Governator kicks nurses butts!!!

kathi yudin · Dec 23, 2004

i have to say for those that believe that there is NO NURSING SHORTAGE get your heads out of the sand!!!.. there IS a nursing shortage..!!!.. living in southern california there is a huge pool to draw upon.. problem???.. there are NO NURSES TO DRAW UPON!!!!...i can advertise and advertise for nurses and get NO responses..!!.. while money is always an issue.. it is not a reason not to hire... i have an administrator that would hire because.. like the acute.. the long term care facility has ratio's.. based upon nursing hrs.. they can not be met because there are NO NURSES OUT there!!!.. for years.. nurses have attempted to be considered professionals.. as long as they act unprofessionally.. they will not be considered professionals.. thank you for having already stated this steph... we all want the best care for our patients.. we would not have gone into nursing otherwise.. we certainly won't get rich from it.. but.. the job we do is important.. and heartwarming most of the time.. however.. we can not give good nursing care when there are not enough nurses available to deliver the care.. no matter what the ratio is!!.. we have to change our outlooks.. work on why nurses are not going into nursing.. get more nurses to teach so that we can educate more in the field of nursing.. and then.. work on the ratios.. i am well aware of the law that states what the ratios are and will be..i am also well aware that they can not be met as long as men and women don't enter the profession..!!!.. as for those who insist lvn's can not assess.. they have to because there are not enough rn's to do it all.. and the lvn plays a very important role in the nursing profession...as long as we are divided we will not be able to affect any changes.. we must stand together.. and work on the cause before we work on the effect.. then.. we can affect change...

Hi Stevierae - Actually, I'm in Northern California and you are in Central California At least that is how those of us who live north of Sac feel. Most of us think of the Bay Area as not part of rural Northern California. :kiss
Rural nursing in California has its own special needs and trying to comply with the 1:6 ratios has been tough but I think my management and our nurses have done a very good job. We have not fired the CNA's or ward clerks. I work with another RN and at least one CNA and usually two (when our other day CNA gets back from maternity leave).
The California Nurse's Association does not speak for me and it IS a special interest group and the Gov was right to call them that although I don't think he should talk about them as if they are not legitimately representing SOME nurses . . .and special interest is not a dirty word. I have no problem with people organizing to make changes (CNA). Just don't say you represent me. Because you don't.
I don't believe that this is an either/or situation. It isn't black/white . . good guy/bad guy. The more we portray hospitals and administrators as evil, the less work we will get done to advance our patient's well-being and safety. And hospitals/administrators need to not portray nurses in a bad light either.
I think Music and Kathi make some very good points.
I know my DON and our little rural hospital works very hard for the nurses. And they need more time to implement the ratios. There are bugs galore . . .
steph

allnurses Guide · Dec 23, 2004

LVN's . . .

We have an awesome LVN who fills in for us when someone is sick - which leaves us VERY shortstaffed. Just one person calls in sick and we are in trouble. Anyway, she is very skilled. I have no problem working with her. We all go into the room together at 4 a.m., the CNA for vitals and the LVN and me. I assess the pt. with everyone right there. I write the initial assessment. Then the LVN takes up to 6 patients and I take up to 6. We don't admit over the ratio. I trust her ability to care for the patients the rest of the day. We communicate during the day. I'm well aware of what is going on with all the patients as the CNA and the LVN keep me informed.

