Nurses are divided about setting staffing standards

  1. Nurses are divided about setting staffing standards
    Some say a policy is needed to ensure quality care for patients
    PETER WONG
    Statesman Journal
    March 28, 2007

    Some nurses asked lawmakers Tuesday to specify how many patients can be assigned to a registered nurse in a hospital.

    Linda Boly, who works at Legacy Good Samaritan Hospital in Portland, said a patient who had just left surgery went unattended for nearly an hour because all the nurses had their hands full with other patients.
    "We believe hospitals will not regulate themselves," she told the House health-policy subcommittee. "We need staffing standards in place, and we also need a union to enforce safe patient standards."

    Legacy Health System is not unionized. House Bill 3416 was introduced at the request of the Oregon Federation of Nurses and Health Professionals, AFT Local 5017, and would specify minimums based on the nature of the hospital unit.

    "For the sake of patients, there needs to be enough nurses to ensure quality care," said Kathy Geroux, a registered nurse at Kaiser Permanente and the local's president.
    California enacted staffing standards in 1999.

    But other nurses, and the hospitals, oppose the bill....

    http://www.statesmanjournal.com/apps...703280330/1042
  2. Visit pickledpepperRN profile page

    About pickledpepperRN

    Joined: Mar '99; Posts: 13,361; Likes: 1,375

    30 Comments

  3. by   Sheri257
    Also opposed was Dr. Marvin Fickle, the superintendent and chief medical officer of Oregon State Hospital, who said in written testimony that it would require the hiring of 832 more nurses and $60.5 million in the 2007-09 budget. The hospital has 20 percent of its registered-nurse positions vacant.

    Duh ... the reason you have a 20 percent vacancy rate is because nobody wants to work with those patient loads. And of course, they don't want to spend the money.

    What's really surprizing is that the Oregon Nurses' Association is opposed to this. Their members must be mostly managers because I've never heard of floor nurses opposing ratios before.

    :typing
    Last edit by Sheri257 on Mar 30, '07
  4. by   1Tulip
    Quote from lizz
    Also opposed was Dr. Marvin Fickle, the superintendent and chief medical officer of Oregon State Hospital, who said in written testimony that it would require the hiring of 832 more nurses and $60.5 million in the 2007-09 budget. The hospital has 20 percent of its registered-nurse positions vacant.

    Duh ... the reason you have a 20 percent vacancy rate is because nobody wants to work with those patient loads. And of course, they don't want to spend the monty.'

    What's really surprizing is that the Oregon Nurses' Association is opposed to this. Their members must be mostly managers because I've never heard of floor nurses opposing ratios before.

    :typing
    Just a caution, here. Mandatory minimum patient loads are turning out to bite RN's in the behind. The budget numbers are real. It does require the institution to hire more nurses. (And I'm totally for that!) BUT, once the law is in place, they hire the RN's, then fire transport, unit clerks, RT/PT/Speech therapists, etc. etc. etc.

    The law is also a huge hammer that can't be wielded with any finesse and, of course, the institution would NEVER let nurses sort out staffing issues themselves. A 5 patient load on post-partum is WAY different than 5 patients on a Neuro unit (think acute stroke, total care, feeders, wanderers, aggressive/combative pts, spine and cranial surgery etc. etc.)

    So, just think about it. It isn't the cure all you dream it will be. At least you have to make your legislators be very careful and specific when they craft the language of the bill. And remember, the Hospital Association pays way more on lobbyists than the nurses do.
  5. by   SueBee RN-BSN
    Nurses are devided on just about everything. Staffing, education, abuse tolerance-- Go figure--
  6. by   Sheri257
    Quote from 1Tulip
    BUT, once the law is in place, they hire the RN's, then fire transport, unit clerks, RT/PT/Speech therapists, etc. etc. etc.

    So, just think about it. It isn't the cure all you dream it will be.
    And you're basing this on what?

    I live in California where we already have a ratio law so, I'm not dreaming. While it's not a cure all, it's not the nightmare you're predicting either.

