Texas Marchers back bill seeking mandatory staffing ratios

  1. http://www.statesman.com/search/cont.../28nurses.html
    about 250 nurses wore red t-shirts, chanted and carried signs as they marched up congress avenue to the capitol on tuesday and warned that texas patients risk medical errors and even death because, they said, hospitals overload them with patients.
    "somewhere in texas, people die every day because of neglect," and it's not because nurses are lazy, elizabeth bryan, a 56-year-old nurse from hico, said as she stood on the capitol steps. "we're not there to see subtle changes . . . because we're busy taking care of other patients."







    nurses repeated similar stories as they rallied to support legislation that calls for strict, state-required nurse-to-patient staffing limits. the legislation would also put in place new whistle-blower protections for nurses who object to a supervisor's orders that they believe put patients at risk.
    the texas hospital association and the texas nurses association oppose the bill, which is being sponsored by rep. garnet coleman, d-houston.
    while some nurses are stretched too thin, coleman's bill is "very simplistic" and little more than an effort to create a nurses' union in texas, said clair jordan, executive director of the texas nurses association.
    representatives of the texas hospital association said hospitals follow staffing rules and whistle-blower protections to ensure high-quality and safe patient care.
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    About HM2VikingRN

    Joined: Apr '06; Posts: 11,159; Likes: 11,316

    38 Comments

  3. by   wooh
    They get ratios there, I'll move back to Texas in a heartbeat. Good luck to them!
  4. by   glasgow3
    When a so-called nurse"s association is on the same side of an issue as the hospital association, does that tell you anything?

    I would suggest that any bedside nurse in Texas withdraw from the Texas Nurses Association. Except, of course, that bedside nurses are probably few and far between in that organization as it stands.

    Mandatory minimum staffing ratios are in no way "simplistic". The nursing literature clearly demonstates that mortality and complication rates increase when specified staffing levels are not maintained. And there is nothng which prevents hospitals from exceeding those ratios should a higher than normal acuity occur for any given level of care. The requirements would function as a "floor".

    If staffing rules and whistleblower protections were in any way adequate, you would not see the kinds of demonstrations that you do.
  5. by   HM2VikingRN
    Time for a strong nurses union in Texas....
  6. by   gauge14iv
    Time for no union but a strong nursing ORG in Texas.

    TNA has about 2500 members - and I agree that few of them are bedside nurses.

    A good org could accomplish a lot without the constraints and bullying of a union.
  7. by   1Tulip
    Hi folks,

    I've written this on similar threads so I apologize if I'm being redundant.

    Listen, mandatory ratios can be an illusion. Here is what will happen. The hospitals will be forced to hire 25% more RN's. (That's certainly good.) But then you will lose your transport aides, your unit clerks, the pharmacy techs, the mobile admissions nurses, almost all therapists (I work on neuro and doing with fewer PT/OT/Speech Therapy would be a killer... literally.) You will be doing your jobs and everything your CNA's are currently doing. If you want supplies in the middle of your shift, you may have to go to central supply and get it yourself.

    Our hospital is in a financial crunch (aside... hospital administration is an oxymoron...) and they've instituted a hiring freeze. BUT... they hasten to add, they are not sacrificing any bedside nurses. However... the kitchen is now only open 10 hours a day. If it's 3 AM and you don't have another liter of Jevity or Glucerna... well, the tube feed won't resume until the next shift. The floors in the patient's rooms are sticky. Sinks and toilets are not cleaned except between admissions. Our dirty utility room stinks. If we run out of paper for the printer... tough, you better hope the other printer on the unit has some in it. Most patient supplies are now warehoused off campus (and actually in a nearby town!) so if you run out of non-skid sox, or suture removal kits, or even SUCTION CATHETERS!!! (happened last week) you either won't have them until later in the week or you have to steal them from another pt's room.

    Listen... unless those patient ratio laws are written very, very carefully... nurses (and patients) are going to be SOL. And always remember, the Hospital Association pays for way more lobbyists (and junkets and campaign contributions) than nurses do. And even if you get the law you think you want, the HA's will have had a hand in crafting the language of the bill.