I think LVN's definitely have a role to play in the ratios.

steph

kathi yudin · Dec 23, 2004

the lvn's most certainly do.. they do a job.. and for the most part do it very well.. i have been in california for 6 yrs.. in ny.. i worked med surg.. icu/ccu.. telemetry.. coming to california.. i started working in long term care..(ltc)... i can advertise for rn's from today until doomsday.. i get lvn's.. they are better then most of the rn's i have had working for me.. my lvn's assess.. call the md's .. are in charge of the cna's.. do admissions and treatments.. they write care plans or plans of care.. they are an essential part of the workings in the nursing profession... and.. they fill my nursing hours.. they do serve a role and a purpose.. when the lower ratio's came out.. i needed to send a resident to a geropsych unit.. this resident was a danger to him/herself and the other 90+ residents in the facility... i had difficulty transferring because that one extra patient.. was over their ratio and they could not admit..!!... ratio's have a purpose.. but.. again.. the problem is that there are not enough nurses to fill the ratio's.. one of the problems with our profession.. and why new nurses get discouraged??.. we "older" nurses have a tendency to as the old adage goes.."eat our young!!".. we do not give the new nurses a chance... we expect them to come out running.. and they can't.. baby steps are needed...lets work at the problems from within.. make nursing a profession that others want to go into.. teach our young.. work with them.. work on the shortage.. then... the ratio's.. we can't have ratio's that can't be met.. lets be realistic.. until we get nurses into the profession.. the baby boomers are retiring.. leaving a huge void.. it is not a figment of administrations imaginations that there is a shortage.. it is a reality!!!...

LVN's . . .
We have an awesome LVN who fills in for us when someone is sick - which leaves us VERY shortstaffed. Just one person calls in sick and we are in trouble. Anyway, she is very skilled. I have no problem working with her. We all go into the room together at 4 a.m., the CNA for vitals and the LVN and me. I assess the pt. with everyone right there. I write the initial assessment. Then the LVN takes up to 6 patients and I take up to 6. We don't admit over the ratio. I trust her ability to care for the patients the rest of the day. We communicate during the day. I'm well aware of what is going on with all the patients as the CNA and the LVN keep me informed.
I think LVN's definitely have a role to play in the ratios.
steph

immigrant1956 · Dec 23, 2004

!.. i applaud governor shcwarzenagger for his wisdom.. we first need to solve the shortage dilemma.. and then work on the ratio's..

AAAAAAAAAAggggghhhh! Please don't tell me you really believe that. Long time nurse here will tell all of you her opinion of what has happened to nurses. We have not stood up to the abuses in our profession by not only administration and physicians, by regulatory agencies. But the most important factor is for us to conduct ourselves with professionalism, courtesy and pride. The public only sees what is portrayed on the news. My opinion of the CNA is guided by the propoganda, thrust at me in the parking lot of my hospital. 1960's union tactics have no place in this time. I think time and money are better spent becoming part of the solution.

However, I wish the governor had been more explicit about who was badgering him, my family from the rest of the country thinks he doesn't like nurses.

Maybe we could try the Southwest Airlines approach, and invest in what we do. We vest our souls in our jobs every minute we are there, let's own our profession, not the unions.

SmilingBluEyes · Dec 23, 2004

Make the work environment safe, attractive and well-paid, treat them like the valued part of the medical team, and quit letting doctors, managers and patients/family members run rough-shod over them, give them the equipment and tools that WORK to do the job, quit expecting nursing to cover lab, housekeeping, cardiopulmonary, dietary and others--------- and they will come. Oh,yes, they will. I would go to a place that did all that, even if the pay was not more than I make now. Do all this, Especially in urban and suburban areas.....(I know rural situations are unique, having been there), and they will come.

The trouble is, most hospitals don't want to affect their "bottom line" (or their fat bonuses for their administrators) or alienate their much-admired and needed doctors to do so. And they are left wondering "where the nurses are"..........

