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Pennsylvania Lawmakers Consider Nurse-Patient Ratio Legislation

Posted

Specializes in Stepdown, ECF, Agency.

NurseyBaby'05, BSN, RN

Specializes in Neuro/Med-Surg/Oncology.

My gripe is that SEIU is trying to make the numbers cut and dried, black and white. The objective of ancilary staff is not being addressed. Yes, I may only have five patients, but there's no aide, one person in pharmacy (for the whole 800+ bed hospital), only one person in central supply and he can't leave to deliver your equipment (Yet, when there were three people earlier when the supplies were ordered, why didn't they send it then? :rolleyes: ), no secretary, etc. I still won't be able to provide good care to those patients b/c I'm forced to wear too many other hats. When the hospital has to comply with specific ratios for nurses, they just cut corners somewhere else. Until that issue is addressed, the ratio numbers won't mean a lot and SEIU refuses to aknowledge that.

Edited by NurseyBaby'05

Mahage, LPN

Specializes in IMCU. Has 1 years experience.

My gripe is that SEIU is trying to make the numbers cut and dried' date=' black and white. The objective of ancilarry staff is not being addressed. Yes, I may only have five patients, but there's no aide, one person in pharmacy (for the whole 800+ bed hospital), only one person in central supply and he can't leave to deliver your equipment (Yet, when there were three people earlier when the supplies were ordered, why didn't they send it then? :rolleyes: ), no secretary, etc. I still won't be able to provide good care to those patients b/c I'm forced to wear too many other hats. When the hospital has to comply with specific ratios for nurses, they just cut corners somewhere else. Until that issue is addressed, the ratio numbers won't mean a lot and SEIU refuses to aknowledge that.[/quote']

Yeah, I think any legistlation needs to be mindful of all that. I also think that ratios should be determined based on acuity. We have functioned without a secretary on nights and we sometimes don't even have an aide or the aide has 21 pts to care for. We may have as many as 3 vented patients with all that goes along with those pts such as isolation, diarrhea, bed sores, tube feedings and our managers seem to have little concern about the ability of one nurse to handle such a load. Another nurse may have 3 patients who are only on our unit because they need monitored beds and are up with bathroom privileges. Something is bad wrong with this, I keep putting it in my comments everytime they give us one of those surveys to fill out, but seems to go unnoticed. I could take care of 3 vented pts with issues if I have good tech support, but if the tech is non existent or has 21 pts to care for, then it is next to impossible. Thank goodness we do have great respiratory support.

I wouldn't even begin to know how to utilize a secretary because we never have had one.

Mahage

ChristineN, BSN, RN

Specializes in Pediatric/Adolescent, Med-Surg.

I just finished doing a paper on PA nurse-to-patient ratios for my ethics class. It's interesting how at first ratios seem like such a great idea (especially if you have 8-10 or more patients), but once you realize that they may not be thinking about secretaries, CNA's, or other ancillary staff, you begin to realize there could be problems. I think that in order for a law to be passed that will actually work, there needs to be good input from floor nurses telling Harrisburg that we need our support staff, and we need a flexible ratio (flexible based on acuity).

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

prior hb171 introduced in 2007-2008 legislative session introduced by rrp. solobay, never made it out of health and human services (hhs) committee:

hb 171 amends the health care facilities act, further providing for purposes & duties of the dept. of health, for admin & licensure; for public disclosure of staffing requirements; for license standards; & for medical assistance payments. sets specific patient-to-nurse staffing ratios based on the type of care needed in a particular hospital or care unit. ratios would range from 1:1 in emergency trauma room and or; 1:2 in critical care, pacu and l+d units; 1:3 ed; 1:4 med surg/ acute psych; 1:5 rehab, up to 1:6 in postpartum and well-baby nursery units.

solobay’s legislation includes grant programs to encourage more students in nursing education programs.

hb 147 health care facilities act, again referred to hhs committee.

the staffing plan must incorporate, at a minimum,

the following direct-care nurse-to-patient ratios:

(i) one nurse to one patient: operating room and

trauma emergency units.

(ii) one nurse to two patients: all critical care

areas including emergency critical care and all intensive

care units, labor and delivery units and postanesthesia

units.

(iii) one nurse to three patients: antepartum,

emergency room, pediatrics, step-down and telemetry

units.

(iv) one nurse to four patients: intermediate care

nursery, and medical/surgical and acute care psychiatric

units.

(v) one nurse to five patients: rehabilitation

units.

(vi) one nurse to six patients: postpartum (three

couplets) and well-baby nursery units.

(vii) for any units not listed above, including

psychiatric units in facilities other than acute care

hospitals, the direct-care nurse-to-patient ratio as

established by the department.

(3) the ratios set forth in paragraph (2) shall

constitute the maximum number of patients that may be

assigned to each direct-care nurse in a unit during one

shift. a nurse, including a nurse administrator or

supervisor, who does not have principal responsibility as a

direct-care nurse for a specific patient shall not be

included in the calculation of the nurse-to-patient ratio....

appropriate license required.--for purposes of

compliance with the minimum staffing requirements standards set

forth under section 806(h), no nurse shall be assigned, or

included in the count of assigned nursing staff in a nursing

department or unit or a clinical area within the health facility

unless that nurse has an appropriate license under the

applicable registered nurse law, received prior orientation in

that clinical area sufficient to provide competent nursing care

to the patients in that area, and has demonstrated current

competence in providing care in that area. hospitals that

utilize temporary nursing agencies shall have and adhere to a

written procedure to orient and evaluate personnel from these

sources to ensure adequate orientation and competency prior to

inclusion in the nurse-to-patient ratio....

