Pennsylvania Lawmakers Consider Nurse-Patient Ratio Legislation

brookeashm · Aug 16, 2008

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

rabbitgirrl · Feb 28, 2009

Rest of the story here...

http://www.rwjf.org/humancapital/digest.jsp?id=9562

Source: http://www.afscme.org/workers/68.cfm

NurseyBaby'05, BSN, RN · Feb 28, 2009

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 · Feb 28, 2009

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? ), 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 · Feb 28, 2009

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).

Home Health Columnist / Guide · Mar 1, 2009

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 · Mar 1, 2009

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.

s1shaw · Apr 2, 2009

Eight to Ten Patients....I had 20 Rehab patients the other night. One new admit, new orders for over 1/2 of the patients and a night nurse that came on and said that if she had to do all the orders she was leaving. So I didn't get out of there until 1am...no breaks and no lunch...and again I question...what is safe standards???? Oh sure, they can tell us what is safe for the patient...What I want to know is...WHAT IS SAFE FOR US, THE NURSES???...

Also, if I am mandated to stay an extra 8...so I would be there from 2:30pm to 7:30 or 8:00am...should I have to come back in at 2:30pm??? Isn't there a law that we are to have as much time off between shifts as we have worked...example...worked 16+...should we have at least that much off before the next shift??? Maybe I'm just getting old...lol

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).

311ltc · May 11, 2009

I'd like to see ratio changes in LTC/ALF also. We deal with people not objects. Just can't set them aside and finish with them later. It's hard to provide quaility care when you can have 30 to 40+ people to care for.

allnurses Guide · Jun 22, 2009

more nurses equals better care
...i've been a registered nurse for 33 years, and for the last 10 have worked in a busy emergency room. as president of our state's largest professional rn union, i have the opportunity to speak to a lot of nurses from hospitals all over the state. they report that their patient loads can be 10 extremely ill patients on a general medical floor. for our patients, this presents an unsafe and unfair situation. after all, we expect to go into a hospital to get better, not be the casualty of a serious error caused by inadequate staffing. ...
...the good news is that we know how to fix this problem. the pennsylvania association of staff nurses and allied professionals, affiliated with the national nurses organizing committee, is sponsoring vital legislation in pennsylvania (sb 742, the pennsylvania hospital patient protection act of 2009) and nationally that will guarantee a minimum safe-staffing ratio of rns per patient in our hospitals.
no longer will rns have to go home after work and wonder if they forgot a vital medication or treatment, and no longer will patients lack appropriate nursing care....
http://www.philly.com/dailynews/opinion/20090622_more_nurses_equals_better_care.html

text of the bill:

http://www.legis.state.pa.us/cfdocs/legis/pn/public/btcheck.cfm?txttype=pdf&sessyr=2009&sessind=0&billbody=s&billtyp=b&billnbr=0742&pn=0837

tebird65 · Jun 23, 2009

I have been hearing rumblings about a "strike" or "work stoppage" next month. Does anyone have any info about this? I need to rearrange my vacation plans if my hours are not going to be there.

Gabriel13 · Oct 12, 2009

To the original post by Kathy moving to Erie...

My father recently had a heart attack last month and was taken to St. Vincent's Hospital in Erie. I came that night to see him in the CCU. I was quite impressed with the care he received there. The CCU was more like a CTICU. There was a 2:1 ratio on that unit, and that unit appeared well staffed and the rooms looked modern and well equipped. Later he was transfered to a stepdown unit. It was probably a telemetry unit but it might of been a med-surg floor. The nurses there had a 8:1 ratio! I was confounded. I did hear that the nurse did have a PCA with her assignment, so I'm sure that's a tremendous help, but I still think that 8 patients is insane and potentially dangerous. The other major hospital in Erie is Hamot, but I don't know about the ratios there. Hope this helps and good luck!