HELLLOOO they are right under your NOSE! You just can't see the forest for the TREES. :angryfire :rolleyes:

dazzle256 · Dec 23, 2004

i have to say for those that believe that there is NO NURSING SHORTAGE get your heads out of the sand!!!.. there IS a nursing shortage..!!!.. living in southern california there is a huge pool to draw upon.. problem???.. there are NO NURSES TO DRAW UPON!!!!...i can advertise and advertise for nurses and get NO responses..!!.. while money is always an issue.. it is not a reason not to hire... i have an administrator that would hire because.. like the acute.. the long term care facility has ratio's.. based upon nursing hrs.. they can not be met because there are NO NURSES OUT there!!!.. for years.. nurses have attempted to be considered professionals.. as long as they act unprofessionally.. they will not be considered professionals.. thank you for having already stated this steph... we all want the best care for our patients.. we would not have gone into nursing otherwise.. we certainly won't get rich from it.. but.. the job we do is important.. and heartwarming most of the time.. however.. we can not give good nursing care when there are not enough nurses available to deliver the care.. no matter what the ratio is!!.. we have to change our outlooks.. work on why nurses are not going into nursing.. get more nurses to teach so that we can educate more in the field of nursing.. and then.. work on the ratios.. i am well aware of the law that states what the ratios are and will be..i am also well aware that they can not be met as long as men and women don't enter the profession..!!!.. as for those who insist lvn's can not assess.. they have to because there are not enough rn's to do it all.. and the lvn plays a very important role in the nursing profession...as long as we are divided we will not be able to affect any changes.. we must stand together.. and work on the cause before we work on the effect.. then.. we can affect change...

There are nurses out there. Just because they don't respond to your multiple adds don't mean they aren't there. I know personally several RNs that are working in other fields. Just off the top of my head some of the nurses I know don't work as nurses is a Real Estate Agent... another works for an insurance company and yet another works as a dog groomer :). There is another nurse I know that isn't even going to renew her liecense doesn't know what she is going to do... she just knows it isn't nursing. I've made a decision myself after the first of the year to look into other avenues...I'll stay a nurse but will not work in acute care again.

I do agree that we do need to stick togeth and work on the cause. Nothing is being done to keep nurses.

stevierae · Dec 23, 2004

i have to say for those that believe that there is NO NURSING SHORTAGE get your heads out of the sand!!!.. there IS a nursing shortage..!!!.. living in southern california there is a huge pool to draw upon.. problem???.. there are NO NURSES TO DRAW UPON!!!!...i can advertise and advertise for nurses and get NO responses..!!..

BECAUSE YOU DON'T PAY ENOUGH IN SOUTHERN CA!!!!!!!

That's why you can't attract nurses, and that's why you must use travelers!!!!!!!

I have taught IV nursing at both Sharp and Scripps in San Diego. Seemed like all the RNs there were travelers. The ones who weren't were interested in doing a job like I did---teaching at different facilities.

I've worked with STAFF from Scripps and Sharp who take their time off to fly into the Bay Area and work per diem here and there--there is ALWAYS work in SF, and it pays well.

SharonH, RN · Dec 23, 2004

Make the work environment safe, attractive and well-paid, treat them like the valued part of the medical team, and quit letting doctors, managers and patients/family members run rough-shod over them, give them the equipment and tools that WORK to do the job, quit expecting nursing to cover lab, housekeeping, cardiopulmonary, dietary and others--------- and they will come. Oh,yes, they will. I would go to a place that did all that, even if the pay was not more than I make now. Do all this, Especially in urban and suburban areas.....(I know rural situations are unique, having been there), and they will come.
The trouble is, most hospitals don't want to affect their "bottom line" (or their fat bonuses for their administrators) or alienate their much-admired and needed doctors to do so. And they are left wondering "where the nurses are"..........
HELLLOOO they are right under your NOSE! You just can't see the forest for the TREES. :angryfire

Thank you!

