How does California manage to staff with a 5:1 ratio?

[RNsRWe, ASN, RN]

...when no one else seem to be able to?

I know if you pay nurses enough, you'll have enough staff, that's pretty clear. Enough nurses=better working conditions, so it snowballs into a good environment.

So, how is it that CA can do this and NY can't? We keep hearing the pitiful cries of administration that there just aren't enough RNs, so we're always shortstaffed, and of course the conditions plummet from there.

Is it a chicken-or-the-egg scenario, where more RNs miraculously and immediately showed up once the mandated maximum went into effect, all dying to work in CA? Were there already enough RNs, allowing the maximum law to go into effect without hospitals being in fear of breaking it (by not having the staff)?

I know nurses there aren't being paid dirt-poor wages to enable the safe ratios, so how the heck is it working THERE and not HERE?

Anyone?

[TheCommuter, BSN, RN]

Although I don't know the exact science of it, I'll take a conjecture.

Since the nurse/patient ratio law was enacted a few years ago, several hundred thousand RNs have relocated into California to take advantage of this legally mandated staffing. I suppose many of these nurses became excited at the thought of no longer having to care for 6 to 10 patients on a med/surg floor in their previous states of residence, and decided to move out west.

In addition, the less desirable parts of California have no problem attracting travel nurses from lower-paying states. The poorer, more isolated regions in California stay staffed with travelers and agency.

[RNsRWe, ASN, RN]

Sounds reasonable. But I also wonder, for what period of time was the law in effect before it was obeyed...meaning, if they used the "if you build it they will come" philosophy then there was a period of time where the mandate was in effect but the nurses had not yet arrived by the truckful.

I'd be willing to bet we'd have success, too, but I also wonder how long we'd have such a ratio being touted while still having an average of 8-9 patients on nights. Just seems that everywhere in the State is so short, it'd take many months, a year, more(?) to actually achieve that staffing even IF it was mandated. Hey, we have a matrix in effect for staffing our floors each shift NOW, and we still don't manage to stay within them much of the time. So while the "law" of our hospital may be a 7 patients per nurse ratio on nights, if they don't have enough staff in, it's going to be 9-10 apiece. Oh well. The "law" means crap then, doesn't it? Maybe I'm wrong. I don't know, I'm just frustrated and trying to single-handedly solve my State's understaffing issues TONIGHT, lol!

I don't think we have poorer paid areas too close by (tri State area) from which to pull, not remarkably anyway.

I don't want to move to CA. I also don't want to keep doing these ridiculous ratios.

[TheCommuter, BSN, RN]

Just seems that everywhere in the State is so short, it'd take many months, a year, more(?) to actually achieve that staffing even IF it was mandated.

Remember that there are 500,000 actively licensed nurses who left nursing due to the poor working conditions. Since a state-mandated nurse/patient ration would serve to improve the quality of working conditions by decreasing the patient loads, I'm assured that a sizable number of these actively licensed nurses would swiftly return to the bedside in a state where rations were the law.

[Annisme]

Since I have only been working in the hospital for a little over a year, and I am still a student, I can only venture to guess what the difference might be. I have been reading posts about how hard it is for new grads to find jobs on the East Coast and that seems to be true for some areas of California but it may be that there are hospitals in some areas are expanding their new grad programs and hiring them...just a thought.

[RNsRWe, ASN, RN]

Remember that there are 500,000 actively licensed nurses who left nursing due to the poor working conditions. Since a state-mandated nurse/patient ration would serve to improve the quality of working conditions by decreasing the patient loads, I'm assured that a sizable number of these actively licensed nurses would swiftly return to the bedside in a state where rations were the law.

Good point. And just think of the revenue generated by refresher courses!

[RNsRWe, ASN, RN]

Since I have only been working in the hospital for a little over a year, and I am still a student, I can only venture to guess what the difference might be. I have been reading posts about how hard it is for new grads to find jobs on the East Coast and that seems to be true for some areas of California but it may be that there are hospitals in some areas are expanding their new grad programs and hiring them...just a thought.

