why can't nurses get safe staffing laws passed

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Why does it seem that nurses here in the USA cannot get safe staffing laws passed. Only California has been able to do this

We always stay within the 1 or 2 pt ratio at my hospital.....NEVER go higher....should come work with us! We also have great med surg ratios and that makes me think, if MA passes a law, we would lose our ancillary staff....cant TELL you how many times I have asked, would you rather me float you an aide or upstaff a nurse and I ALWAYS 100% of the time am told "we want the aide".....our med surg ratio is 4 to 5 on days (5 max always) and 5 to 6 on nights. Our mainly surgical floor is 4 pts on high surgical volume days all shifts (if nurse has more than 1 fresh post op) and 5 on low days. If other hospitals were made to do this also, a law wouldnt be needed. A law will decrease our ability to decison make, be autonomous and use our knowledge base to rationalize what works and what doesnt. It also will cause major ED issues with backups in waiting rooms, increased wait times and also force holds to happen and OFTEN as if pts need inpt beds and there arent enough nurses, they would hold for who knows how long in the ED?? Would you want to be that person or have it be your loved one so nurses could have 4 pts vs 5 and also have no ancillary help anymore to be able to get them to the toilet or on bedpans etc?? I wouldnt. I also wonder if these places cut ancillary staff, how long will it take before nurses who always delegate out the tasks they dont like to leave because now they have less pts but have to do ALL the care their CNA used to do because the hospital has to follow the law but also has to be cost effective?? I just cant back this law....I agree with safe staffing but when thibgs are made into law? Brings it to a WHOLE new level that I know isnt going to make pts or nurses truly happy in the long run!

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I still say that the RN-LPN-CNA "team nursing" model would be the safest and most economical way to staff a hospital unit. More hands on deck is always better.

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Specializes in school nurse.
We always stay within the 1 or 2 pt ratio at my hospital.....NEVER go higher....should come work with us! We also have great med surg ratios and that makes me think, if MA passes a law, we would lose our ancillary staff....cant TELL you how many times I have asked, would you rather me float you an aide or upstaff a nurse and I ALWAYS 100% of the time am told "we want the aide".....our med surg ratio is 4 to 5 on days (5 max always) and 5 to 6 on nights. Our mainly surgical floor is 4 pts on high surgical volume days all shifts (if nurse has more than 1 fresh post op) and 5 on low days. If other hospitals were made to do this also, a law wouldnt be needed. A law will decrease our ability to decison make, be autonomous and use our knowledge base to rationalize what works and what doesnt. It also will cause major ED issues with backups in waiting rooms, increased wait times and also force holds to happen and OFTEN as if pts need inpt beds and there arent enough nurses, they would hold for who knows how long in the ED?? Would you want to be that person or have it be your loved one so nurses could have 4 pts vs 5 and also have no ancillary help anymore to be able to get them to the toilet or on bedpans etc?? I wouldnt. I also wonder if these places cut ancillary staff, how long will it take before nurses who always delegate out the tasks they dont like to leave because now they have less pts but have to do ALL the care their CNA used to do because the hospital has to follow the law but also has to be cost effective?? I just cant back this law....I agree with safe staffing but when thibgs are made into law? Brings it to a WHOLE new level that I know isnt going to make pts or nurses truly happy in the long run!

So, if your hospital ratios are so good, they would already be within the mandates of a law. Why would they need to cut staff then? Essentially, they're already doing it...

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In LTC, the nurse/pt ratio is completely rediculous.. As LPN's we have no less than 20 pts each per am, afternoon shifts, evening shift 1 LPN per unit reasoned by the fact that pt's sleep.. The am med pass takes every bit of 2-3 hours and that's without interruptions.. When patients ask why meds are late or cna's cant get to them immediately, they want to know why, but our admin would rather the patient's think we are just slow and lazy rather than tell them we dont have enough staff that particular day.. It promotes bad will toward the staff for being lazy!! It is not fair to the patient, nor the staff, who have to suffer the wrath of the waiting patient..

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The Alabama Board of Nursing law regarding staffing states "reasonable staffing per facility to safely care for the patients" or something similar.. The facilities take that to mean that as long as a certain number of nurses are scheduled on paper; not necessarily in-house, ie call outs not covered; they are covered by the mandate by ABON.. WE have 12-15 RN's on staff every day, but are not required nor are they competent enough to carry out a med pass within compliance laws.. However, no matter how much complaints are made, no one will address the problem much less fix it..

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Specializes in Critical care, tele, Medical-Surgical.
If I remember correctly, I believe the nurses went on strike and refused to work. The hospitals had to rely on temp staffing. In Cali, I believe you can strike for anything.
Nurses did not go on strike to achieve our ratios. thousands of nurses lobbied their state assembly members and senators, wrote letters, made phone calls, rallied, hosted town hall meetings, and worked on the campaigns of candidates who promised to vote for the ratios. We testified at hearings by the State.

By the way, when we strike all scheduled nurses along with others are in uniform on the picket line. RN "picket captains" have provided nursing management and medical director their cell numbers. If there are insufficient competent RN staff management can call and one or more nurses goes inside to care for patients. That is NOT considered crossing the line.

Once I was supporting fellow nurses who were on strike. A manager called because none of the replacement nurses was competent to care for a patient who needed specialized equipment. A staff RN went in to care for that patient.

http://www.healthwatchusa.org/downloads/ratios_12year_fight_0104.pdf

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Specializes in Critical care, tele, Medical-Surgical.
The Alabama Board of Nursing law regarding staffing states "reasonable staffing per facility to safely care for the patients" or something similar.. The facilities take that to mean that as long as a certain number of nurses are scheduled on paper; not necessarily in-house, ie call outs not covered; they are covered by the mandate by ABON.. WE have 12-15 RN's on staff every day, but are not required nor are they competent enough to carry out a med pass within compliance laws.. However, no matter how much complaints are made, no one will address the problem much less fix it..
Federal law for any hospital admitting Medicare and/or Medicaid patients. From page 220 of the link:

§482.23(b) Standard: Staffing and Delivery of Care

The nursing service must have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care

to all patients as needed. There must be supervisory and staff personnel for each department or nursing unit to ensure, when needed, the immediate availability of a registered nurse for bedside care of any patient.

