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new staffing laws in mass? CA nurses

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I am an RN in California and we have unit secretary, phlebotomists, CNAs AND lift team personnel. Working with the ratios is great. It provides a safer environment for patients and helps retain seasoned nurses.

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I am also a nurse in MA and I am leaning towards voting NO. MA cannot divert like CA can, I just cannot see how this will work and they are only giving MA hospitals weeks if law passes to make it work, I believe CA had a few years.

It's up to the facilities to make this work. They've created the doubt and uncertainty in nurses and the public in order to justify reducing staff while profits (for facilities, insurance companies and medical supply companies) and bonuses stay the same or increase. Current staffing levels are unsafe for patients and nurses. If burnout could be measured like other work related disabilities, OSHA would have shut a lot of facilities down years ago. The success of health care can't come at the expense of overburdened nurses who provide the care - or we won't have health care.

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Safe care and high quality care in any hospital - and even more so in community hospitals - depends on the bedside nurse being able to "put everything together" - as we all know, the task oriented workflow creates problems when nurses do not have the time to critically evaluate the information that they are supposed to "hold." A bedside nurse having the time to look at the whole picture instead of running through endless list of tasks can make the difference between high quality care and just about safe care. And things get missed more easily when nurses have more patients they can safely care for.

Safe patient care has become a public health problem as care has become more complex. Patient do not just come in for one thing - they usually have a gazillion things wrong with them plus a lot of them also have psychosocial problems, lack of suport, and financial problems but no Medicaid. The argument that nurses should consider acuity is just a tool by the Hospital Association to try to sway nurses from mobilizing the public to vote "yes". And so is the fear mongering - if a hospital closes because of the staffing ratios it was already on shaky grounds financially. Perhaps they should consider to cut back on CEO salaries - just saying...

Hospitals will always safe on nurses because they know that nurses do not speak up as a collective (unless they are unionized) and as soon as they make an appeal about "patients waiting and not getting care" nurses will re-consider. But - here is the thing: Public health related issues need to be pushed from above - with policy and regulations. Otherwise nothing happens. Right now there is no incentive for hospitals to fix dysfunctional systems.

What does it say about us as nurses ? They ask nurses to go to school for a 4-year degree but then they are unable to actually use their knowledge and critical thinking skills because they literally have no time to employ critical thinking - it is all about tasks. And the over charting to satisfy payors like Medicare takes away time without doing anything for real communication.

Anyhow - we need mandated ratios in Massachusetts.

Vote Yes - I am supporting Yes although I am not a bedside nurse anymore.

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if a hospital closes because of the staffing ratios it was already on shaky grounds financially. Perhaps they should consider to cut back on CEO salaries - just saying...

+++1. Heaven forbid the CEO doesn't get their enormous bonus!

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I'm in California and worked both before and after ratios. On the Tele unit in my hospital, the nurse-patient ratio is 1:4. We have a charge nurse who does not take patients, a throughput nurse, CNAs and a unit based Pharmacist. Phlebotomists draw blood, Resp Therapists give treatments, and lab techs take ECGs. We have 2 unit secretaries and 2 monitor techs. It's a 44 bed unit.

That sounds like a little slice of heaven compared to my experiences.

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Does anyone have a link to the exact wording/actual bill/law being passed? Our nurse manager couldn't find it, and has hoped we'd forget that we asked for it, because this week we're back to scare tactics.

Last night the grapevine said we'd lose our IV Therapy RNs and our designated RRT RNs. Anyone know if they constitute 'ancillary personnel'? I've also been told we'd only be able to work 8h shifts instead of 12h. Again, no one wants us to find or read bills before we vote on them? Or is the hospital just trying to keep our noses out of it and it's super easy to find?

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Does anyone have a link to the exact wording/actual bill/law being passed? Our nurse manager couldn't find it, and has hoped we'd forget that we asked for it, because this week we're back to scare tactics.

Last night the grapevine said we'd lose our IV Therapy RNs and our designated RRT RNs. Anyone know if they constitute 'ancillary personnel'? I've also been told we'd only be able to work 8h shifts instead of 12h. Again, no one wants us to find or read bills before we vote on them? Or is the hospital just trying to keep our noses out of it and it's super easy to find?

Unfortunately, nurses have come to be very wary of changes handed down from on high. It typically means more to do in less time, more pandering to hotel expectations on the part of "guests" leadership is trying to please, more redundant data mining in the form of charting, and "improvements" staff have had no input into and which make caring for patients no easier or more efficient. So when facilities are faced with changes that will cut into profits and bonuses, it's not very hard to start rumors of bad outcomes for nurses if the changes leadership doesn't want are implemented.

Following is an excerpt from the new initiative which refers to the prohibition against reducing the work force in response to the initiative, and a link to the full text.

http://www.mass.gov/ago/docs/government/2017-petitions/17-07.pdf

Edited by Katillac

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I do believe that some hospitals cut back on nurse's aides when the ratio went into effect or did so over time. Some tout it as all RN staff! Some hospitals cut back on the number of nurse's aides on a floor, so now maybe two for a unit of 30 patients where before it was 4. I also worked with someone who about 8 years ago came from a hospital in the central valley of California that would tell staff "they were a ratio free" hospital and they tried to get away without following the law of 5 patients at all times on med-surg etc. There are no such hospitals in CA that are ratio free.

However despite the law not being perfect it has 1) increased patient safety 2) increased nurse satisfaction. Why is is much harder to get a job in California? Many travel nurses have taken permanent positions in California, even with the high cost of living in most areas.

After having only 5 patients I don't think I could work in another state where I'd sometimes have 8 patients at one time.

If it has worked in California it can work in other states too. Nurses in MA would be wise to vote for this new law.

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My mind is blown that any nurse would vote no on this issue.

Nurses in MA would be wise to vote for this new law.

Absolutely agree. Yet, OP seems unconvinced for some reason?

I am also a nurse in MA and I am leaning towards voting NO.

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Absolutely agree. Yet, OP seems unconvinced for some reason?

I guess it just shows how effective anti-labor fear-mongering can be?

Edited by LibraSunCNM
grammar

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I have a non-nurse friend in MA who posted on FB asking for opinions. Someone jumped in and said most of his nurse friends are voting no and then shared a post with similar reasons that have been mentioned here. It seems like fear mongering to me. I also think that perhaps some nurses work in a hospital with ok ratios, so they don't see the need for it however they may not know that nurses in another community aren't so fortunate with such good ratios. Nurses in my state have recently really started to push and lobby for state mandated ratios and I shared the stats about improved patient outcomes and how much it costs when we lose a single nurse to burnout. When I was a floor nurse my ratios really weren't that horrible- I worked tele and had 5 patients on day or night shift- but would have really appreciated 1 less patient. My ratio was fairly reasonable, but some tele nurses in my state get up to 8 or more patients! Just because I'm ok doesn't mean other nurses are and I feel I'd be doing them a great disservice to not give them my support and the benefit of doubt.

I'm not sure if I'm doing a good enough job of articulating my thoughts right now- I just worked night shift and haven't had much sleep. I hope what I said makes sense to others.

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