2/26/09, pasnap press release

state senate introduces bill to protect pennsylvania's patients and nurses,

C-DIFF PHIL RN

Specializes in icu/er ccrn.

to bad the legislation here in good ole mississippi don't seem to care about this issue unless it's their family member in the unit. But it wont affect them, cause the hospital will be pulling nurses and techs,clerks etc.. from all over to make a strong showing.

wonderbee, BSN, RN

Specializes in critical care; community health; psych.

Wow, we currently have 1:15 on our acute care psych unit. That would send shivers up my facility's spine to have a 1:4 ratio.

ChristineN, BSN, RN

Specializes in Pediatric/Adolescent, Med-Surg.

Wow, we currently have 1:15 on our acute care psych unit. That would send shivers up my facility's spine to have a 1:4 ratio.

I know psych is different than the medical setting but 1:15?!? Wow, that is too many

nicurn001

Specializes in Psych , Peds ,Nicu.

Nursing by acuity seems a good idea , but who assesses the acuity of the patients , my experience is that although the bedside nurse inputs the scores , if the floor management , thinks they should be different , they change the scores and amazingly , always so that there is a lower number of bedside RN's .

Who sets the Acuity tool parameters ? , again on this if the acuity tool doesn't provide the staffing numbers management want to pay for ,the tool is changed . Again so that a lower number of RN's are needed .

Whether you use a acuity based system or a Staff Ratio law to set staffing levels , management will use it to manipulate staffing , to their benefit . If management feels in either system that the nuring budget is too high , they will cut nursing hours . If you do not have a staff ratio law they can and will cut both RN's and ancillary staff . If you have a ratio law they cannot reduce the RN hours to unsafe levels .

Although I would prefer that no staff was cut , I believe it is better for patients to be cared for by RN's , if I have to accept that a few more tasks are directed at me , it is part of the bargain , because on balance it is my experience I have more time to care for my patients , also my total workload is not as bad , as prior to ratios.

rabbitgirrl

Specializes in Stepdown, ECF, Agency.

"Wow, we currently have 1:15 on our acute care psych unit."

Now, thats crazy! Does this include the administrators that think that's an OK ratio?

rabbitgirrl

Specializes in Stepdown, ECF, Agency.

My gripe is that SEIU is trying to make the numbers cut and dried' date=' black and white. The objective of ancilarry staff is not being addressed. Yes, I may only have five patients, but there's no aide, one person in pharmacy (for the whole 800+ bed hospital), only one person in central supply and he can't leave to deliver your equipment (Yet, when there were three people earlier when the supplies were ordered, why didn't they send it then? :rolleyes: )[/quote']

Yes, I have experienced this syndrome, too. Clearly, we need whole-facility based ratios, but I do believe that nursing ratios is a step in the right direction.

herring_RN, ASN, BSN

Specializes in Critical care, tele, Medical-Surgical. Has 49 years experience.

There is another bill:

State Senate Introduces Bill to Protect Pennsylvania's Patients and Nurses

...The bill is mirrored on a highly successful California law that has brought more RNs into the workforce...

...The Pennsylvania RN ratios would require minimum ratios by unit, with increased staffing when needed based on the severity of patient illness....

http://www.pennanurses.org/news/2009/PA_Senate_Ratios.html

bsg rnc

Specializes in Maternal Child. Has 29 years experience.

You would think a smaller n/p ratio would be more cost effective.

Example: Pt turned more often preventing bed sores. Hospital aquired bed sores are no longer reinbursed by Medicare thus hospital foots the bill. One more nurse/shift could prevent this and really make a cost SAVINGS! Duh, what a concept. By heaping it on already strained staff, newer nurses flee the hospital adding to the already known shortage, another duh. In my facility the mantra is

"bring it in at or under budget or you are fired". Do the administrators watch too much "Apprentice"?

ChristineN, BSN, RN

Specializes in Pediatric/Adolescent, Med-Surg.

You would think a smaller n/p ratio would be more cost effective.

Example: Pt turned more often preventing bed sores. Hospital aquired bed sores are no longer reinbursed by Medicare thus hospital foots the bill. One more nurse/shift could prevent this and really make a cost SAVINGS! Duh, what a concept. By heaping it on already strained staff, newer nurses flee the hospital adding to the already known shortage, another duh. In my facility the mantra is

"bring it in at or under budget or you are fired". Do the administrators watch too much "Apprentice"?

At my last place of employment managers periodically got bonuses for coming in under budget. The easiest way to under budget was not to replace staff.

PeaceonearthRN

Specializes in cardiac, psychiatric emergency, rehab.

I just wrote to a friend of mine at the state before reading these posts but after reading the article about the legislation. I explained that it's not just ratios but the acuity of the patients.. telemetry .. two getting blood, two post ops.. , two on drips.. with pcu status etc.

After my wonderful hospital experience, you'd better believe I'd be willing to testify in harrisburg. I hope this gets a lot more press!

rabbitgirrl

Specializes in Stepdown, ECF, Agency.

I just wrote to a friend of mine at the state before reading these posts but after reading the article about the legislation. I explained that it's not just ratios but the acuity of the patients.. telemetry .. two getting blood, two post ops.. , two on drips.. with pcu status etc.

After my wonderful hospital experience, you'd better believe I'd be willing to testify in harrisburg. I hope this gets a lot more press!

I am glad you will and I hope you do get to testify. I hope there is a whole sea of nurses there, inside and out of the building, whenever this sort of legislation comes up for debate.

PeaceonearthRN

Specializes in cardiac, psychiatric emergency, rehab.

If I have the day off, I will BE THERE!!

I have seen enough of hospital abuse; it is TIME for it to end and time for nurses to stop shouldering the load! I am ready for this!

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