Senator Boxer Introduces Bill that Sets Nurse-to-Patient Ratios to Improve Patient Ca - page 3

Senator Boxer Introduces Legislation to Address Nationwide Nursing Shortage Bill Sets Nurse-to-Patient Ratios to Improve Patient Care Wednesday, May 13, 2009 Washington, D.C. - U.S.... Read More

  1. by   PeaceonearthRN
    I am writing a thank you letter to Senator Boxer from the bottom of my nursing heart and soul!
  2. by   TuTonka
    Quote from CityKat
    She may believe in the "shortage myth", but she is right on point with this legislation! What a GREAT thing to FINALLY see!!


    I believe you are accurate with this person and I for one would be happy to enlighten her on several things.



    TuTonka
  3. by   sandyrae
    I do hear what you are saying and I believe that ratios need to be addressed, but I do not know if mandating ratios is the answer. Is there any proof that clinical outcomes are any better in California since implementation? To me this takes the autonomy away from me as a charge nurse looking at assignments based on acuity, If everyone had 5, then that seems like a cookie cutter approach versus taking a critical look at the care requirments. I know at times we will give our new graduate nurses off orienation 1-2 patient less which means our experience nurse would take the extra. This is done with a lot of thought and collaboration. This has proven very successful in helping our new nurses transition successfully and safely. I am afraid legistation this restrictive will take away that ability to support them. Like I said, I am in agreement that some framework needs to be in place, but I am not convinced this is the answer.

    Thanks for listenting
    Sandy
  4. by   Valerie Salva
    Quote from eriksoln
    Yeah, I thought the same thing as Valerie when I read it. How many patients we take on is only part of the problem. Hospitals not hiring is part too (hence the shortage is a myth, just ask anyone who has graduated in mid 08 till now).

    The part of the problem the bill will not address though is the issue of nurses being considered the "jack of all trades". Its no secret that places with mandated ratios just give you the ratio, but no support staff. No transports, very few CNA's, housekeeping is minimal..............it all gets dumped on you cause, well, not like the money for the extra nurses to cover the ratios is going to come out of the administrations pockets. Heck, I worked for a well known facility here in PA that didnt have the ratios (we took 8 pt's on daylight! M/S) and still tried to stretch our responsibilities out beyond nursing. A list of housekeeping duties that were being transfered to nurses was sent out. The RNs laughed and responded "Good luck with that", and administration threatened a few jobs, but in the end it just went away. But, they would have done it if they could have.

    No ratio is any good if there is no support staff in place nor and definition of what can be placed in a nurses scope of care. Could you imagine the laughter that would fill the halls for years if they tried to tell MDs they were going to be expected to assist housekeeping? Or if they told housekeeping they would be transfering pt's? How about Radiology doing security rounds? No, they dont even try that. But for some reason, it makes sense to try it with the RNs. Go figure.
    I agree with you except for one thing- I worked a med surg unit where the fewest number of pts I was ever assigned was seven- the most was thirteen- AND....
    There was no support staff even with that load- only 4 hrs a day of housekeeping, no transports, no CNAs, no unit clerk. At least if there were ratios I would not have had so many pts. I worked there three months and quit. Quitting saved my mental (and physical) health and my license.

    BTW- this was an HCA hospital- the former CEO of which is currently spending millions in his campaign to thrwart any healthcare reform in the US- Bill Frist.
  5. by   Valerie Salva
    Quote from Aneroo
    If this becomes law, there will be a very real nursing shortage. Currently facilities are able to overwork their nurses at unsafe staffing levels. They'll have no choice but to either hire more nurses or shut down beds.
    Think about it- just a couple of years ago, we were hearing over and over in the media about how California had the "worst nursing shortage in the nation."
    The CA hospital association fought against the ratios tooth and nail, saying hospitals would be shut down, pts wouldn't get care-

    Well, the opposite happened- CA is now flooded with nurses- new grads can't get jobs and even some experienced nurses are having a hard time.
    This was happeneing to a degree before the recession-

    A few months after the ratios were enacted, I asked my recruiter if he had a travel assignment for me in CA- he said that since the ratios were in effect, nurses had been coming out of the woodwork and wanting to go to CA- he called it "The new California Gold Rush." Many travelers were so happy with the working conditions that they relocated to CA, and many nurses who had left the bedside have returned, nurses who couldn't tolerate working full-time because of the overwork, went back to full time, and even took on overtime- The "nursing shortage" in CA is history.

    I think that national, reasonable ratios could have the same effect- nationwide.
  6. by   sandyrae
    I do hear what you are saying, there is such a variation between ratios throughout the country, that is another reason I would hesitate to try and make a one size fits all. While things are really tough in some areas of the country, there are some facilites that are doing things pretty well. Not everywhere is bad. It will be interesting to see how this plays out. Thank you for commenting.