    It's a really nice dream, folks, but a dream nevertheless.
  8. by   pickledpepperRN
    [FONT="Arial"]
    "Texas Hospital
    Patient Protection
    Act of 2007"


    Legislative Summary
    Title: Texas Hospital Patient Protection Act of 2007

    LEGISLATIVE PURPOSE

    ESTABLISHING MANDATORY HOSPITAL DIRECT CARE NURSING PRACTICE
    STANDARDS AND PROFESSIONAL PRACTICE PROTECTIONS TO ASSURE THAT
    NURSING CARE IS PROVIDED IN THE EXCLUSIVE INTERESTS OF PATIENTS--

    MANDATING ADOPTION OF MINIMUM DIRECT CARE REGISTERED NURSE-TO-PATIENT STAFFING RATIOS BY LICENSED HOSPITAL FACILITIES NECESSARY FOR COMPETENT, SAFE AND THERAPEUTIC NURSING CARE AND FOR RETENTION AND RECRUITMENT OF QUALIFIED DIRECT CARE REGISTERED NURSES--

    RECOGNIZING PROFESSIONAL DIRECT CARE REGISTERED NURSE DUTY AND RIGHT OF PATIENT ADVOCACY--

    PROVIDING EFFECTIVE PROTECTION AGAINST RETALIATION FOR REPORTING
    UNSAFE PATIENT CARE CONDITIONS AND FOR REFUSING UNSAFE PATIENT CARE ASSIGNMENTS.
    (Amending and Adding Provisions in the
    Texas Health & Safety Code, Labor Code and Occupation Code)

    LEGISLATIVE FINDINGS

    Health care services are becoming more complex and it is increasingly difficult for patients to access integrated services.

    Safe, therapeutic and competent patient care is jeopardized because of staffing changes implemented in response to managed care.

    To ensure the adequate protection of patients in acute care settings, it is essential that qualified registered nurses be accessible and available to meet the individual needs of the patient.

    The basic principles of staffing in the acute care setting should be based on the patient's care needs. The severity of condition, services needed, and the complexity surrounding those services.

    Current unsafe hospital registered nurse staffing practices has resulted in adverse patient outcome.

    Direct care registered nurses must be able to advocate for their patients without fear of retaliation from their employer.

    Whistle blower protections that encourage registered nurses to notify government and private accreditation entities of suspected unsafe patient conditions; including protection against retaliation for refusal of unsafe patient care assignments by competent registered nurse staff will greatly enhance the health, welfare and safety of patients.

    Direct care RNs have an irrevocable duty and right to advocate on behalf of their patient's interest and this duty & right shall not be encumbered by cost-saving schemes.

    UNIFORM STATEWIDE STANDARDS

    1. Direct Care Registered Nurse Planning and Implementation of Hospital
    Patient Care


    Essential Functions of a Direct Care RNs: A direct care RNs, employing scientific knowledge and experience in the physical, social and biological sciences, and exercising independent judgment in applying the nursing process, shall directly provide:
    (a) Continuous and ongoing patient assessments of the patient's condition based upon the independent professional judgment of the direct care RN; (b)The planning, implementation and evaluation of nursing care provided to each patient, including the implementation of advocacy intervention based on the direct care RN independent professional judgment.

    Determining Nursing Care Needs; the nursing care needs of individual patients shall be determined by a direct care RN through the process of ongoing patient assessments, nursing diagnosis, formulation and adjustment of nursing care plans.

    Independent Judgment; Competent performance of the essential functions of a direct care RN requires the exercise of independent judgment in the interests of the patient. The exercise of such independent judgment, unencumbered by the commercial or revenue generation priorities of a hospital and/or employing entity of a direct care RN, is essential to safe hospital patient nursing care.

    2. Direct Care RNs are Professional Employees
    The exercise of independent professional judgment in assigning and clinical supervision of nursing personnel by a direct care registered nurse shall not disqualify the direct care registered nurse as a professional employee.

    3. Direct Care Registered Nurse Patient Advocacy - Professional Duty of Patient Advocacy

    Professional Obligation; an RN has the professional obligation and therefore the right to act as the patient's advocate.

    Acceptance of Patient Car Assignments; the RN is always responsible for providing safe, competent nursing care to assigned patients.


    Acceptance of Orders; the direct care RN shall assess each medical order before implementation to determine if the order is: (a) in the best interests of the patient; and (b) initiated by a person legally authorized.

    Free Speech - Whistle Blowing - Patient Protection; all direct care registered nurses responsible for patient care in a hospital facility shall enjoy the right of free speech, such as reporting unsafe practices or violations of statutes and/or regulations, without fear of retaliation; and shall be protected in the exercise of that right both during working hours and during off-duty hours.

    Collective Patient Advocacy; engaging in acts of collective patient advocacy shall constitute an exercise of the direct care RN duty and right of patient advocacy.

    Direct care RN professional responsibility; reversal of the "safe harbor provisions and reinstatement of the statutory rights against retaliation for refusing unsafe assignments.

    4. Minimum, Specific, and Numerical Direct Care Registered Nurse-to-
    Patient Staffing Ratios by Clinical Unit for Acute Care Hospitals

    (a) Unit-specific direct care registered nurse-patient ratios for all shifts at all times

    Additional direct care registered nurses and other licensed and unlicensed nursing personnel shall be assigned through the implementation of a patient classification system (PCS).

