New California Nurse to Patient Ratio

TigraRN · Jan 8, 2021

1:6 in ER, all 6 being MedSurg patients, 1:3 ICU "with a nurse extender" (who cannot be given appropriate orientation time). It really depends on the day. Rapidcare patients ESI 4 - a lot ?.

JBMmom, MSN, NP · Jan 8, 2021

11 hours ago, JKL33 said:

Well...in my heart I'm trying to use proper netiquette (other thread ?) but in my very humble and polite opinion we should make sure to not imply that the nurses were wrong and are just screaming no matter what admin does.

I know that you are not familiar with my particular hospital and the people I am referring to, so my post may have seemed misguided. I am not in the least painting a broad brush across our nurses, not blaming any nurses for the position we are in, I am referring to a few very vocal "screamers" that are constantly posting hysterical statements on a private facebook page for hospital nurses. These few nurses are very active in the union and project a very unrealistic image of what nursing should be in any hospital. We recently went on strike (in October) in order to get a "better contract" and some of the things we agreed to in this new contract, which included the wage scale the most vocal nurses wanted, required that concessions be made in other areas, like pick up incentive. Then, when the pick up incentive, which was clearly written in the contract, went into effect, these screaming nurses said the hospital should appreciate us more and change it. Less than two months after they agreed to it. I'm not totally behind management in some cases, but in this area, the nurses that drove the contract negotiations didn't do what needed to be done in order to help us deal with situations like what we are experiencing.

Advanced Practice Columnist / Guide · Jan 8, 2021

I'm an ICU NP in Northern California so I do have to know which ones of the nurses are taking care of the patients in the unit. So far, we are not faced with changing the provisions of AB394 aka "ratio law".

We are a referral center so our ICU patients are higher acuity than other hospitals. Our ECMO patients still get 2 nurses to 1 patient (with some exceptions when we're short, such as 2 ECMO patients get assigned to 1 nurse each and a third nurse floating between the 2 rooms). We've cannulated COVID-19 patients to ECMO.

Our intubated COVID-19 patients who are being proned are still 1:1. Our CRRT patients are still 1:1. Post-op heart, lung, liver transplants are still 1:1. The run of the mill, typical ICU patients are still 1:2. Units are 16 beds with 3 RT's, 1 PCA and 1 secretary. Charge Nurse takes no patient assignment. We are CNA represented.

JKL33 · Jan 8, 2021

Thank you for the clarification @JBMmom.

I just have mixed feelings about it all (even though I probably wouldn't choose to behave exactly as what you're describing) since overall I believe there are fundamental disparities between the behavior that is considered acceptable for employers (especially large corporations) vs. employees. For example, take a case where nurse:patient ratios go into effect. The employer may then choose to remove all ancillary help and let the nurses do all the jobs that need to be done on the unit including taking out the trash. They can get away with that, but it wouldn't be the spirit of the law/regulation and it definitely isn't in the interest of good patient care.

I have a hard time disparaging people even in the scenario you describe because in my entire time as a nurse I have not seen employers even entertain a scenario where they actually get the short end of the stick. Rather they will make sure someone else is left with that end every time. They will achieve it one way or another. And due to their resources they are able to do it without resorting to unpleasant-appearing screaming on social media.

ExceptionRN · Jan 9, 2021

I took a travel assignment in Southern California and the ICU's here have been 3 to 1 staffing for the last 3 weeks! Most of the ICU nurses only care for COVID-19 patients while the few clean patients are placed in the CVICU. 3:1 ratio, in my opinion, is simply ridiculous. You are stuck mindlessly running around the entire shift trying to complete never-ending tasks. Every patient is on at least 6 drips which never seem to stop alarming. I usually don't start charting until 30 minutes before the end of my shift. On the floor I usually work on, we have 21 patients for 7 nurses and 1-2 resource nurses. No CNAs, no LVNs, and 2 RT's for the 16-20 Vents. To add to our troubles, we have been putting 2 patients in 1 room. Our main ICU is equally as busy but they generally have an extra resource nurse, a charge nurse, and upper-level nurses that can lend a helping hand.

Career Columnist / Author · Jan 9, 2021

LVNs haven't worked in acute care for some time, but they could certainly be used now.

Career Columnist / Author · Jan 9, 2021

I am ALL FOR nurse:patient ratios but my question for the union is, what other options are there now? It's a dire situation.

klone, MSN, RN · Jan 9, 2021

13 minutes ago, Nurse Beth said:

I am ALL FOR nurse:patient ratios but my question for the union is, what other options are there now? It's a dire situation.

Exactly. These are unprecedented times. It sucks.

Advanced Practice Columnist / Guide · Jan 9, 2021

It should be a last resort. In many hospitals, over half of patient admissions in the acute and critical care units are from elective surgeries. Some of those surgeries are done because of the life threatening nature of the underlying medical conditions but some can actually be delayed. Early in the pandemic, many hospitals actually cancelled a lot of elective admissions/surgeries in preparation for an influx of COVID-19 admissions but they never saw that surge...instead, they had empty beds for weeks which led to lost revenues for many that probably haven't been financially recouped. I feel like many of the CEO's are not willing to go through losing revenue with that strategy again and are allowing the overcrowding to happen now. Just my theory, I can be totally wrong in this.

Career Columnist / Author · Jan 10, 2021

58 minutes ago, juan de la cruz said:

It should be a last resort. In many hospitals, over half of patient admissions in the acute and critical care units are from elective surgeries. Some of those surgeries are done because of the life threatening nature of the underlying medical conditions but some can actually be delayed. Early in the pandemic, many hospitals actually cancelled a lot of elective admissions/surgeries in preparation for an influx of COVID-19 admissions but they never saw that surge...instead, they had empty beds for weeks which led to lost revenues for many that probably haven't been financially recouped. I feel like many of the CEO's are not willing to go through losing revenue with that strategy again and are allowing the overcrowding to happen now. Just my theory, I can be totally wrong in this.

So true, we lived through that.

But now CDPH has mandated " All hospitals and ambulatory surgery centers shall categorize all elective procedures by Tier using the Elective Surgery Acuity Scale (ESAS) from St. Louis University and suggested by the American College of Surgeons"

I can tell you, hospitals here are not doing elective surgeries. It's real this time.

Advanced Practice Columnist / Guide · Jan 10, 2021

2 minutes ago, Nurse Beth said:

So true, we lived through that.

But now CDPH has mandated " All hospitals and ambulatory surgery centers shall categorize all elective procedures by Tier using the Elective Surgery Acuity Scale (ESAS) from St. Louis University and suggested by the American College of Surgeons"

I can tell you, hospitals here are not doing elective surgeries. It's real this time.

Hope so.

Sometimes you just have to take the news with a grain of salt:

https://www.latimes.com/california/story/2020-07-09/as-covid-19-patients-strain-hospitals-many-are-not-ending-nonemergency-surgeries

Career Columnist / Author · Jan 10, 2021

3 minutes ago, juan de la cruz said:

Hope so.

Sometimes you just have to take the news with a grain of salt:

https://www.latimes.com/california/story/2020-07-09/as-covid-19-patients-strain-hospitals-many-are-not-ending-nonemergency-surgeries

Thanks for the article. I do think northern CA is having a different experience than central and southern