Enough SAID

stevierae · Dec 23, 2004

the lvn's most certainly do.. they do a job.. and for the most part do it very well.. i have been in california for 6 yrs.. in ny.. i worked med surg.. icu/ccu.. telemetry.. coming to california.. i started working in long term care..(ltc)... i can advertise for rn's from today until doomsday.. i get lvn's.. they are better then most of the rn's i have had working for me.. my lvn's assess.. call the md's .. are in charge of the cna's.. do admissions and treatments.. they write care plans or plans of care.. they are an essential part of the workings in the nursing profession... and.. they fill my nursing hours.. they do serve a role and a purpose.. when the lower ratio's came out.. i needed to send a resident to a geropsych unit.. this resident was a danger to him/herself and the other 90+ residents in the facility... i had difficulty transferring because that one extra patient.. was over their ratio and they could not admit..!!... ratio's have a purpose.. but.. again.. the problem is that there are not enough nurses to fill the ratio's.. one of the problems with our profession.. and why new nurses get discouraged??.. we "older" nurses have a tendency to as the old adage goes.."eat our young!!".. we do not give the new nurses a chance... we expect them to come out running.. and they can't.. baby steps are needed...lets work at the problems from within.. make nursing a profession that others want to go into.. teach our young.. work with them.. work on the shortage.. then... the ratio's.. we can't have ratio's that can't be met.. lets be realistic.. until we get nurses into the profession.. the baby boomers are retiring.. leaving a huge void.. it is not a figment of administrations imaginations that there is a shortage.. it is a reality!!!...

I am not saying LVNs do not have a role in patient care---I am saying that they are NOT to be included as part of the staffing ratios!!!! AB 394 addresses RN to patient ratios clear and simple, and those are MINIMUM ratios--they can actually be INCREASED based on patient acuity.

I just did chart audits at a facility in the CA desert, about 2 hours from Phoenix, that is ignoring AB 394 and citing Title 22--that is, using the terminology "licensed nurses" as their rationale for utilizing LVNs as part of the safe staffing ratio. They had no aides. There was 1 RN in ICU for 4 patients,--1 on a vent with liver failure and ARDS, trying to die; one morbidly obese patient, actively seizing and hemorrhaging; needing to be LifeFlighted to a hospital that could handle her--this ICU did not even have the capability of doing art lines or CVP lines-- and that poor RN was spread horrendously thin---it was a horrible, horrible situation. I am surprised they have not yet been shut down by the state--they are in trouble with JCAHO, hence, the chart audits. But, they won't become compliant until they follow the law, which they are reluctant to do.

LVNs are supposed to GATHER data--any "assessments" they make or care plans they write need to be overseen by an RN--meaning they cannot function independently, making MORE work for the RN----instead of having 2 patients in ICU, she now has 4!!! I would suggest, kathi, that you call both the BRN and the LVN Board in Sacramento to clarify how you are using LVNs, or simply go on the site and get the nurse practice acts explaining the scope of practice for EACH. In the case of a disagreement as to which prevails--Title 22 or AB 394--AB 394 does. In the case of any other disagreement, the CA RN nurse practice act prevails. The CA BRN will validate this. I am not even certain that LVNs are allowed to write care plans--their roles are very well defined by their own nurse practice act--whereas RNs have a wide scope of practice--the only caveat we have is not to do anything that could be construed as practicing medicine.

Gray Davis originally signed AB 394 as a bill in, I believe, 1996 or '97---maybe even before. Facilities have had a LONG time to become compliant before the January 1, 2004 deadline, after which they could be fined.

Don't have enough RNs on a given day to fulfill safe staffing? Then you call registry--that's what they are there for---and they are in abundance all over CA. I know in the SF Bay area hospitals often utilize not one, not two, but up to 25 different registries from which they can pull staff--and some registry staff work for some hospitals for a year or more at a time--they just show up every day, as if they were staff.

If there are sick calls the night before (that is, RNs call in to the 3-11 staff to say that they can't work their 7-3 shift tomorrow, due to illness) then the p.m. supervisor should be on the phone to registry or the house supervisor, replacing that RN or those RNs with registry RNs. I got my nursing license in CA in '81, and worked there full-time until '90--still work exclusively there, when I want to work in the hospital, since the working conditions and salary have always been great, wherever I have worked--THANKS TO CNA.

