Please come sign a petition to lower nurse-to-patient ratio

sanakruz, ADN · Nov 15, 2002

Wow least amt of nurses in all 50! I signed!

cactus wren · Nov 15, 2002

What good would it do for a nurse in another state ,and not licensed in Nev, to sign this.? I`m confused here...... :confused: Goos idea, tho....

-jt · Nov 15, 2002

Hospitals in Nevada, like facilities in most other states are actively recruiting across state lines. Not only are the targetting nurses in California and other states along their borders, but their advertisements have even been in publications all the way over here in NY. They are trying to lure RNs from all over the country to come work in Nevada. It would do a lot of good for them to hear what those nurses have to say.

**SKM-NURSIEPOOH, BSN, RN** · Nov 15, 2002

originally posted by nurse nevada
please come sign a petition to lower the nurse-to-patient ratio in nevada. hospitals are increasing our patient load and nurses are leaving the state. we already have the least amount of nurses in all 50 states. please help us by signing a petition. go to:

http://users.lvcm.com/nursenevada

thanks for your help!

dianne moore, rn:kiss

- moe

-jt · Nov 15, 2002

I clicked on the envelope & saw the copy of teh letter from your Senator. Good response from a terrific Congressional supporter of nurses. Just have one suggestion -- you might want to XXXX out your address from the top of the letter. Youre opening yourself up to all kinds of crazies on the internet.

quackers · Nov 15, 2002

:roll I also work here in Nevada. If you think the hospitals are short try working in LTC. LTC nursing has always been challenging but now it is getting scary. I know that patients in the hospitals are sicker than before because of the payment systems. These same patients are being transferred to the LTC facilities for continued medical treatment. Last night I had to take care of 17 medicare residents which means 17 total assessments, all the medications and treatments as well as taking care of 44 nonmedicare residents. The staffing is to short for good nursing care. I greatly depend on my CNAs to watch the other residents. Which they really do a good job. But there are times when there just isn't enough time to get everything done. Why do I stay? Because this old nurse has worked in LTC most of my life and I will probably stay in it and complain that there isn't enough staff to work and to many patients to take care of. There isn't a day that goes by that I don't think about changing professions, but then nursing is in my blood.

Nurse Nevada, RN · Nov 16, 2002

Hello again,

Much thanks to all of you who signed the petition. Even if you're not from Nevada, other states will follow suit if enough of us stand up for patient safety. I am going to be working with the Nevada Nurses Association to see what we can do with all the out of state signatures. Nothing gets done if we don't try. I had a nurse tell me last week that she had 14 patients on the night shift in med-surg. They also assigned her a new nurse to precept who also had 4 patients of her own. That made the staff nurse responsible for 18 patients on her shift. It is impossible to give decent care to that many patients. The nurse was frantic and was talking about leaving nursing altogether. This is just one of many stories I hear all the time.

Anyway, thank-you!

Please encourage others to sign!

Dianne Moore, RN

Nurse Nevada, RN · Nov 19, 2002

Hello all,

I am the one who started the petition in Nevada. Even if you're not from this state, I'd appreciate your signatures. Who says we can't try to change it at a National level? If anyone is interested in how to start a petition in your own state, you can contact me at: [email protected]

I sent an email to the members of the Nevada Nursing Association telling them of my intentions to start a petition and put it on a website. They contacted me and are giving me their support. It only takes one person to get the ball rolling. Fortunately I've learned how to build web sites and was able to do it with minimal cost. There are other ways to get it done. The nursing agency's are all supportive and are handing out pieces of paper (business card size) with the address of the website to sign the petition. I also says on the paper "pass it on." Nurses are giving the paper to their co-workers. This is just the beginning. We need to stand up for ourselves and the safety of the public. People are dying because of unsafe nursing conditions and the public is unaware of it. As nurses, it's our responsibility to bring it to their awareness. I expect the media will be jumping all over this soon, as the word gets out. Dr's are leaving the state because of the high cost of malpractice insurance and a lot of it is being covered by the media.

I can hardly believe how supportive everyone is being. I didn't think I'd get that much support. In fact, the first person I spoke to about the idea (a city councel person in Minnesota) tried to discourage me from doing it because of the shortage. I believe this issue is contributing to the shortage. Hospitals want to show profits as every business does. Cutting staff is one way of achieving it. But when they are using profits to build beautiful new hospitals and not paying attention to causes of shortages it hurts everyone.

