Question about union and ancillary staff

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Specializes in OBGYN, Neonatal.

Hey all, another question for you - I've been told and want to clarify. I've been told that in states where there is a union mandated ration i.e. one nurse to four couplets, that nurse has no ancillary help at all and that nurse is responsible for hearing screens, birth certificates, newborn screens, and everything else that goes along with being a couplet. That if you are guaranteed that ratio of no more than four couplets then those nurses do not have any additional help and they are responsible for their own vital signs, trays, etc.

The vital signs and trays are nothing new to me as we do all that ourselves anyway but we do have someone that does our birth certificate and hearing stuff for us. We do our own newborn screening unless we are fortunate enough to have someone available to help and we have 5+ couplets normally with 5 being the average.

Just wanted to make sure if that was the case or if it was something passed down through the grapevine. If it is true, do you feel that with hvaing only four couplets you can do all those other things without the need for ancillary staff?

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I think that it depends on the RN union & the ancillary staff union (if they have one). The RN union, which is really the staff themselves, may have agreed to a much lower ratio and no ancillary help. However in my experience it seems that ultimately if the work load on an RN is too great, then grievances can be filed. After all ratios do not replace patient acuity systems which indicate the level of care needed. Ratios are the Minimum requirement.

Also, if the ancillary staff is union, they have more job security and therefore are less likely to be fired.

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Specializes in OBGYN, Neonatal.
I think that it depends on the RN union & the ancillary staff union (if they have one). The RN union, which is really the staff themselves, may have agreed to a much lower ratio and no ancillary help. However in my experience it seems that ultimately if the work load on an RN is too great, then grievances can be filed. After all ratios do not replace patient acuity systems which indicate the level of care needed. Ratios are the Minimum requirement.

Also, if the ancillary staff is union, they have more job security and therefore are less likely to be fired.

I guess my thinking is wondering if that is true or just a way to deter anyone from thinking union. I'm not really of any opinion yet as far as a union goes and we don't have any talk of it. But I think from nurses complaining about ratio's someone decided to bring up that if we had gauranteed ratios then we'd have zero help. Strange though!

Also where I work we do not have an acuity rating. They do not take acuity in to consideration with our assignments. A couplet is a couplet reglardess of whether the mom has meds/baby as meds, mom needs blood or is on mag, etc. So that stinks in my opinion b/c more and more moms are not your normal delivery. And we have a LOT Of c-sections.

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Specializes in L&D.

It's only been the last 6-7months that my mb unit had any ancillary staff. It just wasn't needed. Personally, I would rather go back to my 4 couplets with no ancillary staff than have our 5 couplets with ancillary staff. Although, if we are lower census, my unit cancels the ancillary staff anyway, but I found it much less stressful to have just 4 couplets tops.

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The California law requires a patient acuity system. This is also one important part of the ANA sponsored bill. Just wanted to put that out there so anyone can look it over and take action if they choose to support safe staffing & nursing decisions.

Lots of Pro's & Con's, please look it over before you make a decision.

http://safestaffingsaveslives.org/

One last note... as nurses we are told we are professionals, we talk like we are professionals, the research & work we do is no less than any other profession. We would defend a patient's rights to the hilt, and yet put up with a lot of bad behavior by our management & co-workers. Organizing your peers with or without a union is an important part of being a team as well as a professional. I recommend reading some of Suzanne Gordon's books on communicating what we know as well as "Crucial Confrontations: Tools for Resolving Broken Promises, Violated Expectations, and Bad Behavior".

Maybe this will help you to talk to your peers & managers about the unsafe situations you have on your unit.

Godspeed

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Specializes in OB - L&D, M/B & Nursery.
Hey all, another question for you - I've been told and want to clarify. I've been told that in states where there is a union mandated ration i.e. one nurse to four couplets, that nurse has no ancillary help at all and that nurse is responsible for hearing screens, birth certificates, newborn screens, and everything else that goes along with being a couplet. That if you are guaranteed that ratio of no more than four couplets then those nurses do not have any additional help and they are responsible for their own vital signs, trays, etc.

The vital signs and trays are nothing new to me as we do all that ourselves anyway but we do have someone that does our birth certificate and hearing stuff for us. We do our own newborn screening unless we are fortunate enough to have someone available to help and we have 5+ couplets normally with 5 being the average.

Just wanted to make sure if that was the case or if it was something passed down through the grapevine. If it is true, do you feel that with hvaing only four couplets you can do all those other things without the need for ancillary staff?

The 4:1 M/B couplet is not a union mandated ration it is an AWHONN guideline. A union has nothing to do with it. AWHONN recommends safe guidelines and it is up to the hospital to enforce them. 5:1 is not acceptable except in situations where you are so busy and short staffed that it is necessary. But this should not be an every day thing. Read the AWHONN guidelines - they are posted here at the top of the page. At the hospital in which I work we have two Techs that are trained to do hearing screens, blood sugars, first time out of bed, baths, etc. as well as taking vitals. We believe that a nurses time is too valuable to do things that ancillary personnel can do under our supervision. We also have a person who is strictly responsible for collecting birth certificate information and filing it with the state. We are a unionized hospital but unions are not always the answer. They do help oversee the hospital to make sure they are following the AWHONN guidelines, however, and give the nurses a voice in how things are run. It depends upon the union and how much time they are willing to invest in you. The more I read some of these posts, the more I realize how good we really have it in our hospital. I wish the whole staff could read them. I have suggested they subscribe so they can get a feel of what is happening in the rest of the country.

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Specializes in OB - L&D, M/B & Nursery.
I guess my thinking is wondering if that is true or just a way to deter anyone from thinking union. I'm not really of any opinion yet as far as a union goes and we don't have any talk of it. But I think from nurses complaining about ratio's someone decided to bring up that if we had gauranteed ratios then we'd have zero help. Strange though!

Also where I work we do not have an acuity rating. They do not take acuity in to consideration with our assignments. A couplet is a couplet reglardess of whether the mom has meds/baby as meds, mom needs blood or is on mag, etc. So that stinks in my opinion b/c more and more moms are not your normal delivery. And we have a LOT Of c-sections.

We consider our ancillary staff part of our "family" and treasure them. The only time one of them is fired is for serious infractions of the rules. I have only seen one tech fired in all the time we have had them. Also, we do not consider a couplet is a couplet. If a patient is on Mag she is usually 1:1 or 1:2 M/B at the most. Also, the NICU is responsible for caring for all babies 35 weeks and under, regardless if they are in the NICU or out with mom. Acuity is definitely one thing we try to always take into consideration. There are never any "guaranteed ratios" as we all know that there are times when the bus drops off a load of preggos and, no matter how many nurses you have, it's not enough. We try very hard to stick to the 3:1 or 4:1 M/B couplets. We occasionally have an LPN on the floor to help give out meds & do secondary assessments - in our hospital an LPN cannot do an admission or initial assessment. We have just recently hired two "Discharge Nurses" who will be doing all of the discharge paper work, reinforce teaching, giving bath classes, etc. We are very big on patient education and I think these discharge nurses will be a big help to the staff. EVERY hospital has a lot of c/s - I think the national average is approaching 50% as rates go up for the physicians. We do have a lot of c/s for "failure to wait", when the doctor wants to go home for dinner or has some place to go that evening. But I think that's the same all over. Our girls really need to read these posts to see how good we have it where we work. :chuckle

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