good ... but they're not all bad either.

:typing

Nancyebg · Oct 9, 2006

Everyone hasn't benefitted. How many hospital closures have there been, not to mention unit and service closures in California that these standards have attributed to? THe horror stories abound such as the closing of both rural and metropolitan facilities, the inability to transfer a child with brain trauma from a small rural hospital to a specialized pediatric faciltiy because they couldn't accept him due to staffing ratios. Forcing a one size fits all approach that doesnt take into account differences in the skill levels of nurses, the availability of ancillary and other support personeel, the equpment and technology available in a particular hospital, etc to meet an arbitrary standard isn't the best for nurses or the patients.

Sheri257 · Oct 10, 2006

Everyone hasn't benefitted. How many hospital closures have there been, not to mention unit and service closures in California that these standards have attributed to? THe horror stories abound such as the closing of both rural and metropolitan facilities, the inability to transfer a child with brain trauma from a small rural hospital to a specialized pediatric faciltiy because they couldn't accept him due to staffing ratios. Forcing a one size fits all approach that doesnt take into account differences in the skill levels of nurses, the availability of ancillary and other support personeel, the equpment and technology available in a particular hospital, etc to meet an arbitrary standard isn't the best for nurses or the patients.

I don't know what your source of information is but, most of the closures in California have been ER's ... and that's been attributed to illegal immigrants, not ratios.

Bottom line: there are 2.9 million licensed RN's in this country. Nearly 500,000 of them ... or 17 percent ... choose not to work, probably because of lousy working conditions.

In California ... the percentage of RN's who choose not to work is a lot less ... only 6 percent. Probably because ratios have greatly improved working conditions.

If there were mandated ratios nationwide and, consequently, better working conditions ... you could cut the percentage of non-working RN's down to 6 percent like California has.

That means getting 11 percent ... or 300,000 of those RN's back to work. You would also solve the nursing shortage overnight.

Now I ask you ... what's better for patients? Running RN's ragged with 8-10 patients and pushing them to the point that they quit the profession all together? Or giving them manageable patients loads so that they and, more importantly, the patients, don't suffer.

Because patients are already suffering as it is with substandard staffing levels. Right now you've got half a million RN's who've walked off the job ... and for good reason.

:typing

RN34TX · Oct 10, 2006

Everyone hasn't benefitted. How many hospital closures have there been, not to mention unit and service closures in California that these standards have attributed to? THe horror stories abound such as the closing of both rural and metropolitan facilities, the inability to transfer a child with brain trauma from a small rural hospital to a specialized pediatric faciltiy because they couldn't accept him due to staffing ratios. Forcing a one size fits all approach that doesnt take into account differences in the skill levels of nurses, the availability of ancillary and other support personeel, the equpment and technology available in a particular hospital, etc to meet an arbitrary standard isn't the best for nurses or the patients.

And why aren't there similar horror stories in Texas?

Because the hospitals here have a different standard:

If there is a clean room, then someone is going to take that admission, regardless of how many patients one nurse already has.

So let's say every PICU nurse at this specialized peds facility already had two patients each.

One of them is supposed to take a third patient?

And this third patient is a ped. brain trauma on top of it??

Now that's a horror story.

One that I'm sure happens in some Texas ICU's every day because we get threatened and strong-armed into taking unsafe patient assignments.

If this small hospital really couldn't provide proper care for this brain trauma peds patient, then the specialized hospital should have taken one of their hot shot administrators who still like to flash "RN" on their name badges along with the alphabet soup of degrees and designations and put them in scrubs to take this patient.

If you still want to claim "RN" on your badge, then you'd better keep up on your skills and prepare to actually be a nurse when times like that happen.

No ICU or PICU nurse should EVER have more than 2 patients at any time.

And that should be the law, not to be decided by some bean counter administrator who stands to get a big bonus if they stay "within budget" for a given fiscal year if they cut corners (and safety) in staffing.