Ratio question

[275Main]

I was wondering how the ratios in California have influenced your patient care? Do you feel that you can take better care of your patients? Have a lot of hospitals moved towards "primary nursing" in order to cut corners financially? The idea of state mandated patient ratios is appealing to me (having 5 patients sounds better to me than having 7 or 8 patients on a telemetry unit) but it might be a case of the grass is greener on the other side.

[pickledpepperRN]

Well first it is against the intent of the ratio law to institute total patient care with the minimum ratios.

Total patient care basically means NO HELP. Some hospitals are trying ti di that.

Primary Nursing replaced 'Functional Nursing' at my hospital in the late 1970s. We had a medication nurse, treatment nurse, IV nurse, and so on. Primary nursing increased the percentage of RNs who would be responsible for 'Primary Patients'. Associate nurses followed the plan of care developed by the primary nurse when the primary nurse was not on duty, evaluating and changing the plan as needed.

At my hospital the ratios are 100% RN with LVNs, CNAs, clerks, and monitor observers as determined by the patient classification system (PCS) which we still call acuity.

An example is that we need an extra LVN when there are MANY more routing PO meds or dressing changes. If a patient needs a sitter that requires another nursing assistant. Very heavy patients who cannot move themselves, diarrhea, and other routine bur time consuming care also requires another CNA. Our charge nurse is not to be assigned patients so she can relieve us for breaks and coordinate the unit.

This is not to say it ALWAYS works that way. One night we got 4 admits. One was very disoriented, pulling out the IV and so on. We had to have a CNA stay with the patient ) (this is telemetry).

Our charge nurse (not me I only float there) had to assign herself four of the five patients. Clearly the other patients did not get ideal care.

Here are links to the regulations:

Kathy

http://ccr.oal.ca.gov/cgi-bin/om_isapi.dll?clientID=301513&E22=title%2022&E23=70215&E24=&infobase=ccr&querytemplate=%261.%20Go%20to%20a%20Specific%20Section&record={609F1}&softpage=Browse_Frame_Pg42

http://www.calnurse.org/finalrat/ratio7103.html

http://www.leginfo.ca.gov/pub/99-00/bill/asm/ab_0351-0400/ab_394_bill_19991010_chaptered.pdf

http://www.calnurse.org/finalrat/ratio7103.html

http://www.rn.ca.gov/news/news.htm

http://www.dhs.ca.gov/