    I've seen at least six hospitals still provide aides, phlemotomists, RT's, PT's, speech therapists and unit clerks ... and they still comply with nurse ratios. Those people are still employed on the floors I've been on.

    Now maybe it's because four out of the six hospitals are unionized, and the union would probably throw a fit if they made support staff cuts, but two of the non-union hospitals didn't make any support staff cuts that I could see either.

    :typing
    Last edit by Sheri257 on Mar 30, '07
  7. by   Sheri257
    Quote from 1Tulip
    The law is also a huge hammer that can't be wielded with any finesse and, of course, the institution would NEVER let nurses sort out staffing issues themselves. A 5 patient load on post-partum is WAY different than 5 patients on a Neuro unit (think acute stroke, total care, feeders, wanderers, aggressive/combative pts, spine and cranial surgery etc. etc.)
    I'm sorry but, this is more misinformation. I have seen cases where management did not take acuity into account when they should have. No question about it. However, I've mostly seen cases where management did let the nurses take acuity into account.

    In some hospitals the acuity of the patients is posted on the board, and you can see where those nurses actually got less patients than the law allows because they got the higher acuity patients.

    Case in point: I worked on a cardiac DOU. Technically they could give the nurses five patients all the time. But, because of the higher acuities, I never saw an RN get more than four patients. Never. One time they did try to give an RN five patients but, she refused and that was the end of it.

    I now work in an ER where the ratios are supposed to be 4:1. But most of the nurses only get 3 patients because of the high acuities. Only one nurse gets four, and those are the most stable patients.

    But even if you happen to get too many high acuity patients, there are remedies for that in California also. You can protest the assignment as unsafe, and file an incident report documenting it. That way, if anything goes wrong, it's on the hospital, not you.

    Have you actually been in some California hospitals because, it doesn't sound to me like you have. It is not anywhere near the nightmare you're portraying here.

    :typing
    Last edit by Sheri257 on Mar 30, '07
  8. by   1Tulip
    Quote from lizz
    I'm sorry but, this is more misinformation. I have seen cases where management did not take acuity into account when they should have. No question about it. However, I've mostly seen cases where management did take let the nurses take acuity into account.

    In some hospitals the acuity of the patients is posted on the board, and you can see where those nurses actually got less patients than the law allows because they got the higher acuity patients.

    Case in point: I worked on a cardiac DOU. Technically they could give the nurses five patients all the time. But, because of the higher acuities, I never saw an RN get more than four patients. Never. One time they did try to give an RN five patients but, she refused and that was the end of it.

    I now work in an ER where the ratios are supposed to be 4:1. But most of the nurses only get 3 patients because of the high acuities. Only one nurse gets four, and those are the most stable patients.

    But even if you happen to get too many high acuity patients, there are remedies for that in California also. You can protest the assignment as unsafe, and file an incident report documenting it. That way, if anything goes wrong, it's on the hospital, not you.

    Have you actually been in some California hospitals because, it doesn't sound to me like you have. It is not anywhere near the nightmare you're portraying here.

    :typing
    I live near the CA border. No personal experience but have talked to people who have lived it and left... obviously the ones who've had bad experiences. So, my data is drawn from a scewed population, but a real one, nevertheless.

    I'm truly encouraged that competent CA hospitals have woken up and done the budgeting that matters... putting the right people in the right positions. The hospitals you are describing have by all appearances done their fiscal homework.

    My only personal experience is working in a hospital that hasn't. (Their shortfalls did not happen due to legislation but grand expansion plans and little foresight.) My place of employment is daily cutting more and more positions that they define as "non-clinical". It's the first thing they do to stop the hemorrhage of red ink and it's brutal.

    If this legislature imposed the miracle mandatory ratios this year, hospitals in our state would fold. I know ours would. And maybe that's what should happen. Some well known hospitals in our state are not even paying their bills, are unable to get companies to contract to do work for them any longer. (Why don't CEO's and CFO's get sued for malpractice?)