I will not work in a hospital in OR, where I live. Too much money spent on bonuses for middle management and upper management who attend meetings all day and suggest that problems be addressed by forming a staff "task force;" (taking the responsibility off them) too little on safe working conditions and even having enough equipment to do our jobs properly and deliver optimal patient care.

stevierae · Dec 24, 2004

That's a great idea. All the so called "professional nurses" should call in ill for 1 or 2 days. We can let a few patients die and then everybody will finally see how professional and needed we really are. I just hope a member of your family is not a patient when we do this.

Actually, Sutter RNs went on strike just recently because of hospitals that were ignoring the safe staffing ratios. Of course, there are those RNs who came in--I hate to use the word scabs, but that's what they are--and worked in their places. THEY don't care about all the progress we've worked hard to achieve over the years--they care about the $45 an hour (which is not much in Northern CA, but to these RNs, many of whom come from rural areas in the South, it's a lot) plus overtime they were offered by strike companies who exist just to make themsleves rich (they probably got at least $75 an hour for each nurse they sent) and exploit RNs who don't know any better, and don't even know the reasons the staff RNs are striking.

TennRN2004 · Dec 24, 2004

[QUOTE=begalli]"Do what you can?" "Stabilize the patients?"

Is that the way you want your nursing practice to be?

Is that the way you want your loved one or yourself treated?

The Union may be considered a PAC, but not a special interest group.

Maybe 1:6 is okay, but 1:5 is better.

All I can say is when my dad was taking his last breaths and there was no nurse available to be in the room with my mom and brothers to explain what was happening and lend support because she had 8 other busy patients is just crazy and not what I believe the profession of nursing respresents. It was my mom who hit the call button to let the nurse know that her patient just stopped breathing. Inexcusable. This was not in California.

The cost of healthcare is ridiculous. That's why this country needs an overhaul because billions and billions of dollars are thrown into healthcare, but it's so terribly mismanaged that we have what we have. This affects nursing directly. Who cares about hospital profits?!?! How about taking care of people?!?!

It would be much safer for new admits when a nurse is starting out with an assignment of 5 patients than it is when they start out with 8-9.

And yet again, if you don't like it...leave. Is there no other answer for you. Must we accept everything as it is because that's the way it is? Most do not follow blindly.

Totally agree with you here on this issue. No one can understand the stress, the safety risk, and the potential for harm our patients are placed in when staffing ratios are too high. No one can understand these things but nurses- so it is up to us as nurses to make our voices heard and speak up for ourselves- and those we advocate and represent- our patients. As far as staffing affecting healthcare dollars--- who is jumping on the insurance companies? the pharmacutical reps? the MDs? for all of their outrageous contributions to the skyrocketing cost of medical care. How sad that one of our own would see the issue of SAFE RATIOS in a framework of money vs. patient care. Bottom line, the healthcare field cannot function without nurses. Nursing is at an all time shortage, nursing salaries are not in line with this ever increasing demand, nurses satisfaction of their job continues to plummet, and political figures and leaders continue to allow these and so many other issues in the nursing profession. When we as nurses collectively realize our value, stand up for ourselves as a group, maybe then things will get done for nursing. I wonder if Arnold or Maria had to go to a hospital, how would they feel to know the nurse assigned to them had 7 or 8 other patients and barely had time to keep tabs on all of the patients? It infuriates me to think we elect leaders like this who have such attitudes towards nurses. I for one am proud of my California nurses- where they go let us all take their example and follow to improve our profession.

SmilingBluEyes · Dec 24, 2004

Arnold and Maria will NEVER have to compete with 8 or 9 other patients in the hospital for decent nursing care, not will their relatives, and they know it.......... so that is really a non-issue. That is partly why, I am sure, Arnold feels so confident reversing the progress toward safer ratios is a-ok. It pleases his special interests and fellow rich citizens for whom adequate nursing care need not be an issue-----as long as such care can be bought privately by them, or received in hospitals that have units that cater to rich citizens exclusively, why should they care??? As for the rest of us, too darn bad.