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Pennsylvania Lawmakers Consider Nurse-Patient Ratio Legislation

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Specializes in MICU, neuro, orthotrauma. Has 7 years experience.

I am moving to Erie by fall this year, and am wondering what the staffing ratio is in med-surg, tele and ICU.

Erie area numbers are perfect, but I am curious about any ratios in PA.

Thanks!

kathy

When I worked as an Aide for a large Pittsburgh area health system, it was not uncommon for nurses to have ten patients.

This was a Med-Surg floor. Once a week I saw nurses with tears in their eyes.

geekgolightly, BSN, RN

Specializes in MICU, neuro, orthotrauma. Has 7 years experience.

When I worked as an Aide for a large Pittsburgh area health system, it was not uncommon for nurses to have ten patients.

This was a Med-Surg floor. Once a week I saw nurses with tears in their eyes.

That is frightening.

My raio is half that. Once in three years I have had 6 patients instead of 5, and it was due to severe staffing issues. My manager apologised and thanked us for that day as well.

I work in Kansas City.

I have seen nurses in a Philly suburb hospital have 8 on first shift. Then the other day in the same hospital they had 4pts on first shift. So it varies alot.

geekgolightly, BSN, RN

Specializes in MICU, neuro, orthotrauma. Has 7 years experience.

I hope that there are better numbers, and that these are exceptions to the rule :uhoh3:.

I have been considering ICU and if med-surg is this poorly staffed, I will diligently work on getting an ICU position. Unless of course they stak ICU with 3 and 4 pt each.

I've worked in ICUs where there was a three pt assignment. There is no law in PA mandating ratios. You get what you get and hope it doesn't get worse.

K98

Specializes in He who hesitates is probably right....

The nursing staff at AGH in Pittsburgh are unionized, and negotiated nurse-patient ratios as part of their labor agreement. The ICUs are 1-1 or 2-1, I'm not certain what the telemetry and medical-surgical floors are. My daughter works for the DarkSide, and they have no ratios. Assignments are heavy and mandation is common.

ChristineN, BSN, RN

Specializes in Pediatric/Adolescent, Med-Surg.

The nursing staff at AGH in Pittsburgh are unionized, and negotiated nurse-patient ratios as part of their labor agreement. The ICUs are 1-1 or 2-1, I'm not certain what the telemetry and medical-surgical floors are. My daughter works for the DarkSide, and they have no ratios. Assignments are heavy and mandation is common.

Mandation from the"Darkside?!" I work for the Darkside and was under the impression they can not mandate? *confused*

K98

Specializes in He who hesitates is probably right....

That's news to me. My daughter was mandated last week. Twice.

I graduate in May and I was wondering what you mean by mandate? Do they force you to work a double if there is a call off? But you are only allowed to work 16hr/24hr period right?

ChristineN, BSN, RN

Specializes in Pediatric/Adolescent, Med-Surg.

That's news to me. My daughter was mandated last week. Twice.

I would suggest you encourage her to check her policy and procedure manual on the topic. My boss would try to mandate, but we knew that it was against "darkside" policy and did not fall for it.

geekgolightly, BSN, RN

Specializes in MICU, neuro, orthotrauma. Has 7 years experience.

I interviewed with the two major hospitals in Erie and one of them has a medsurg ratio of 8+ on nights and 6+ on days. I don't know the numbers for the other hospital; I never asked. I was interviewing for ICU positions at both hospitals.

The ICU's, OTOH are 1:2 unless they are on CRRT or other intensive monitoring and needs and then it's 1:1. They do stack higher, but only with tele or floor orders that are awaiting transfer. One of the hospitals has a charge nurse without patients and one has the charge nurse take patients. I chose the one with a free charge nurse. That hospital also seemed to be more into teaching in general, which I appreciate and need at this point as I will be new to ICU nursing.

i work in a hospital about 2 hours outside of pittsburgh. normally our ratio is 5-6 per nurse. the other night i did have 6 patients and covered 4 patients for an LPN

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 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.

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,

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