trita

Here is a good article about hospitals meeting ratio requirements (Where there is a will, there is a way!) Some Hospitals Met Nurse Ratios By Jia-Rui Chong Los Angeles Times February 6, 2005 http://www.latimes.com/news/local/la-me-hospitals6feb06,0,3488447.story Though the hospital industry has insisted it was all but financially impossible to meet the state's strict nurse-to-patient ratios, a number of hospitals have been able to do it without breaking their budgets. About 36% of the hospitals inspected by the state's Department of Health Services passed their surveys, according to a Times review of state data from the first 10 months of last year. That's more than the 15% compliance rate that the California Healthcare Assn. has estimated based on its survey of 300 institutions. The findings come as the Schwarzenegger administration and major hospitals are trying to scale back the ratios in California, which was the first state in the nation to limit the number of patients a nurse can treat. Though most of the hospitals inspected by the state did not meet the ratio standards, those that did offer a lesson in balancing the financial burden of hiring more nurses with the benefits of complying with the law. The hospitals that have been able to meet the ratios vary in size and location, from a 70-bed public facility in Banning to a 540-bed medical center run by UC San Diego. But they tend to have several things in common: * Many have been able to make up the costs of more nurses by renegotiating rates with private insurance companies or persuading insurers to send more patients their way. * Most are in relatively good fiscal health, with a median net income of about $10 million for 2003. Only two facilities reported losses for 2003. * Officials at some hospitals say they have less trouble recruiting than other medical centers because their facilities have nationally known specialties and they work hard to keep their nurses happy. Their rates for turnover and job vacancy are lower than state averages, which both hover around 15%. The hospitals also tend to have low rates of using temporary nurses. Many have the added perk of being in attractive locations: pretty seaside towns, for instance, or areas with affordable housing. The numbers of patients that nurses are allowed to handle are based on the severity of patients' illnesses. In an operating room, for example, each patient is required to have a nurse. In a medical-surgical ward, one nurse can care for six patients. The nurse-patient ratio law took effect in January 2004. But Gov. Arnold Schwarzenegger's administration has moved to scale it back, citing complaints from hospitals. Schwarzenegger wants to give hospitals more flexibility in emergency rooms during unexpected surges of patients. He also wants to delay implementation of a second phase of the law that would further reduce nurse-to-patient ratios. The department inspects hospitals only when it receives a complaint, and it had completed reports on nurse staffing at just 28 hospitals by October. A Times review of those reports showed that 10 hospitals complied with the law. One of those hospitals was UC San Diego Medical Center, which was accused of assigning nurses too many patients in the orthopedics department in January. When a state inspector reviewed records in February, she found nothing wrong. Mary Middleton, the hospital's chief nursing officer, said she manages the situation by having her office count heads at the units every four to six hours. She also constantly tries to predict influxes of patients by the time of day, day of the week and weather. For instance, she said, clusters of patients often show up after 5 p.m. because clinics close at that time. People often arrive Monday because they wait for doctors' offices to open on the first work day of the week and then find out they need care at the medical center. When it rains, she added, there usually are more car accidents, so she beefs up intensive care units. If a unit needs a nurse, Middleton said, she tries not to use temporary nurses - who cost on average about $65 an hour, compared to $40 an hour for a staff nurse. If staffing officials determine that a unit needs more nurses, they begin by calling part-time nurses who work only on certain days and full-time staffers who might want to earn overtime pay. Robert Hogan, the hospital's chief financial officer, said it has cost an extra $10 million to meet the ratios. Administrators found the money by renegotiating contracts with private insurance companies to reimburse at 6% to 10% more than they did