new staffing laws in mass? CA nurses

Meriwhen, ASN, BSN, MSN, RN · Sep 19, 2018

My facility still maintains techs and CNAs, but I've seen facilities that did away with most/all of those staff and expect the nurses to do total care nursing.

KelRN215, BSN, RN · Sep 19, 2018

Does anyone have a link to the exact wording/actual bill/law being passed? Our nurse manager couldn't find it, and has hoped we'd forget that we asked for it, because this week we're back to scare tactics.
Last night the grapevine said we'd lose our IV Therapy RNs and our designated RRT RNs. Anyone know if they constitute 'ancillary personnel'? I've also been told we'd only be able to work 8h shifts instead of 12h. Again, no one wants us to find or read bills before we vote on them? Or is the hospital just trying to keep our noses out of it and it's super easy to find?

Why would you only be able to work 8 hr shifts instead of 12 hrs? That makes no sense. You need more nurses to staff 8 hour shifts since you have to staff 3 shifts/day instead of 2. The people who are telling you this are trying to scare you into voting no because they know that most bedside nurses prefer 12 hr shifts.

It just occurred to me that the people voting no on this have similar opinions/attitudes to the people who voted no on the earned sick time law 4 years ago. They all work for hospitals that already have excellent ratios and they're worried that, by the government saying, for example, that med-surg patients can have a maximum of 5 patients, that their employer will change their ratios to 5:1 on all shifts instead of whatever they have now, be it 3:1 or 4:1. When earned sick time was on the ballot, the people who I heard say they were against it were against it because they already had excellent PTO benefits and they felt their employers would use the law to decrease their benefits. That's not a problem with the law, it's a problem with the employer using the law as an excuse. I've yet to see anything like that happen anywhere in response to that law, though.

KelRN215, BSN, RN · Sep 19, 2018

yes, but I do think once an aid or secretary quits they will not rehire.

Why do you think this?

And why do you think not filling such a position if someone leaves wouldn't count as "reducing ancillary staff", which the law specifically prohibits?

The No on 1 commercial with the ED Doc just came on as I'm watching the Red Sox game and the part of this ad that bothers me in particular is that it says the law would "override the judgment of DOCTORS and nurses". When do doctors ever have any say in nurse to patient ratio?

lorie101 · Sep 21, 2018

ugh still so undecided . A hospital is more about nurses. We also need more doctors. When they say not enough staff it's not always nurses. We need more PCAs, more Respiratory therapist, more physical therapist. A patients plan of care is made up of multiple teams not just nurses and each patients plan of care requires different needs. Each hospital unit requires different needs for staffing. This law is only about nurses and it only is being enforced in acute care settings NOT nursing homes and rehabs that are most definitely understaffed - they need more staff as well since a good majority of our population does reside in nursing/rehab centers. Also need for more home care. Some patients go home because their insurance won't pay for rehab, or a nursing home would be private pay so now family members have to come up with a way to mange their care that they may not have the means to do. Or patients who don't have a family, who go home to no one and end up back in the hospital. This bill proposes that it would leave to less readmissions but I teach and preach to my patients until I'm blue in the face about their care. What they do at home, whether it be compliant with meds and diet, have money for medications, have insurance coverage for home health aids or VNA determines whether or not they end up readmitted for a reoccurrence of their CHF, COPD exacerbation, etc. Healthcare as a WHOLE needs to be evaluated not just acute care facilities and mandated ratios.

I cannot even imagine the ERs, what happens if a critical patient comes in and no beds? I heard the ambulance will have to stay with them until a bed opens up, then that will leave 1 less ambulance on the road.

Then hospitals only have 37 days to comply to this? Which is crazy, CA I believe got a few years and they can use/count LPNs

guest769224 · Sep 22, 2018

OP, why would you vote against a law that will improve your working conditions, increase patient safety, and hold hospitals accountable? I see no downsides.

If CA can figure it out, so can MA.

