Safe Staffing Facebook Live Event Part 3 - Get the Facts About Opposing Legislation

Trauma Columnist · Mar 27, 2018

Looking forward to this episode and I want a t-shirt!!!

Columnist · Mar 27, 2018

Looking forward to this episode and I want a t-shirt!!!

Just click on the shirt and it will take you to the store. By the way, the shirt is just $15.00 with free shipping.

Editorial Team / Admin · Mar 27, 2018

I bought my T-shirt!!

LovingLife123 · Mar 27, 2018

I have a unit meeting tomorrow night, but would like to know more about this. As an ICU nurse, I'm starting to see the writing on the wall where I will see 3-4 patients soon which is not at all safe.

Being in critical care, there are days when I can barely keep up with the one, much less two. I have to make that decision on whether or not a patient is safe for the floor, can they come off of BP gtts, is this a neuro change, how do I get them off the vent. How do I prevent additional infection from occurring or pressure ulcers?

It's all about the care I give. I can't give adequate care if I'm bogged down charting on 4 vented patients. Turns and oral care won't get done. Being able to analyze meds and see what is appropriate won't happen. How do you do MTP while titrating 3 plus gtts on another, and manage to prevent infection on your other two relatively stable, but intubated patients?

It makes no sense to be against mandated ratios. Patients could leave the hospital faster, meaning lower readmits and less cost to insurance companies.

Oh that's right, insurance companies never look at the long term savings, it's instant gratification savings for them. We all see how that's working for them. My question is, does anybody that actually works for an insurance company or Congress fit that matter have a business degree??

Columnist · Mar 28, 2018

Hello LovingLife123

If you can't attend the Facebook Live session, you will be able to view the video afterward on the Nurses Rock facebook page or on the allnurses YouTube channel.

You can view the previous videos by going to the links provided above.

I will make sure that Beth and Keith see your comment.

Career Columnist / Author · Mar 28, 2018

I have a unit meeting tomorrow night, but would like to know more about this. As an ICU nurse, I'm starting to see the writing on the wall where I will see 3-4 patients soon which is not at all safe.
Being in critical care, there are days when I can barely keep up with the one, much less two. I have to make that decision on whether or not a patient is safe for the floor, can they come off of BP gtts, is this a neuro change, how do I get them off the vent. How do I prevent additional infection from occurring or pressure ulcers?
It's all about the care I give. I can't give adequate care if I'm bogged down charting on 4 vented patients. Turns and oral care won't get done. Being able to analyze meds and see what is appropriate won't happen. How do you do MTP while titrating 3 plus gtts on another, and manage to prevent infection on your other two relatively stable, but intubated patients?
It makes no sense to be against mandated ratios. Patients could leave the hospital faster, meaning lower readmits and less cost to insurance companies.
Oh that's right, insurance companies never look at the long term savings, it's instant gratification savings for them. We all see how that's working for them. My question is, does anybody that actually works for an insurance company or Congress fit that matter have a business degree??

It's short-sighted to cut back on nurses, you say it so well. As my Dad used to say "stepping over a dollar to pick up a dime".

icu/don · Mar 30, 2018

"Did you know there are currently 2 sets of bills in the House and Senate that are going before the legislators? While the bills have similar names, they are vastly different."

I am confused by this comment in the original post. When I go to the Nurse Keith and Nurse Beth Staffing Ratio Video, the links on the page take you to the House and Senate bills at Congress.gov. This bills are touted as identical bills at Congress.gov.

So what is meant by the above quote?

Columnist · Mar 30, 2018

"Did you know there are currently 2 sets of bills in the House and Senate that are going before the legislators? While the bills have similar names, they are vastly different."
I am confused by this comment in the original post. When I go to the Nurse Keith and Nurse Beth Staffing Ratio Video, the links on the page take you to the House and Senate bills at Congress.gov. This bills are touted as identical bills at Congress.gov.
So what is meant by the above quote?

This is one set of bills - 2 identical bills - one in the House and another in the Senate. This is the legislation supported by NurseTakeDC, ShowMeYour Stethoscope, etc.and calls for Federally mandated nurse-patient ratios.

There is another set of bills-identical to each other but different than the first ones mentioned. This one is supported by AHA and ANA. THis one focuses on staffing committees in each hospital to determine the ratios.

Beth and Keith explain this in the third video which will be posted on allnurses soon. You can see this video now on Nurses Rock Facebook page.

Sorry for the confusion. But you are not the only one who is confused. The legislators are confused too. That's why we are trying to get the word out so nurses can contact their legislators and let tem know which bill to vote for...

icu/don · Mar 31, 2018

After reading both bills (S 2446/HR 5052) and (S 1063/HR 2392) I wonder if there wouldn't be a way to pass both of them. They don't look mutually exclusive. In fact, for California nurses, we would be better off with the "Staffing Committee" bill. The ANA & AHA bill would maintain the states current laws and ratios and would add mandatory staffing committees to each hospital. This would at least give the bedside nurses the 55% contribution, but I agree that the bill does not mention anything about the hospital abiding by the staffing committee decision. It does not give any authority or power with the 55%. The "Staffing Committee" bill does talk about using Specialty Area ratio recommendations which I imagine should be pretty close to the ratios mentioned in the other bill but not spelled out in the bill itself.

Having lived/worked in California my whole career, I am not convinced that the "Mandatory minimum ratio" is the final solution. Bad hospitals will find a way to abuse the minimum ratios just as they will not hand over power to the "Staffing Committees". Having worked in only two hospitals within the same system, my views in this area may be a bit limited.