before. Hogan said the hospital also expected to make up some of the money by economizing on supplies. But even facilities that have done well in meeting the ratios insist that they struggle to do so, and say they may not always have the numbers right every hour of every day. Passing an inspection can be "luck of the draw," said Jennifer Jacoby, who oversees nursing at Sharp Mary Birch Hospital for Women in San Diego, which also passed a state inspection. "If they come in and say, 'Show me staffing schedules for April 5 and 10,' it can be great on the 5th and 10th and not on the 11th," she said. Indeed, two other hospitals she oversees at the same campus, Sharp Memorial Hospital and Sharp Mesa Vista Hospital, did not pass the state review. Jacoby said she set down the same nursing rules for all three sites. One policy that has helped Mary Birch is shifting some scheduled nurses to "on-call" status when there are not as many patients as expected. If, for instance, four nurses were scheduled to work, but managers found that three could handle the load, the fourth could leave and return when new patients came to the unit. This nurse would receive a lower rate of pay when she was off-campus, but would receive full salary if she had to come back. Jacoby said Mary Birch had several strategies for paying the $2.3 million in added costs for nurses to meet the ratios. As an example, she said, the hospital was able to persuade insurers to send more women to give birth at Mary Birch because the free-standing women's hospital handles a high volume of births and has specialized staff and equipment to handle difficult deliveries. A state inspection of Glendale Memorial Hospital for staffing has not been completed, but the nursing union and the Hospital Assn. of Southern California say the hospital has become a model for complying with the ratios. The facility has added about $1 million to the budget - including creating two positions just to monitor the ratios - to pay for the new staffing law, said Patrick Lash, chief financial officer. The hospital will make less money this year than the $6 million in profit last year, but will remain on the plus side, he said. Like UC San Diego, Glendale Memorial has been able to stanch most of the loss by negotiating higher reimbursement rates from private insurance companies. Lash said the hospital, which is part of Catholic Healthcare West, also plans to reduce some costs by buying supplies in bulk with other network hospitals and paying less for services such as legal consultations. Glendale's low usage of traveling and local registry nurses helps keep the costs of the ratios in check, officials said. Fewer than 1% of the nurses at work on a given day come from temporary agencies, said Rhoda Vincent, who oversees nursing for the hospital. Vincent said the facility has been able to hire 340 full-time nurses and has to cover for only 36 vacancies. "We have to make sure our nurses are happy," Vincent said. "We have a low turnover rate - 0.2% for this past year - so I think we are." Though the 36% compliance rate for meeting the ratios is more than the hospital association found, it is far less than the 80% estimated by the nurse union that pushed for the law. Though both sides stand behind their statistics, they acknowledge that the state's inspections are a useful snapshot of hospital compliance. Jan Emerson, spokeswoman for the California Healthcare Assn., said state reports don't tell the whole story. Inspectors pulled only selected records during their visits and looked at just a fraction of the 450 hospitals licensed in the state, she said. Jill Furillo, who is Southern California director for the California Nurses Assn. and lobbied for the ratio law, said nurses monitoring 175 hospitals have told her that far more facilities were in compliance than the state found. "What the data is showing and what our information is showing is, where there is a will, there is a way to meet the ratios," she said. Hospital staffing A Times review of state data from the first 10 months of 2004 revealed that 10 of 28 hospitals inspected for nurse staffing were complying with the law: Desert Regional Medical Center in Palm Springs Petaluma Valley Hospital in Petaluma Riverside Community Hospital in Riverside San Gorgonio Memorial Hospital in Banning Scripps Memorial Hospital in Chula Vista Sharp Grossmont Hospital in La Mesa Sharp Mary Birch Hospital for Women in San Diego Sutter Solano Medical Center in Vallejo Ukiah Valley Medical Center in Ukiah UC San Diego Medical Center Source: California Department of Health Services