    It's ugly here and ratios would be in the short run, a disaster. Perhaps, judging by what you are saying, one must take the longer view.
  9. by   Sheri257
    Quote from 1Tulip
    I live near the CA border. No personal experience but have talked to people who have lived it and left... obviously the ones who've had bad experiences. So, my data is drawn from a scewed population, but a real one, nevertheless.

    I'm truly encouraged that competent CA hospitals have woken up and done the budgeting that matters... putting the right people in the right positions. The hospitals you are describing have by all appearances done their fiscal homework.

    My only personal experience is working in a hospital that hasn't. (Their shortfalls did not happen due to legislation but grand expansion plans and little foresight.) My place of employment is daily cutting more and more positions that they define as "non-clinical". It's the first thing they do to stop the hemorrhage of red ink and it's brutal.

    If this legislature imposed the miracle mandatory ratios this year, hospitals in our state would fold. I know ours would. And maybe that's what should happen. Some well known hospitals in our state are not even paying their bills, are unable to get companies to contract to do work for them any longer. (Why don't CEO's and CFO's get sued for malpractice?)

    It's ugly here and ratios would be in the short run, a disaster. Perhaps, judging by what you are saying, one must take the longer view.
    I think a lot of it also has to do with location. I intentionally moved to an area of California where there are a lot of hospitals because I did want lots of job options. I knew there would be some bad hospitals, just like anywhere else, so I wanted a lot of choice so I could avoid the bad ones.

    But if I lived an hour or more drive's away, I'm sure it could be completely different, especially in one hospital towns. From what I've heard, they do take more advantage of their nurses because they can.

    I just wanted to point out that not all hospitals are like that though. If you move to an area where there are lots of options, you can find really good hospitals who do treat their nurses well.

    :typing
  10. by   oldnewnurse46
    Quote from 1Tulip
    Just a caution, here. Mandatory minimum patient loads are turning out to bite RN's in the behind. The budget numbers are real. It does require the institution to hire more nurses. (And I'm totally for that!) BUT, once the law is in place, they hire the RN's, then fire transport, unit clerks, RT/PT/Speech therapists, etc. etc. etc.

    The law is also a huge hammer that can't be wielded with any finesse and, of course, the institution would NEVER let nurses sort out staffing issues themselves. A 5 patient load on post-partum is WAY different than 5 patients on a Neuro unit (think acute stroke, total care, feeders, wanderers, aggressive/combative pts, spine and cranial surgery etc. etc.)

    So, just think about it. It isn't the cure all you dream it will be. At least you have to make your legislators be very careful and specific when they craft the language of the bill. And remember, the Hospital Association pays way more on lobbyists than the nurses do.
    You are so fortunate to have been blessed with such ratios. Just because YOU have been lucky, please don't undermine those nurses that are used and abused by management. We had NO support staff at all this weekend - nurses answering phones, putting together charts on the fly, and doing all the CNA work. Admissions, assessments, and a 6:1 ratio. All 12 patients were on suicide precautions and one on homicidal precautions. It was dangerous and scary. All the CPAs see is money, money, money. They were too cheap to hire even one agency CNA to help us, and too cheap to go on divert. Therapy? Treatment? Heck no, we were just trying to keep everyone from dieing. I was sold a bill of goods in nursing school.
  11. by   NurseJacqui
    Quote from lizz
    I'm sorry but, this is more misinformation. I have seen cases where management did not take acuity into account when they should have. No question about it. However, I've mostly seen cases where management did let the nurses take acuity into account.

    In some hospitals the acuity of the patients is posted on the board, and you can see where those nurses actually got less patients than the law allows because they got the higher acuity patients.

    Case in point: I worked on a cardiac DOU. Technically they could give the nurses five patients all the time. But, because of the higher acuities, I never saw an RN get more than four patients. Never. One time they did try to give an RN five patients but, she refused and that was the end of it.

    I now work in an ER where the ratios are supposed to be 4:1. But most of the nurses only get 3 patients because of the high acuities. Only one nurse gets four, and those are the most stable patients.