Coffee Nurse, BSN, RN · Sep 22, 2018

ugh still so undecided . A hospital is more about nurses. We also need more doctors. When they say not enough staff it's not always nurses. We need more PCAs, more Respiratory therapist, more physical therapist. A patients plan of care is made up of multiple teams not just nurses and each patients plan of care requires different needs. Each hospital unit requires different needs for staffing. This law is only about nurses and it only is being enforced in acute care settings NOT nursing homes and rehabs that are most definitely understaffed - they need more staff as well since a good majority of our population does reside in nursing/rehab centers. Also need for more home care. Some patients go home because their insurance won't pay for rehab, or a nursing home would be private pay so now family members have to come up with a way to mange their care that they may not have the means to do. Or patients who don't have a family, who go home to no one and end up back in the hospital. This bill proposes that it would leave to less readmissions but I teach and preach to my patients until I'm blue in the face about their care. What they do at home, whether it be compliant with meds and diet, have money for medications, have insurance coverage for home health aids or VNA determines whether or not they end up readmitted for a reoccurrence of their CHF, COPD exacerbation, etc. Healthcare as a WHOLE needs to be evaluated not just acute care facilities and mandated ratios.

So, while all this is true (and obvious to any patient-care-oriented person), it is irrelevant to the topic at hand. Question 1 is an opportunity to improve one particular area of this problematic system, and you are suggesting that it be rejected because...there are a whole lot of other improvements that are needed as well?

Honestly -- I don't mean to offend, but your posts read like a troll sent by hospital administration, with your straw-man "but what about"s and fearmongering "I hear that"s, designed to sow confusion and doubt in those who might vote Yes.

unknownjulie · Sep 22, 2018

Take a look at my post "Back on med/surg after 15 years" to see what happens to nurses without government regulation (and that's only the hiring process). If the hospitals can figure out how to give 6 figure bonuses to CEO's then they can figure out humane staffing.

Mrs.D., BSN · Oct 4, 2018

If anyone wants to check out the most current conversation on this topic but may have missed it...

https://allnurses.com/general-nursing-discussion/nurse-staffing-ratios-1175251.html

HomeBound · Oct 4, 2018

So, while all this is true (and obvious to any patient-care-oriented person), it is irrelevant to the topic at hand. Question 1 is an opportunity to improve one particular area of this problematic system, and you are suggesting that it be rejected because...there are a whole lot of other improvements that are needed as well?
Honestly -- I don't mean to offend, but your posts read like a troll sent by hospital administration, with your straw-man "but what about"s and fearmongering "I hear that"s, designed to sow confusion and doubt in those who might vote Yes.

My thoughts exactly. I don't have 'RN' after my avitar because i am too lazy to change it. I suspect thatany dissenting voices are not nurses, and if they are, they are being compensated to troll.

This is recon. Find out what the opposition is saying, and tailor your fear mongering to counter the logical arguments to pass something that is in the best interests of the working class.

Typical and classic anti union rhetoric and tactics. There are not "so many of my friends" who dont want safe staffing, and anybody can make up a thousand different screen names and post on social media to appear as if thre is a strong opposition BY NURSES to this law.

Union busting is big business. Go work in the south for awhile. Say the word "union". See the violent reaction. Its immediate and its swift. MA nurses were going on strike awhile ago...I can't recall when...2015? And this crap started...the misinformation campaign by the hospitals. When someone is facing losing their job and management pulls enough people aside and says....i know who you are and i hear you talking about passing this law....what do you think most people do?

Unionizing and workers' rights are only for the brave. Watch and learn how unions were formed and why. If employers did the right thing, unions would be unnecessary.

How is that "my employer cares about me" working for all of the posters here who relate stories of no lunches for 12 hours, UTIs, being fired for taking vacation, retaliation....if these employers care so so deeply about their employees and patients, why is a union or safe staffing or ratios even being THOUGHT of?

LovingLife123 · Oct 5, 2018

It's actually kind of scary all the fear mongeting tactics and how far these hospitals are willing to go.

I'll be honest, if staffing ratios are in line with patient safety, you shouldn't need a bunch of techs.

I do total care on my patients. I never ever have more than 2 in the icu. On a medsurg floor where u see these ratios, you wouldn't have more than 4. A couple of your medsurg patients I'm guessing are going to be far more independent than the others. Some days, our unit has no tech. We all make it just fine with teamwork. Very, very few of my patients are independent. I had one last week. She was my first in years.

Why would you vote no against patient safety? That's your priority.

In my state, we don't have mandated ratios. It's just something my unit does. We close down rooms before ever giving a nurse a third patient. That's how it should be.