We have been successful in getting a bill INTRODUCED that has good minimum staffing levels and accounts for acuity -- which both would assure more nurses working. However, it will take lots of hard work in order to actually get the bill PASSED. In the meantime, the staffing disclosure law that has passed (after much hard work) will help by: 1. making the public and health care employees aware of various ratios, so they can better choose a hospital 2. providing evidence that we can use in our fight to get staffing ratios passed. To see the entire staffing bill that has been introduced (including specified ratios) into the New Jersey State legislature, go to http://www.hpae.org, click on "legislative upfdate", then click on "Staffing bill".

"Union" means coming together, uniting, backing each other. In order to have the legal protection that forces management to live up to agreements, you have to get a contract. In order to have good networking, communication, support, back-up, etc., it will take at least some money. If you don't trust the unions that already exist, you can form your own, independent union. (Nurses at Englewood Hosp in NJ did this). It takes lots of time and effort, but can have real successes. But you will have to have some kind of funds (dues?) and then the nurses that benefit from all your hard work 10-15 years later will probably complain about you just wanting their money ....

On Monday, January 24, 2005, NJ Acting Governore Cody signed the Staffing Disclosure Bill. This bill requires posting each shift of the patient census, # of RNs actually doing patient care, as well as the # of specific ancillary personel. This information must be made available to the public and must be collected and turned into the Department of Health (DOH). Nurses from HPAE worked hard on this - as a first step toward actually obtaining good, mandated ratios. The full bill can be viewed at http://www.hpae.org. Click on "Legislative Update", then click on the staffing disclosure bill. The bill now goes to the DOH to work on rules and regulations for implementation scheduled to start in 6 months.

On Monday, January 24, 2005, NJ Acting Governore Cody signed the Staffing Disclosure Bill. This bill requires posting each shift of the patient census, # of RNs actually doing patient care, as well as the # of specific ancillary personel. This information must be made available to the public and must be collected and turned into the Department of Health (DOH). Nurses from HPAE worked hard on this - as a first step toward actually obtaining good, mandated ratios. The full bill can be viewed at http://www.hpae.org. Click on "Legislative Update", then click on the staffing disclosure bill. The bill now goes to the DOH to work on rules and regulations for implementation scheduled to start in 6 months.

Yes, I have heard the hospitals are putting out a lot of untrue propaganda and scare tactics. The California Nurses' Association has been refuting these -- but, of course that is not what gets publicized. From my understanding, the one or two hospitals that have closed since the ratios started were tiny and would have closed anyway. Individual nurses cannot be held liagble for taking breaks -- the hospitals can be held liable for not staffing well enough to take breaks into account. Hospitals always cry about the "nursing shortage", but the truth is there is no shortage of nurses with an RN license. The shortage is because many RNs have chosen to not work at the bedside - or to severely cut back hours - due to conditions. If they know the conditions are better and nursing can properly be practiced, more will return to the bedside and up their hours. I will look up some facts and post them soon - so maybe you can give them to your friend.

i know some nurses at virtua memorial in burlington if you would like to contact them.

Yes! That is what I was referring to. I will be there!

New Jersey state government is divided into 40 districts. Each district has one State Senator and two State Assembly members. You should write to all three in the district where you live to tell them why you support the safe staffing law. If you are in Monmouth County, you could be in the 10th, 11th, 12th, or 13th district, depending on your town. You can email me directly at [email protected] with your town & I will give you the names and addresses of your representatives. Also the League of Women Voters has this information at http://www.lwvnj.org and the state government website at http://www.nj.gov. (But sometimes the information is not easy to find.) I also have pre-printed postcards to send to legislators. I will let people know when there will be testimony. The dates are not set yet.

That is great that you are writing a letter about this! The legislators need to hear from more nurses. Of course, the Hospital Association opposes ratio legislation - and they make that known to the legislators. I know nurses who have sent post cards and testified and can get more information about that if anyone wants. Let me know. The proposed legislation in NJ is similar to California as far as no more than 6 patients for med-surge per RN to start, then going to 5 patients per RN after one year. This is at ALL times - so that means more than the minimum scheduled to cover for breaks, etc. Let me know if you know anyone who would actually like to testify. Also, FYI, for anyone who lives near Philadelphia, author Suzzanne Gordon, who writes about nurses will be speaking at a free forum to help nurses learn how to speak better about nursing issues to the general public -- in order to get more support for better laws, contracts, and policies to improve conditions for nurses and patients.

A union is not a business, it is a membership organization. If you think your organization should be doing more or different things, then you need to raise that at meetings, etc. If you think you can do a better job for less than 1%, then you should raise that in meetings and put forth a budget. HPAE was formed by RNs at Englewood Hospital & the leadership are RNs. Each hospital elects its own officers and negotiates its contract with help and support from the broader group. A Jersey Shore RN took a pay cut to work full time for the union. If not for unions, management would mandate overtime without paying anything extra (unions fought for the overtime laws - now some politicians are trying to do away with it.)

Have you checked out the HPAE website at http://www.hpae.org? Besides information about the union at each hospital, there is also information about staffing legislation, etc.

Just reading old threads and wondering if you have graduated and started at Jersey Shore?

undefined Just wondering if people know about the staffing disclosure bill that was passed by the NJ state legislature last month. Also, staffing ratio bills have been introduced in both the state Senate and state Assembly, but nurses are needed to write letters, postcards, and emails to legislators, etc. so we can get this passed.