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

[RNsRWe]

...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?

[2bNurseNickStat]

Why does California always seem to be lightyears ahead of everyone else in just about everything? I've definitely wondered this myself RNsRWe. I work on a busy Tele floor and our Nurse Manager will call every shift to see what Winpf (not sure if anyone else uses this but it is a computer program that indicates how many staff members should be on the floor. Which I still find interesting that we rely on a computer to tell us how to staff the unit) says and intentionally make us work one staff member under what Winpf says so she can be under budget and look good to the higher ups. Nurses may have 7-8 tele patients and aides and techs may have 17. It gets really crazy sometimes.

It is really nice to see that there is a state where we can go to work and have an expectation of what we are walking into and that we are starting off with our patients safety in mind. And a state that when we walk out of work, we can hit the marijuana vending machine on the way out, go to the beach, and marry whoever you want.

Are we sure this place is in the United States? It almost sounds mythical.

And just for clarification, I wouldn't want to hit the marijuana vending machines but just read an article that they now have them there. I wonder if those machines ever take your money and how people react when it does?!

[classicdame, MSN, EdD]

see the recent Nursing2008 periodical. Although staffing ratios are smaller, so is ancillary staff. Nurses are still complaining of being overworked.

[emmycRN]

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.

A 1:4 ratio in med-surg would be glorious. At this point, I would never consider working med-surg in my area because the nurses usually take care of 6-8 patients at least. I even left ICU where the ratio was 1:2 because I didn't want to have to float to other areas where I knew I could not possibly do a good job. There were other reasons, but the floating issue was a biggie. I don't understand why hospitals refuse to acknowledge the sound research that supports low ratios. They act like there is no problem at all with nurses caring for so many patients. It's disheartening that this huge problem never gets addressed in most facilities. They'll pick apart every other little part of "the patient care process" but overlook the most important thing. If you don't have enough nurses the patients aren't going to get good care! DUH!

[Chico David, 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.

parts of this are accurate, but there are two very important points to be made: the law came about because of a lot of work by one organization - the california nurses assn wrote the law, persuaded a legislator to sponsor it, drove it through the process, saw a republican governor veto it, did it all over again and finally saw it become law when a new democratic governor signed it. then got it through the rulemaking process (2 more years of work) and finally had to defend it when a new republican governor tried to roll back part of the law. various organizations may have provided a bit of support, but one above all made the law happen.

second point: the statement that 45 hospitals closed when the law came in is not remotely close to true. i think it was 5 in the first year the law was in effect, which was pretty much the same rate of closure that had been occorring for the preceding ten years.

finally: there have been a lot of financial pressures on hospitals for a long time, largely due to inadequate reimbursement and uninsured patients. staffing ratios are one part, but a relatively small part of that picture.

[wooh, BSN, RN]

We don't have a nursing shortage. We have a shortage of nurses willing to work in unreasonable conditions. Make the conditions reasonable, the nurses will come back to the bedside.

[RNsRWe, ASN, RN]

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.

Well, then it sure isn't the financial problem they (administration) sure make it out to be. Here, they cry that they can't pay more for more nurses (even if they were available). I think that's BS, seeing as how they pay agency and traveling nurses premium pay scales!

[RNsRWe, ASN, RN]

see the recent Nursing2008 periodical. Although staffing ratios are smaller, so is ancillary staff. Nurses are still complaining of being overworked.

Seriously? If I had only four or a max of five patients on my med-surg unit, I'd have everyone watered, fed, bathed, medicated, plumped, fluffed, and standing at attention! Why do I say this? Because I'm responsible for two or two and a half times that just about every shift, frequently with one aide for the entire floor, so I'm quite used to being everything to everyone. Overworked with four patients? So what if there's fewer aides, or NONE....I'd trade ALL our techs for a staffing ratio of four patients to one nurse! Not that I don't appreciate a good aide, but since I'M responsible for those patients, not them, I'd take half my assigned load by myself any day of the week.

[RNsRWe, ASN, RN]

Why does California always seem to be lightyears ahead of everyone else in just about everything? I've definitely wondered this myself RNsRWe. I work on a busy Tele floor and our Nurse Manager will call every shift to see what Winpf (not sure if anyone else uses this but it is a computer program that indicates how many staff members should be on the floor. Which I still find interesting that we rely on a computer to tell us how to staff the unit) says and intentionally make us work one staff member under what Winpf says so she can be under budget and look good to the higher ups. Nurses may have 7-8 tele patients and aides and techs may have 17. It gets really crazy sometimes.

Yeah, our supervisors call every unit every shift to see what our numbers are, so they know what the staffing is supposed to be on the next shift. And there's always one or two of them who purposely staff one nurse and/or one aide below the grid, just to make THEM look good ("see, DON, I'm a fab supervisor: no one died last night, AND I saved us $500 in salary!!"). Sick and sad.

About the "mythical place" comment: I said something to my husband about the "country of California", some kind of Freudian slip, LOL, and my husband had to agree that when it came to nursing issues, they sure looked like they were operating on a different plane than the rest of us!

[RNsRWe, ASN, RN]

A 1:4 ratio in med-surg would be glorious. At this point, I would never consider working med-surg in my area because the nurses usually take care of 6-8 patients at least. I even left ICU where the ratio was 1:2 because I didn't want to have to float to other areas where I knew I could not possibly do a good job. There were other reasons, but the floating issue was a biggie. I don't understand why hospitals refuse to acknowledge the sound research that supports low ratios. They act like there is no problem at all with nurses caring for so many patients. It's disheartening that this huge problem never gets addressed in most facilities. They'll pick apart every other little part of "the patient care process" but overlook the most important thing. If you don't have enough nurses the patients aren't going to get good care! DUH!

It's not that they are missing it....it just falls farther down on the priority list than it does for the nurses. Somewhere below "number of cable channels" and "can we get Starbucks in the lobby?", I think.

And really, it IS no problem with our staffing ratios from their perspective: if no one died last night, well then, see: no problem!

[BradleyRN]

They act like there is no problem at all with nurses caring for so many patients.

I always find it so amazing how these desk jockeys are nurses too, and yet such good actors to pretend they dont understand why we want safer ratios. It's amazing how people are willing to sell off their values and ideals for a price. Get these so called "nurses" an Oscar i say!

:):):)

[student456]

Come to Canada! Where I live, all the hospitals seem to have 1:4 days and 1:6 nights( sometimes 1:5 on days) for medsurg...we have no aides, cna's or lpn's to help us though. It might be higher ratios in other cities in Canada but I live in a huge city and thats the numbers I have been seeing...

RN's here do total patient care by themselves. Still sounds better than what US nurses have to handle

[RNsRWe, ASN, RN]

Come to Canada! Where I live, all the hospitals seem to have 1:4 days and 1:6 nights( sometimes 1:5 on days) for medsurg...we have no aides, cna's or lpn's to help us though. It might be higher ratios in other cities in Canada but I live in a huge city and thats the numbers I have been seeing...

RN's here do total patient care by themselves. Still sounds better than what US nurses have to handle

That's what I'm talking about! Truthfully, if I had six patients every night, I do think I'd want an aide available, even if it was one aide shared by the floor. Then again, it's not like that's an option for us. :icon_roll