    (b) The direct care registered nurse-to-patient ratios are;
    Intensive/Critical Care 1:2;
    Neonatal Intensive Care 1:2;
    Operating Room 1:1;
    Conscious sedation 1:1;
    Post-anesthesia Recovery 1:2;
    Labor and Delivery 1:1;
    Ante partum 1:3;
    New Born Nursery 1:2;
    Postpartum couplets 1:3;
    Postpartum women
    only 1:4;
    Pediatrics 1:3;
    Emergency Room 1:4;
    ICU patients in the ER 1:2;
    Trauma
    patients in the ER 1:1;
    Step Down & Telemetry 1:3;
    Medical/Surgical 1:4;
    Other
    Specialty Care 1:4;
    Psychiatric 1:4;
    Rehabilitation Unit & Skilled Nursing Facility 1:5

    (c) Restrictions on Use of Unlicensed Assistive Personnel (UAP)

    Prohibits the use of a UAP lieu of a direct care RN
    UAPs shall not perform RN functions under the direct care RN supervision

    5. Enforcement

    Fines for Violating Employee Whistle Blowing Rights; Acute care hospital and any person that violates employee rights under this Act shall be subject to civil penalties.

    Ratios Violation Fines; any acute care hospital that violates any provision dealing with direct care RN-to-patient ratios shall be subject to civil penalties.

    http://www.calnurses.org/nnoc/texas/...mmary_1106.pdf
    http://www.calnurses.org/nnoc/texas/
  9. by   Sheri257
    Quote from 1Tulip
    Hi folks,

    I've written this on similar threads so I apologize if I'm being redundant.

    Listen, mandatory ratios can be an illusion. Here is what will happen. The hospitals will be forced to hire 25% more RN's. (That's certainly good.) But then you will lose your transport aides, your unit clerks, the pharmacy techs, the mobile admissions nurses, almost all therapists (I work on neuro and doing with fewer PT/OT/Speech Therapy would be a killer... literally.) You will be doing your jobs and everything your CNA's are currently doing. If you want supplies in the middle of your shift, you may have to go to central supply and get it yourself.

    Our hospital is in a financial crunch (aside... hospital administration is an oxymoron...) and they've instituted a hiring freeze. BUT... they hasten to add, they are not sacrificing any bedside nurses. However... the kitchen is now only open 10 hours a day. If it's 3 AM and you don't have another liter of Jevity or Glucerna... well, the tube feed won't resume until the next shift. The floors in the patient's rooms are sticky. Sinks and toilets are not cleaned except between admissions. Our dirty utility room stinks. If we run out of paper for the printer... tough, you better hope the other printer on the unit has some in it. Most patient supplies are now warehoused off campus (and actually in a nearby town!) so if you run out of non-skid sox, or suture removal kits, or even SUCTION CATHETERS!!! (happened last week) you either won't have them until later in the week or you have to steal them from another pt's room.

    Listen... unless those patient ratio laws are written very, very carefully... nurses (and patients) are going to be SOL. And always remember, the Hospital Association pays for way more lobbyists (and junkets and campaign contributions) than nurses do. And even if you get the law you think you want, the HA's will have had a hand in crafting the language of the bill.

    It's a really nice dream, folks, but a dream nevertheless.
    From your other posts, it doesn't look like you live in California. Nevertheless, I'm sure some of those things are happening in some hospitals, but I know for a fact they are not in others. I don't think you can judge the success of the law by just one hospital or, even, one unit.

    In the past, I've been criticized for pointing out that as a student, I did clinicals/externships in a bunch hospitals. Afterall, what did I know: I was "only" a student. But how else do you get to see whether the ratio law was working first hand in a variety of facilities and units.

    I have yet to see nurses having to work a Med Surg or Tele floor without CNA's, unit clerks, etc. except for Kaiser where their ratios are lower than the law requires ... 4:1 instead of 5:1 but, the lower ratios did seem to make up for it. There are other hospitals like Riverside Community that cut aides during a labor dispute but, I don't know if that continued once the contract was resolved.

    Nevertheless, the list of hospitals that I saw with aides, unit clerks, PT's, RT's, etc. was much longer: San Antonio, Arrowhead, St. Mary's, Community Hospital of San Bernardino, St. Bernadine's, Desert Valley Hospital. In addition to clinicals and preceptorship, I also worked at two of those hospitals and never saw them cut back on aides, etc. either the whole time I worked there. For units like ICU, PACU, ER and Peds, they didn't have aides but, from what I was told, most of those units didn't have aides before the law either.

    Now maybe it was different on other Med Surg and Tele floors because I wasn't on all of them in every facility, but for the floors I was on ... there weren't any major cutbacks on support staff that I saw in those hospitals.

    Some hospitals had problems with supplies, others didn't. Some hospitals had problems with housekeeping, others didn't. To me, at least, it really depended on the management and, in particular, the manager of that floor.