Interpretive Guidelines §482.23(b)

The nursing service must ensure that patient needs are met by ongoing assessments of patients' needs and provides nursing staff to meet those needs. There must be sufficient numbers, types and qualifications of supervisory and staff nursing personnel to respond to the appropriate nursing needs and care of the patient population of each department or nursing unit.

There must be a RN physically present on the premises and on duty at all times.

Every inpatient unit/department/location within the hospital-wide nursing service must have adequate numbers of RNs physically present at each location to ensure the immediate availability of a RN for the bedside care of any patient.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf

Clearly no nurse can be in more than one place at a time so insufficient staffing precludes the required immediate availability of a registered nurse for each patient.

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Specializes in Tele, ICU, Staff Development.

We have a way to achieve safe nurse:patient ratios now, but there's a short window in time. And it takes you- or it will not happen..

Support HR 2392.

Support S 1063.

How do you support these bills?

Keep in mind YOU are needed. Why? Because the American Nursing Association (ANA) and the American Hospital Association (AHA) are fighting against these bills. But YOU are a constituent and a trustworthy nurse. As such, you have considerable influence with your elected representative.

Call your representative and say "My name is (Beth Hawkes) and I support HR 2392. I am calling to ask you to support this important bill"

Call your Senators and say "My name is (Beth Hawkes). I am a constituent and i support S 1063. I am calling to support this important bill".

Your call will be tallied and makes a difference! Representatives pay attention to voting constituents!

Make a difference. Speak up and change the status quo. You know when you have too many patients- it's simply not right.

Still not convinced? Read "Nurse:Patient Ratios: A Biased View"

Watch Nurse Keith Carlson and I

on You Tube.
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Specializes in Critical care, tele, Medical-Surgical.
We have a way to achieve safe nurse:patient ratios now, but there's a short window in time. And it takes you- or it will not happen..

Support HR 2392.

Support S 1063.

How do you support these bills?

Keep in mind YOU are needed. Why? Because the American Nursing Association (ANA) and the American Hospital Association (AHA) are fighting against these bills. But YOU are a constituent and a trustworthy nurse. As such, you have considerable influence with your elected representative.

Call your representative and say "My name is (Beth Hawkes) and I support HR 2392. I am calling to ask you to support this important bill"

Call your Senators and say "My name is (Beth Hawkes). I am a constituent and i support S 1063. I am calling to support this important bill".

Your call will be tallied and makes a difference! Representatives pay attention to voting constituents!

Make a difference. Speak up and change the status quo. You know when you have too many patients- it's simply not right.

Still not convinced? Read "Nurse:Patient Ratios: A Biased View"

Watch Nurse Keith Carlson and I

on You Tube.
Thank you Nurse Beth!

Our ratios in California truly save lives.

Health Services Research, August 2010

The researchers surveyed 22,336 RNs in California and two comparable states, Pennsylvania and New Jersey, with striking results, including

: if they matched California state-mandated ratios in medical and surgical units, New Jersey hospitals would have 13.9 percent fewer patient deaths and Pennsylvania 10.6 percent fewer deaths.

"Because all hospitalized patients are likely to benefit from improved nurse staffing, not just general surgery patients, the potential number of lives that could be saved by improving nurse staffing in hospitals nationally is likely to be many thousands a year," according to Linda Aiken, the study's lead author.

California RNs report having significantly more time to spend with patients, and their hospitals are far more likely to have enough RNs on staff to provide quality patient care. Fewer California RNs say their workload caused them to miss changes in patient conditions than New Jersey or Pennsylvania RNs..

Implications of the California Nurse Staffing Mandate for Other States

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Keep in mind YOU are needed. Why? Because the American Nursing Association (ANA) and the American Hospital Association (AHA) are fighting against these bills. But YOU are a constituent and a trustworthy nurse. As such, you have considerable influence with your elected representative.

I am not well-versed here and appreciate the links, well-written articles, and information.

I do know enough to understand that nurses should take a critical look at the ANA position on this if it's such that the AHA agrees. Unfortunately that is telling in and of itself; it means that they have already recognized a way to control and/or exploit it and/or keep right on rolling with business as usual. "Nurse-driven" plays out as a façade, and keeping it up and using some nurses as tokens and, very literally, tools to keep all nurses powerless is something that is taken very seriously.

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Massachusetts will likely vote on a ballot initiative this fall.

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Nurses did not go on strike to achieve our ratios. thousands of nurses lobbied their state assembly members and senators, wrote letters, made phone calls, rallied, hosted town hall meetings, and worked on the campaigns of candidates who promised to vote for the ratios. We testified at hearings by the State.

By the way, when we strike all scheduled nurses along with others are in uniform on the picket line. RN "picket captains" have provided nursing management and medical director their cell numbers. If there are insufficient competent RN staff management can call and one or more nurses goes inside to care for patients. That is NOT considered crossing the line.

Once I was supporting fellow nurses who were on strike. A manager called because none of the replacement nurses was competent to care for a patient who needed specialized equipment. A staff RN went in to care for that patient.

http://www.healthwatchusa.org/downloads/ratios_12year_fight_0104.pdf

It's also unfortunate that some administrators are also RN's and still cheat floor nurses without giving them adequate staffing.

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