Please help me make a change.

Thank you to the person who started this thread!

Dianne Moore, RN

Nursing Nevada

Nurse Nevada, RN · Jan 4, 2003

Please come to the website below and sign our petition. There was a precedent set whereby out of state signatures may be accepted because of travel nursing.

Nursing Nevada:kiss

renerian, BSN, RN · Jan 4, 2003

Some petitions you need to be licensed in the state in order to sign them. Like a voter... Is this a net or other petition?

renerian

Nurse Nevada, RN · Jan 4, 2003

March 2002 issue of the Journal of Clinical Systems Management, formerly CurtinCalls, an "occasionally irreverent" scan of nursing and health care in the United States. The author, Leah Curtin, is a Registered Nurse who has been internationally recognized for her work in nursing ethics for over two decades. For more information, visit http://www.curtincalls.com.

Staffing and Mandatory RN ratios

Now that California has published its mandatory staffing ratios (February 2002), the time for comment and input is practically over. California was the first state to do it, but several other states have ICU ratios, and another 17 are thinking about it. It is legislatively mandated RN/patient ratios -- an eminently predictable result of the overenthusiastic re-engineering efforts of the 90s....

With a system in the midst of chaotic change, a far sicker patient population was placed in the care of an ill-prepared, poorly supervised health care workforce - and, among the results, is a dramatic increase in the number of serious errors made in the care of patients. ... Thus, hospitals began hiring rather than firing RNs, creating a selective shortage of experienced nurses.... So, California's nurse-to-patient ratios for all nursing units in acute care hospitals should surprise no one! The full list of ratios is as follows: -Intensive/critical care unit: 1:2 -OR: 1:1 -Neonatal ICU: 1:2 -Intermediate care nursery: 1:4 -Well-baby nursery: 1:8 -Postpartum (when multiple births, the number of newborns and number of mothers shall never exceed 8 per nurse)1:8 (1:4 couplets); 1:6 (mothers only) -Labor and delivery: 1:2 -Post-anesthesia care unit: 1:2 -Emergency departments (triage, radio, or other specialty nurse are to be added as additional workforce and are not included in the ratio): 1:4 -Critical care: 1:2 -Trauma: 1:1 -Burn unit (a critical care unit): 1:2 -Pediatrics: 1:4 -Step-down/telemetry: 1:4 -Specialty care (oncology): 1:5 -Telemetry unit: 1:5 -General medical-surgical: 1:6 (initial); 1:5 (phased in 12-18 months after effective date of regulations) -Behavioral health/psychiatric units: 1:6 -Mixed units: 1:6 (initial); 1:5 (phased in 12 to 18 months after effective date of regulations) This is happening NOW. And the more part-time nurses there are, the more FTEs left vacant. This, coupled with the aging of the workforce, legislatively mandated RN/patient ratios, and multiple studies tying patient safety to richer mixes of RNs serve as a clarion call to health administrators in other states: change your ways before its too late!

