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?
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!
You got that right! In an honest world, where hospital managers were doing their jobs honestly, an acuity staffing system alone would be the right way to go. But management always games such a system to result in fewer nurses, which is why we were forced to go to the straight numerical system in California. But of course the ANA is working with the hospital assns. to push acuity staffing laws as a way of trying to derail real safe staffing laws.
Specializes in med/surg, telemetry, IV therapy, mgmt.
RNsRWe. . .if any organization in your state is going to do it, it will start with your state nurses association. Have you contacted them about this? Since the law passed in California some of their state memberships have been working for this in other states. It helps to know who your state congressmen are who support healthcare initiatives and are especially supportive of nurses.
My hospital in NorCal had pretty good ratios even before the law went into effect.
Hospitals had several years warning that the ratios were coming. I think hospital administrators thought that the Governator was going to overturn the law that I think was voted in during Gray Davis's term. Well it didn't happen.
My hospital almost always meet ratios for assignments. On occasion we don't stay in ratios for breaks. Now of course we are frequently scrambling for staff to meet ratios. Lots of opportunities to work extra, doubles etc.
I find that there are a lot of nurses who just accept poor staffing even in union facilities even in my own hospital. I work with nurses who fill out ADO, turn in the Missed break forms, and charge overtime when they have to work over. A lot of other nurses donate this extra time. What does that say to administration that "we are doing ok" I feel bad for my manager because her budget doesn't always balance like the budgets of managers on other floors. But this is because my managers nurses follow the rules and put in for the work they do beyond their 8 hr shift. I have told my manager that nurses that stand up for themselves are more likely to stand up for their patients.
Someone once told me always be on the clock for any work you do. If 15 minutes after the shift ends you insert an IV in someone and they get a complication from it, lets hope you have documentation that you were on the clock, working as an employee of the hospital and therefore the hospital's insurance has to back you up.(this isn't to say you shouldn't have your own insurance).
I volunteer at my kid's school not at work. Well on occasion I have volunteered at work for special community outreach events, but then I know in advance I am volunteering.
I switched managers recently. My old manager is LOVED by administration, but her staff burns out and turns over quickly. She makes excuses for everything and could care less if there's enough staff. As long as our ratios are met at the beginning of the shift (before admissions "we didn't know would come" never mind that ER is packed to the gills), well, they tried. My new manager, not saying staffing is always perfect, but she does try, and she'll pay extra to get it. And if you say there's a problem, she may not be able to fix it but she'll at least recognize that it's a problem. The first manager stays under budget, but which manager do you think has all the super experienced nurses that have worked for the facility for 20+ years?
The fact is, anything CAN be done if it HAS to be done. But when allowed to make excuses, excuses will be made.
RNsRWe. . .if any organization in your state is going to do it, it will start with your state nurses association. Have you contacted them about this? Since the law passed in California some of their state memberships have been working for this in other states. It helps to know who your state congressmen are who support healthcare initiatives and are especially supportive of nurses.
Well, I think first we'd have to be allowed to HAVE union representation. I can't go into details, but mine is one of a number of hospitals in the region that is working hard at keeping NYSNA out. The usual story of classifying about a hundred nurses as supervisors, because they either do charge from time to time (or all the time) or even any RN that 'supervises' an LPN. So at any rate, I don't think we'll get much help there! I'm not feeling much like shaking the apple tree right now...just too worn out from the day-to-day fights of nursing employment. Sigh.
We do not have any CNAs or LVNs, RNs do it all, at least in my area of CA and we start out at one hospital at 18/hr and another at low 20's/hr right after graduation (not good pay though I hear it is better in bigger areas)..(Im in northern northern cal..way up at the top)
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?!
No there are not any Marjuana vending machines here (had to laugh at that), although I am sure a lot wish there was. It is legal but only for medical reasons and they are having problems with that because the federal government is steping in.
We do not have any CNAs or LVNs, RNs do it all, at least in my area of CA and we start out at one hospital at 18/hr and another at low 20's/hr right after graduation (not good pay though I hear it is better in bigger areas)..(Im in northern northern cal..way up at the top)
By California standards that's astonishingly low. I'm guessing you are in one of the very small mountain towns far from population centers. I'm in northern Sacramento Valley, pretty much away from the big centers and we do a lot better than that - new grads start at $33 - and Redding and Mt Shasta are about as good, but all are unionized facilities. And we do have aides, though we would always like to have more.
By California standards that's astonishingly low. I'm guessing you are in one of the very small mountain towns far from population centers. I'm in northern Sacramento Valley, pretty much away from the big centers and we do a lot better than that - new grads start at $33 - and Redding and Mt Shasta are about as good, but all are unionized facilities. And we do have aides, though we would always like to have more.
Yes, i am in Humboldt County, which is Semi-Rural and from what I am told we are the second poorest county in all of California; second to Del-Nort county just over the mountain. (yet our house prices are almost comparable to the sacramento area...its really sad although they keep saying the price of houses are going down, it just takes longer for anyone to get a message around here, a half decent home is still at least 250,000...at least.
Yes, i am in Humboldt County, which is Semi-Rural and from what I am told we are the second poorest county in all of California; second to Del-Nort county just over the mountain. (yet our house prices are almost comparable to the sacramento area...its really sad although they keep saying the price of houses are going down, it just takes longer for anyone to get a message around here, a half decent home is still at least 250,000...at least.
Ah - behind the Redwood Curtain! Your area is sadly pretty depressed economically - the consquence of a resource extraction economy - but I'm still surprised at wages being that low. St Joseph's in Eureka is a unionized hospital and should be rather better than that, I would hope?
They can afford more RN's because they got rid of the CNA's. The RN's may have a 5:1 ratio but they also have to do total care including the baths, changing beds, meals etc...
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Chico David, BSN, RN
624 Posts
You got that right! In an honest world, where hospital managers were doing their jobs honestly, an acuity staffing system alone would be the right way to go. But management always games such a system to result in fewer nurses, which is why we were forced to go to the straight numerical system in California. But of course the ANA is working with the hospital assns. to push acuity staffing laws as a way of trying to derail real safe staffing laws.