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?
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
See, to me this sounds outrageous. I guess I'm oblivious to the ratios that occur outside of my realm. I couldn't imagine having 5-6 pt's. At my hospital, our med-surg areas are 1:3-4, stepdowns 1:2-3, and ICU's are 1:1, and we have techs available at all times.
How can one truly provide safe and in-depth care if they have this many patients?
RNsRWe wrote: "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!"
The difference between California and the rest of the country on nursing issues boils down to one thing: an aggressive and visionary union - the California Nurses Assn. - with a small number of leaders willing to devote their lives to the cause and enough smarts to realize that unions win and prosper when we align our agenda with the public good. Enough nurses on staff, well paid and well educated and with safe working conditions is good for nurses and it's good for patients. Nurse organizations or unions that align themselves with the interest of the boss - hospital management - over the interest of the public and the patient are on the wrong track.
See, to me this sounds outrageous. I guess I'm oblivious to the ratios that occur outside of my realm. I couldn't imagine having 5-6 pt's. At my hospital, our med-surg areas are 1:3-4, stepdowns 1:2-3, and ICU's are 1:1, and we have techs available at all times.
How can one truly provide safe and in-depth care if they have this many patients?
It's interesting hearing some of the comments on the ratios people find in their own hospitals - notably this one in Arkansas and another up-thread in Texas. Here in California, we get a lot of travelers coming from non-union states and most of them that we see tell horror stories of scary staffing ratios in their states. But it is obviously more variable than I would have guessed, with some individual hospitals out there having even better ratios than California law requires. All my experience though tells me those hospitals are extreme outliers and the national norm is a good deal worse - else why would the industry fight so hard against ratio laws?
Specializes in med/surg, telemetry, IV therapy, mgmt.
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.
one of those facilities that had to close was down the road from me! it has since gone totally belly-up. the link to the news article that quoted that figure is no longer active. of course, the nursing organizations were primarily behind the law and the ama and cha were against it.
however, here are other links with information about the law:
it's reasonable that if you have to allocate more money to one area of the budget then other areas of the budget have to get shortchanged. that's why a facility has to hire good accountants and financial planners. that's why every penny spent can't be wasted. that's why the position of utilization review became so crucial. that also is why many insurance companies employ case managers--they are doing what drgs have done for medicare for years.
i think that the california nurse staff ratio law is setting off a domino effect. some states will pass laws of their own. others states and facilities in fear of this happening will re-vamp their internal accounting and nursing structure to adjust their own staffing ratios. ultimately, however, i think that universal healthcare for everyone in the u.s. is on the horizon--details to be worked out over the coming years. nurse staff ratios are just one problem of a health care system in need of change. people want it; many people have been deprived of basic health care and need it; and many are beginning to see health care as a basic right. it's just a matter of time. with it's coming will come a slew of financial problems as well. i think legislators who are discussing the viability of this now are already aware of the problems that it will bring.
See, to me this sounds outrageous. I guess I'm oblivious to the ratios that occur outside of my realm. I couldn't imagine having 5-6 pt's. At my hospital, our med-surg areas are 1:3-4, stepdowns 1:2-3, and ICU's are 1:1, and we have techs available at all times.
How can one truly provide safe and in-depth care if they have this many patients?
Short answer? You can't. You do your best to keep everyone safe and at least minimally cared-for until the next shift arrives.
I realize that on nights, we are expected to shoulder a higher patient load than our daytime counterparts. But when they have four or five patients on days, and we get 8, 9, 10 patients on nights, it seems absurd. Administration's answer? "Keep them safe, just keep your license". Yeah, that's the ticket.
Daytonite and ChicoDavid: thank you both for your information and insights. I really had no idea how it was that all that came to pass in CA; seems that it doesn't look hopeful for us in NY
Specializes in med/surg, telemetry, IV therapy, mgmt.
Daytonite and ChicoDavid: thank you both for your information and insights. I really had no idea how it was that all that came to pass in CA; seems that it doesn't look hopeful for us in NY
If only I wasn't an East Coast Girl!