The Ethics of Staffing

... With California's publication of its mandatory staffing ratios for all hospital units, law stepped into the staffing arena in a big way! And in the USA, the law is often thought of as determining what is the right thing to do in a given situation (which, interestingly enough, is the definition of practical ethics!). If an organization has met 'all the requirements of the law' then it should be safe from allegations of neglect, malpractice, malfeasance and so forth. However, while meeting the requirements of law is a necessary precondition for responsible staffing, the question remains, is it sufficient to define safe staffing? I would argue that it is not, and I'll tell you why: Safe staffing is not determined by the numbers of personnel, including registered nurses, per patient. While a certain minimum - such a dictated by the staffing ratios -- is a starting point, it is nothing more than that: a starting point. Other considerations include (but are not limited to): patient acuity, ancillary help available, competence of the nurses themselves, level of familiarity with the setting, physical architecture of the unit, the level of technology, back-ups available for staff, the immediate presence/absence of a unit manager, and the ubiquitous problems of staff morale. I bring these up in the context of ethics because ethics almost always deals with responsibilities that are over-and-above law (unless, of course, the law is the problem). In a nutshell, the ethical responsibilities of anyone managing health service delivery are (in order of priority): 1. the safety of the services delivered; 2. the safety of the personnel who report to them directly and indirectly; 3. No institution, and no manager is above the law. Manager have a duty to follow all applicable laws governing practice and personnel management. Among the most intractable of staffing problems today is the issue of 'mandatory overtime' - in any of its various interpretations. I shall abstract information from The Economic Policy Institute's Briefing Paper, Time After Time: mandatory overtime in the U.S. economy Golden and Jorgenson (1/2002).* and juxtapose it with manager's ethical obligations. # 1. How Safe is this practice for patients? - overtime resulted in impaired performance in attention and executive functions. - accident rates increase during overtime hours (Kogi 1991). ... - Overtime is a factor contributing to safety incidents at nuclear power plants (Baker et al. 1994), confirming what researchers had previously found at manufacturing plants (Schuster 1985) and among anesthetists (Gander et al. 2000). - after nine hours at work, the accident rate begins to rise; in the 12th hour the accident rate was twice as high as the rate for the first nine hours (Hanecke et al. 1998). - Medical residents cited fatigue as a cause for their serious mistakes in four out of 10 cases (Boodman 2001), - two studies linked infection outbreaks at hospitals to overtime work (Arnow et al. 1982; and Russell et al. 1983). - An Australian study found that sleep deprivation has the same effects as being drunk. As the number of hours increased without sleep, the study's testers took a longer time completing a task, made more mistakes, and had problems with concentration and memorizing information. After 17-19 hours without sleep, the testers' performance and alertness suffered notably, and "performance levels were low enough to be accepted in many countries as incompatible with safe driving" (Williamson and Feyer 2000, 653). #2. How safe is mandatory overtime for staff? - The social costs associated with the growth in work hours and persistent overtime are particularly worrisome when the long hours are involuntary." (Golden and Jorgenson 2002) - Accident rates increase during overtime hours (Kogi 1991). - Workers who work overtime face a greater risk of injury and illness (Aakerstedt 1994; Duchon et al. 1994; Rosa 1995; Smith 1996). - Long work hours also multiply repetitive motions and exposure to harmful chemicals. Further, frequent overtime and compressed work schedules that produce long workdays can be a major cause of the stress and chronic fatigue reported by many workers, as well as the ensuing occupational burnout or serious health conditions (Sparks et al. 1997; Spurgeon et al. 1997; Martens et al. 1999; Barnett et al. 1999; Shields 1999; Fenwick and Tausig 2001). - Stress can result in increased blood pressure and cardiovascular diseases, which in some cases can have fatal consequences. # 3. What does the law require? In the United States, unlike in most European countries, employees who refuse to work overtime can lose their jobs or face other reprisals including dismissal. However, this is changing rapidly. Legislative initiatives at both the federal and state levels would regulate mandatory overtime. Bills have been introduced in the 107th U.S. Congress that would limit the amount of forced overtime that nurses and other licensed health care providers could work. The Safe Nursing and Patient Care Act of 2001 was introduced in the Senate (S-1686) and House (HR 3238 ). It aims to amend the Social Security Act by limiting the number of mandatory overtime hours a nurse may be required to work among providers of services to which payments are made under the Medicare program. On the state level, many states either have banned, or have legislation introduced to ban mandatory overtime. Among them are California, Connecticut, Hawaii, Maine, New Jersey, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Washington, West Virginia and Wisconsin. There are, of course, exceptions, stipulations and limits set into the laws. There certainly is recognition that employers need some flexibility -- but there are some stiff penalties for violating the spirit as well as the letter of the law. To put matters succinctly, mandatory overtime policies generally violate the ethical duties of managers. However, next month's column will deal with the specifics of legislation, and the legal and ethical exceptions to this general statement which, while succinct, is lacking in subtly!

March 2002 issue of the Journal of Clinical Systems Management, formerly CurtinCalls, an "occasionally irreverent" scan of nursing and health care in the United States. The author, Leah Curtin, is a Registered Nurse who has been internationally recognized for her work in nursing ethics for over two decades. For more information, visit http://www.curtincalls.com.

Staffing and Mandatory RN ratios