    If you had a great manager, it really wasn't much of an issue other than the occassional bad day for housekeeping, etc. If the manager sucked then ... basic things like supplies and equipment weren't taken care of. Pretty much the same thing you run into with different floors and facilities anywhere.

    I certainly learned that a job can still suck, even with ratios, if the management of the hospital and, that unit in particular, is really bad. A ratio law is not going to be a panacea for bad management, that's for sure. This is why I've just taken an ER job where the ratios are down to 3:1, below what the law requires at 4:1. I don't know how this manager pulled it off but, that's why I'm working for her.

    But I still think that, overall, the ratio law has improved things. Every California floor nurse I know loves the ratio law.

    :typing
    Last edit by Sheri257 on Mar 30, '07
  10. by   West_Coast_Ken
    Quote from 1Tulip
    Listen, mandatory ratios can be an illusion. Here is what will happen. The hospitals will be forced to hire 25% more RN's. (That's certainly good.) But then you will lose your transport aides, your unit clerks, the pharmacy techs, the mobile admissions nurses, almost all therapists (I work on neuro and doing with fewer PT/OT/Speech Therapy would be a killer... literally.) You will be doing your jobs and everything your CNA's are currently doing.
    That's exactly why a ratio law is not simplistic. It is written in such a way as to enforce safe staffing and not allow a back door for aministration to pull this kind of BS.
  11. by   glasgow3
    Quote from West_Coast_Ken
    That's exactly why a ratio law is not simplistic. It is written in such a way as to enforce safe staffing and not allow a back door for aministration to pull this kind of BS.

    Simplistic? I'll tell you about simplistic staffing.

    Back in the 1990s many of the hospitals hired consultants for the purpose of "redesigning" staffing patterns. They would follow the nurses with stopwatches as though they were actually going to capture the essense of a hospital staff nurse's day in such a manner. But only "hands on" activities were considered in the actual care hours recommended in their final reports. And time to admit patients, discharge patients, complete paperwork, answer questions, assist with codes, restart IVs, assist that elderly patient with their pills, get up a 500 lb patient etc, etc etc-----all these were considered non recurring events and therefore received virtually no consideration in the determination of recommended care hours.

    To this day, many hospital's staffing "grids" are based upon this idiocy. And those grids are, of course, in no way binding. Not enough staff as called for by the grid?----just do the best you can you'll be told. UNTIL something goes wrong, that is, and blame must be assigned.

    Minimum staffing ratios are necessary because acuity based systems can be fudged or the results ignored altogether. I wish I had a dollar for every acuity bubble sheet filled out by RNs in the USA which were subsequently ignored; My wealth would probably rival that of Bill Gates.

    Staffing is an subject which has been studied in great depth over the years. All stakeholders know that a minimum level, a "floor" if you will, can be determined for the various levels of care. It's high time that hospitals provide at least that staffing level or suffer financial consequences for failing to do so.
  12. by   ZASHAGALKA
    duplicate post.
    Last edit by ZASHAGALKA on Mar 31, '07
  13. by   ZASHAGALKA
    I just don't see it in Texas.

    If you want to be politically successful, then you have to understand your political environment.

    CALIFORNIA was the perfect place to start this trend.

    TEXAS is not going to be a trendsetter on this issue. There is a healthy and just fear and skepticism of any government interference here. You would likely find that many bedside nurses, like me, are against just such tactics.

    Nurses don't need a law to embrace ratios. We need a strong organization that will encourage enough nurses to insist upon ratios that the concept cannot be ignored. In THAT way, there would be no concern about how or if hospitals would write or weasle out of the rules.

    Unfortunately, neither TNA or ANA is that organization.

    I'm just being realistic. 250 nurses out of a state with more than a quarter million nurses is not enough to even report about. Unless, it fits an agenda separated from the concept of reality.

    I am in Texas. I full well understand that the political environment, to include the politics of many bedside nurses, will not support this. It's a non-starter.

    Show me 25,000 Texas nurses, instead of 250 clamoring for this concept, and THEN we can talk about the viability of the idea.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Mar 31, '07
  14. by   Sheri257
    Quote from ZASHAGALKA
    250 nurses out of a state with almost a million nurses is not enough to even report about. Unless, it fits an agenda separated from the concept of reality.

    I am in Texas. I full well understand that the political environment, to include the politics of many bedside nurses, will not support this. It's a non-starter.

    Show me 25,000 Texas nurses, instead of 250 clamoring for this concept, and THEN we can talk about the viability of the idea.

    ~faith,
    Timothy.
    Just FYI Timothy but, Texas has about 180,000 nurses, not a million. A million nurses would be really high even for California, which has about 340,000 RN's.

    ftp://www.bne.state.tx.us/06-co-rn.pdf

    :typing

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