I began in a "New Grad Program" in a Telemetry unit in the same closed unit area as the ICU. The nurses were happy to get two new grads because ICU nurses took turns rotating through the Telemetry unit. I started pre-Ratio law in 1998. I provided primary care nursing for 4 Telemetry patients in an 8 bed telemetry unit. Once in a great while we had a CNA, but it was usually just 2 nurses and a shared monitor tech with ICU for 8 patients. The ICU had a ratio of 1:2, but the charge nurse took patients. I remember floating out to the med/surg areas and having 8 to 10 patients, but with CNA help. This hospital system had recently taken over the county contract and many of the practices reflected that. Within one year, was trained to ICU and began floating to Telemetry with the rest of the ICU nurses.

In 2001, I transferred within the hospital system to a Level 2 trauma center with a 35 bed mixed ICU. The staffing was dramatically different even without mandated staffing ratios. Our units took the same patients, were geographically close, but were split into 3 units of 12 beds, 12 beds and 11 beds. Each unit had a charge nurse who didn't take patients, and each unit had a CNA if census was greater than 25. We also had a monitor tech for each unit when it was open. We were very strict about the 1:2 ratio and as far as I know never violated the ratio.

When the 2004 ratios came to the whole hospital, the culture was already well set in the ICU, but that culture never caught on in the rest of the units. The hospital seemed to try keeping 1:4 ratios on telemetry, but this frequently got changed to 1:5 once ER and ICU got backed up with telemetry patients. Even now in 2018, telemetry almost always has at least a few nurse who go out of ratio. Reporting this to the State apparently doesn't do any good because the practice continues and the state seems to look the other way. The nurses must not be standing up and refusing to take assignments as allowed by the law because it continues to happen.

With each CEO change, our ICU unit is told that our staffing is too rich. We are now down to 1 monitor tech for 24 beds and a shared monitor tech with our step down unit for the other 11 beds. We are now only allowed 1 CNA no matter what the census is. The only addition to our staffing has been Rapid Response nurse (shared with ER) and 1 break nurse in order to try to comply with the "at all times portion" of the Ratio law. This break nurse is fair game to pull if needed for admits.

So what I am trying to say is that hospitals can slash the ancillary staff, comply with the "Mandatory Ratios" while driving workload, patient safety, and nurse satisfaction to get worse. I don't blame all of this on the hospital because they have seen their reimbursement suffer due the poor reimbursement from Medicare and Medicaid.

I tend to think mandated ratios for the whole nation would be a good start, but I don't think it is the complete answer.

Career Columnist / Author · Mar 31, 2018

This is one set of bills - 2 identical bills - one in the House and another in the Senate. This is the legislation supported by NurseTakeDC, ShowMeYour Stethoscope, etc.and calls for Federally mandated nurse-patient ratios.
There is another set of bills-identical to each other but different than the first ones mentioned. This one is supported by AHA and ANA. THis one focuses on staffing committees in each hospital to determine the ratios.
Beth and Keith explain this in the third video which will be posted on allnurses soon. You can see this video now on Nurses Rock Facebook page.
Sorry for the confusion. But you are not the only one who is confused. The legislators are confused too. That's why we are trying to get the word out so nurses can contact their legislators and let tem know which bill to vote for...

Just like tnbutterfly said- 2 sets of bills. For a bill to become law, 2 identical bills- one for the Senate (S.), one for the House of Representatives (H.R.) must be passed before they are signed by the President.

The first set is S.1063 and H.R.2392 are identical bills currently in Congress. They are titled Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act. These call for mandated minimum nurse-patient ratios.

The second set is S.2466 and H.R.5052- identical bills currently in Congress. They are titled Safe Staffing for Nurse and Patient Safety Act. These call for hospital-driven "staffing committees".

I call them David and Goliath, the first set being David, supported by grassroots nurses, and the second set being Goliath, supported by big business (hospital association and, unfortunately, the ANA).

I have a little memory trick to tell the 2 sets of bills apart. I remember the "good" set had the word "Quality" in the title.

When you call your Representative to say "My name is Beth Hawkes, I'm a nurse and a constituent. I'm calling to ask that you support S.1063 and H.R.2392" it's important to identify the "good" set of bills as it's easy to confuse the two.

Hope this helps, and please call!

Career Columnist / Author · Mar 31, 2018

After reading both bills (S 2446/HR 5052) and (S 1063/HR 2392) I wonder if there wouldn't be a way to pass both of them. They don't look mutually exclusive. In fact, for California nurses, we would be better off with the "Staffing Committee" bill. Staffing committees are law in Illinois and the committees do not have real authority. Bedside nurses on the "staffing committee" sit across the table from their boss who answers to the CFO, who already set the budget for the fiscal year.
I remember floating out to the med/surg areas and having 8 to 10 patients, but with CNA help. This was pre-ratios. It would still be the same on MedSurg were it not for the 2004 legislation. Hospitals are not voluntarily going to do the right thing.
Even now in 2018, telemetry almost always has at least a few nurse who go out of ratio. Reporting this to the State apparently doesn't do any good because the practice continues and the state seems to look the other way. Hospitals that violate nurse-patient ratios are
breaking the law and subject to penalties. Has this been reported to CDPH by yourself or someone you personally know?
So what I am trying to say is that hospitals can slash the ancillary staff, comply with the "Mandatory Ratios" while driving workload, patient safety, and nurse satisfaction to get worse. Ancillary staff is being cut nation wide. Better to have nurse-patient ratios and ancillary staff cuts, than arbitrary staffing (no ratios) and ancillary staff cuts.
I tend to think mandated ratios for the whole nation would be a good start, but I don't think it is the complete answer.

Good point. We're looking for improvement in patient safety, not perfection. Mandated minimum nurse-patient ratios are definitely an improvement over staffing stories coming out of Florida and other states. Patients deserve better.

Safe Staffing Facebook Live Event Part 3 - Get the Facts About Opposing Legislation

#NursesTakeDC Event

More Like This