    But even if you happen to get too many high acuity patients, there are remedies for that in California also. You can protest the assignment as unsafe, and file an incident report documenting it. That way, if anything goes wrong, it's on the hospital, not you.

    Have you actually been in some California hospitals because, it doesn't sound to me like you have. It is not anywhere near the nightmare you're portraying here.

    :typing


    3 patients? I am so jealous. In NJ and NYC I usually have between 7-10. I have even had up to 15. In the ER. A lot of them high acuity. A lot of times with no transport, clerk or nurses aids. And the doctors or patient's families or patients themselves scream at the nurse because the nurse isn't spending enough (or any) time with them. How the hell can they? ITs to the point where I almost dont want to be a nurse anymore because I am so sick of the daily abuse I have to take. And god forbid some new form or other isnt filled out or charting isnt completed...the clipboard committee will come after you with a vengeance. However, if you are seen sitting down for even a second(to do all the MANDATORY paperwork) it is assumed you are not doing anything and you get screamed at for that too. Forget a break. While said clipboard committees and techs and clerks and everyone else who accuses the nurses of not doing anything get an hour to sit down and unwind, nurses are lucky if they get to shove a 2 day old hospital sandwich down their throat, or even pee for that matter. It's just so unsafe. I remember complaining about it once and was told, " Then you are not a real nurse, "
  12. by   Wave
    Quote from 1tulip
    just a caution, here. mandatory minimum patient loads are turning out to bite rn's in the behind. the budget numbers are real. it does require the institution to hire more nurses. (and i'm totally for that!) but, once the law is in place, they hire the rn's, then fire transport, unit clerks, rt/pt/speech therapists, etc. etc. etc.
    either that, or hospital administrators could cut into their six figure salaries/ bonuses. just a suggestion.
    the law is also a huge hammer that can't be wielded with any finesse...
    i guess you could say that it lacks surgical precision...
    and, of course, the institution would never let nurses sort out staffing issues themselves.

    a 5 patient load on post-partum is way different than 5 patients on a neuro unit (think acute stroke, total care, feeders, wanderers, aggressive/combative pts, spine and cranial surgery etc. etc.)
    i agree whole heartedly.

    so, just think about it. it isn't the cure all you dream it will be. at least you have to make your legislators be very careful and specific when they craft the language of the bill. and remember, the hospital association pays way more on lobbyists than the nurses do.
    why have somebody who understands the problem help fix it when you can hire somebody to sweep it under the rug?
  13. by   Sheri257
    Quote from TerraRN
    3 patients? I am so jealous. In NJ and NYC I usually have between 7-10. I have even had up to 15. In the ER. A lot of them high acuity. A lot of times with no transport, clerk or nurses aids. And the doctors or patient's families or patients themselves scream at the nurse because the nurse isn't spending enough (or any) time with them. How the hell can they? ITs to the point where I almost dont want to be a nurse anymore because I am so sick of the daily abuse I have to take. And god forbid some new form or other isnt filled out or charting isnt completed...the clipboard committee will come after you with a vengeance. However, if you are seen sitting down for even a second(to do all the MANDATORY paperwork) it is assumed you are not doing anything and you get screamed at for that too. Forget a break. While said clipboard committees and techs and clerks and everyone else who accuses the nurses of not doing anything get an hour to sit down and unwind, nurses are lucky if they get to shove a 2 day old hospital sandwich down their throat, or even pee for that matter. It's just so unsafe. I remember complaining about it once and was told, " Then you are not a real nurse, "
    I am so sorry. That sounds horrible.

    :typing
  14. by   CRNAorBust
    My only question about mandating ratios is where are they getting the nurses if there is a supposed nursing shortage? Obviously doesn't sound like there's a nursing shortage in the parts of the country where such ratios are possible. Hence, what is everyone screaming shortage for in general when the shortage is actually a spot shortage AND a shortage of Experienced nurses at that.

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