    Sandy
  7. by   TuTonka
    Quote from Valerie Salva
    I agree with you except for one thing- I worked a med surg unit where the fewest number of pts I was ever assigned was seven- the most was thirteen- AND....
    There was no support staff even with that load- only 4 hrs a day of housekeeping, no transports, no CNAs, no unit clerk. At least if there were ratios I would not have had so many pts. I worked there three months and quit. Quitting saved my mental (and physical) health and my license.

    BTW- this was an HCA hospital- the former CEO of which is currently spending millions in his campaign to thrwart any healthcare reform in the US- Bill Frist.
    IMHO I think any pt/nurse ratio greater than 5 is unsafe for all concerned and if the acuity of one of those pts is high or if they crash on you you cannot possibly give good care to the other 4 of the five. I also believe in the internship for new grads to help them prepare for whatever nursing specialty they enter which includes more than just orientation. I have worked where the nurse/pt ratio was even greater than 13. Needless to say I did not stay.
    These are issues that need to be addressed with reform IMHO.


    TuTonka
  8. by   flightnurse2b
    can i just say that i had a ROTTEN day today. i work on tele/ICU step down and had 7 patients... all in pretty bad shape. pts with K's of 6 and 2.9, one needed emergency cardioversion, another needing 3 amps of D50, another needing unit after unit of blood and still bleeding..... and they are chasing me around to chart this and chart thar and remember patient satisfaction!!!

    it's too many patients. too many. its not fair to me, its not fair to the patients--it's just not safe.

    it pays the bills though, and i am absolutely blessed to have a job... but somedays... like today, i wonder why i didn't go to real estate school.
  9. by   herring_RN
    senator barbara boxer in two parts on you tube:

    part 1
    http://www.youtube.com/watch?v=azcopwagrt0

    part 2
    http://www.youtube.com/watch?v=9uv0sfsyzw0
  10. by   TuTonka
    Herring RN kudos for your post. I loved it. Very informative.


    TuTonka
  11. by   schroeders_piano
    I have to say I have not read any nurse to patient ration legislation that has me jumping for joy. Yes less patients are nice, but a one-size-fits-all approach won't work. I was a Med/Surg nurse manager at a critical access hospital. My unit was a combined unit meaning I had medical patients, surgical patients, peds, tele patients with and without drips, swingbed patients, and critical care patients. We adjusted staffing and patient assignments as needed based on acuity. None of the legislation put forth figures in hospitals with combined units like what I managed. Many critical access/rural hospitals in the US are exactly like this. There were shifts that I worked were I had 7 swingbed patients and 1 medical patient on my unit. I staffed it with 1 RN and 1 CNA. The CNA and I had no problem providing top notch patient care. If the ratios were enacted, I would have to have 2 RNs on the unit. There were night shifts I was lucky just to have 2 RNs in the whole building.

    A few years ago Illinois had legislation put forth to mandate ratios. The hospital I was working in at that time would have neve been able to abide by the law. There was not that big of pool of RNs in the area, nor could the hospital handle the financial impact of adding on the extra RNs. A lot of hospitals in Southern IL are in this same boat. Nowadays they might be able to find enough RNs in order to meet ratios, but it will mean financial disaster for the hospital.
  12. by   herring_RN
    Quote from schroeders_piano
    I have to say I have not read any nurse to patient ration legislation that has me jumping for joy. Yes less patients are nice, but a one-size-fits-all approach won't work. I was a Med/Surg nurse manager at a critical access hospital. My unit was a combined unit meaning I had medical patients, surgical patients, peds, tele patients with and without drips, swingbed patients, and critical care patients. We adjusted staffing and patient assignments as needed based on acuity. None of the legislation put forth figures in hospitals with combined units like what I managed. Many critical access/rural hospitals in the US are exactly like this. There were shifts that I worked were I had 7 swingbed patients and 1 medical patient on my unit. I staffed it with 1 RN and 1 CNA. The CNA and I had no problem providing top notch patient care. If the ratios were enacted, I would have to have 2 RNs on the unit. There were night shifts I was lucky just to have 2 RNs in the whole building.

    A few years ago Illinois had legislation put forth to mandate ratios. The hospital I was working in at that time would have neve been able to abide by the law. There was not that big of pool of RNs in the area, nor could the hospital handle the financial impact of adding on the extra RNs. A lot of hospitals in Southern IL are in this same boat. Nowadays they might be able to find enough RNs in order to meet ratios, but it will mean financial disaster for the hospital.
    To me this is risking the patients who are hospitalized because they need nursing care.

    One patient becoming critical would deprive the other seven patients of the ongoing assessment, planning, intervention, teaching and all that a professional nurse provides.

    How could the one RN responsib;
    le for eight patients take a break for 1/2 hour? Patients need a registered nurse 24/7.

    Otherwise why are they hospitalized?

    I pray every day for patients who may not be rescued because their nurse cannot be in two places at one time.

    It is not nurse managers who create this situation but that does not mke it OK.

    We can ensure our patients are cared for and we should.
  13. by   madwife2002
    This sounds great and I hope that it happens. this will also open up new job opportunities, because as the 4:1 ratio comes into effect the hospitals who are using higher ratios will have to employ more RN's.

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