Reasonable guess, but doesn't seem to be the case. How difficult it is for a new grad to find employment in NYS is really dependent on the exact area: most of the State is wide open. Oh, there may be cities that have less of a shortage and therefore can go with "BSN preferred", but still, those facilities are also running higher ratios than they should be if you talk with people who believe patient care suffers under the current ratio system.

Thing is, if there WERE a surplus of new grads, we also wouldn't have a dearth (sp?) of bedside nurses on a constant basis. And SO many facilities run short of staff, short of RNs, so it can't be that they've just decided to pay more attention to GNs....if that were the case, those new grads would be filling up vacancies all OVER the place. And they're not: we always have more spots to fill than qualified applicants to fill them. And my facility is not unlike many (most?) others: we can't fill up on new grads alone, we MUST have experienced nurses predominantly. We can't expand the new grad programs beyond the abilities of the current staff to train them.

[hypocaffeinemia, BSN, RN]

I don't know how our hospital does it, but we have 4:1 med/surg, 4:1 ER, 3:1 IMU, 1-2:1 active L&D, and 1-2:1 ICU (1:1 for IABPs). Suburban Houston. No legislated ratios in Texas yet.

[RNsRWe, ASN, RN]

I don't know how our hospital does it, but we have 4:1 med/surg, 4:1 ER, 3:1 IMU, 1-2:1 active L&D, and 1-2:1 ICU (1:1 for IABPs). Suburban Houston. No legislated ratios in Texas yet.

Looks like your facility not only has the available nurses in the area, but hires them! I wish I worked with you!

Is the pay scale appropriate? What I mean is, I can imagine having great ratios but also not having good-paying positions because of it. I think of school nurses: everyone would love those hours and vacation schedule, snow days, etc, but because of that they are paid the lowest on the nursing scale (at least, in my knowledge base of my area). So I wonder how your corner of TX pays, when they have that many nurses for that number of patients?

Still not sure how CA manages that: they aren't paying them poorly, and still keep the ratios down.

[hypocaffeinemia, BSN, RN]

Looks like your facility not only has the available nurses in the area, but hires them! I wish I worked with you!

Is the pay scale appropriate? What I mean is, I can imagine having great ratios but also not having good-paying positions because of it. I think of school nurses: everyone would love those hours and vacation schedule, snow days, etc, but because of that they are paid the lowest on the nursing scale (at least, in my knowledge base of my area). So I wonder how your corner of TX pays, when they have that many nurses for that number of patients?

Still not sure how CA manages that: they aren't paying them poorly, and still keep the ratios down.

My area has the highest pay to cost of living ratio in the entire country, and the pay is quite competitive seeing as we're part of the Texas Medical Center (largest collection of hospitals on Earth)-- just a suburban branch.

[Daytonite, BSN, RN]

the california nurse staff ratio law came about with a lot of work by a lot of organizations. the first thing that happened when the law passed was that 45 hospitals shut their doors because, in part, they were not going to be able to comply with the law. poor accounting and finance on their part was the cause in many cases. also, this staffing law only applies to rns in the acute hospitals and not lvns (the official designation for practical nurses here in california). so part of what has happened is to spread patient services out into other venues such as home health where ancillary staff and self-help can be utilized. initiatives to increase rn training programs was begun at the same time. some organizations gave grants to nursing schools so more nursing instructors could be hired and thus more students could be taken into their nursing programs and trained. the state made nursing scholarships and loans more available. the state college and university system has streamlined the nursing programs and worked out some of the redundancies in them in order to encourage bsn education. many don't think that is working so well. within the hospitals themselves, utilization review has become more important than ever and economics are watched very closely. hospitals that are successfully staying in business are teaching their admitting doctors to follow standards of care guidelines in treating their patients, especially when they are medicare or medicaid patients. every penny counts. as a consequence more problems are being treated on an outpatient basis. home health care is being incorporated a lot more than hospitalization and ltc. there still seems to be a nursing shortage here in la. i'm not so sure it exists in other areas except in critical care areas of nursing. i used to live in the boondocks and one could never get jobs in these hospitals because the people who did work in them had been there since methuselah and just never quit.

[soulofme]

strong union, considering col, ca doesnt pay all that well, 'specially hd in n. ca