You can always move out here! I got here from Ohio. My mother had said for years that she was going to move out to California. One day she called me at work and said, "Don't get upset, but I put the house on the market today and it sold in 2 hours. We're moving to California." And not just California, but the middle of the Mojave desert! I went to nursing school out here and I've worked in hospitals in other states. California is serious about its healthcare. I've worked with many wonderful doctors here. You can't beat the weather.
Short answer? You can't. You do your best to keep everyone safe and at least minimally cared-for until the next shift arrives.
I realize that on nights, we are expected to shoulder a higher patient load than our daytime counterparts. But when they have four or five patients on days, and we get 8, 9, 10 patients on nights, it seems absurd. Administration's answer? "Keep them safe, just keep your license". Yeah, that's the ticket.
By me, this represents outdated admin thinking dating from a very different era. When I started med surg nursing, 28 years ago, there were a lot of patients on my floor - maybe even the majority - who would never make it into a hospital today. The idea of admitting them would be laughed at. diagnoses like exhaustion or "conservative back care". Patients on the 7th, 8th, 9th day after uncomplicated abdominal surgeries. A lot of them would sleep through the night. Lots of them, I had little more to do than tip-toe in now and then to make sure they were still breathing. Of course I had 20 patients, so I was still busy enough.
Nowadays, virtually every hospitalized patient is seriously ill and many of them need care activities going on at all hours. The idea that nights can get by with a lot less staff than days is not the reality of today's world. But a lot of managers who haven't been at the bedside in a long time still think it makes sense.
I'm very biased towards CA, esp. northern CA ... if I had to work as a staff nurse again I would move right back to the SFBA. I worked there through the implementing of the staffing ratios. What others said is true that RNs returned to work when it was perceived that now ratios are better and safer, plus salaries kept increasing.
I returned to work as a travel nurse, from the central coast back up to Nor Cal, and the central coast/central valley struck me as very conservative areas compared to SFBA. BUT I think there is a "trickle down" effect of the ratio law: I observed conservative nurses (i.e., call the doctor "Doctor," play the gender roles of female nurse/male doctor, socially conservative) who formed unions and were actively beginning to stand up to management regarding pay, staffing issues, and breaks. This was a sight to behold.
That said, there are hospitals (like the ones I'm thinking of in the previous paragraph) that did not follow staffing laws very well (2 RNs on nights for a packed L&D unit, for example). While these RNs were starting to stand up for themselves, they still weren't filling out ADO forms and otherwise raising hell with poor staffing, but instead grumbled about how "those travel nurses are sucking up all our money!" Then, many hospitals, even in the SFBA, do things to cut down on staff expenses like not having enough unit secretaries, eliminating all the CNAs and LPNs, things like that. They also tried to have LPNs relieve RNs for breaks and lunch. I think there are few legal repercussions for hospitals that do not follow the staffing ratios, and this is bad, because if there is no teeth, then hospitals will keep pushing back against it all they can.
Although there are a few progressive hospitals out there, such as the one in Houston mentioned, that do staff very well, they are outliers. I hope every state nursing association will introduce minimum staffing laws into their legislatures. Nursing unions are taking off in previous so called "right to work states" which historically have ridden union organizers out on a rail and tarred and feathered them. (Of course I keep hoping for a populist revolt against the corporate masters that own our government and politicians, but I am not holding my breath for THAT to happen.)
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?
My facility staffs 4:1 on evenings, 3-4:1 on days. I'm not in California.
My facility staffs 4:1 on evenings, 3-4:1 on days. I'm not in California.
Well, our grid (or matrix) says we're supposed to have 4-5 on evenings, 6-7 on nights. Reality is that we usually have 5-6 on evenings, and 8-9 on nights (10 being the exception, 7 being the occasion--before admissions).
So it's not that we're not SUPPOSED to have fewer patients, it's just that when the staffing office can't scrounge up enough help when it's needed, we just do without the nursing staff we need.
What I'd like to see is not the "suggested matrix" that the hospitals can toss out when it suits them, but a mandatory maximum that is LAW!
Marie.C
15 Posts
In Manitoba (Canada) we talk a lot about the nice working conditions in the states. Looks like it is not that nice!
Over there, the ratio is 5:1 for med/surg, 1-2:1 for L&D and ICU.
We don't realize how lucky we are I guess!