RNs Strike Over Staffing-Kaiser Los Angeles

allnurses Guide · May 2, 2015

I'm not a Kaiser nurse. Many of my family members are Kaiser patients.

I was visiting a loved on on a telemetry unit a couple years ago. There was no assigned monitor observer. Nurses, including the charge nurse tried to watch the monitors as much as possible.

Yesterday a Kaiser nurse told me that it is not uncommon for nurses to be assigned five telemetry patients, but the ratio is four or fewer patients per nurse. Sometimes the charge nurse is expected to provide break relief and watch the monitors. The nurse told me she just doesn't take a break in her 12 1/2 hour shift.She keeps breakfast bars in her pocket to eat on the sly and drinks water and coffee.

I think because nurses generally do the best they can, and their best is amazingly good tragic outcomes are rare.

Still I think that hospital should have learned that shorting on staff to care for patients and watch the monitors is "Penny Wise and Pound Foolish":

No wonder nurses don't take their breaks. Read what happened at least once:

http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567KaiserFoundation-LA-RSQI11-LACounty.pdf

MatrixRn · May 9, 2015

I think many people are having a hard time wrapping their minds around this strike.

I watched the clip of the nurse speaking and she gave zero concrete information as to why they should be striking. She said Kaiser was hurting care but did not say how or why. She went on to say nurses "almost never" strike because of money. I do not have to reach far to find examples of nurses striking for money in CALI or elsewhere.

Next in the video she states she is striking due to pt ratios. All of us who do not work in CALI know that they have the best patient ratios in the country. So how/why is she so desperate or are we really that far under water with what is happening on our floors in the other 49 states?

You Said "I was visiting a loved on on a telemetry unit a couple years ago. There was no assigned monitor observer. Nurses, including the charge nurse tried to watch the monitors as much as possible.

Yesterday a Kaiser nurse told me that it is not uncommon for nurses to be assigned five telemetry patients, but the ratio is four or fewer patients per nurse. Sometimes the charge nurse is expected to provide break relief and watch the monitors. The nurse told me she just doesn't take a break in her 12 1/2 hour shift.She keeps breakfast bars in her pocket to eat on the sly and drinks water and coffee."

All of what is described above is normal when I worked tele.

As to the ratios. We had 6 patients for day shift and 12 for nights. That does not make it right but it is normal.

Last, I think many of us were hoping that the staffing ratios of CALI would also be applied to the other states at some point and that has just not happened. The high wages and plum ratios [by other state standards] have remained a CALI benefit.

allnurses Guide · May 11, 2015

I wish all hospitals staffed by California ratios.

Unfortunately too many California hospitals try to get away with violating their requirements.

I wish everyone who ran a red light, drove too fast, drove while texting or otherwise distracted would be caus=ght. There would be fewer accidents, injuries, and fatalities if the driving laws were obeyed all the time.

I think hospitals get away with it once and then it becomes the norm. it is still a violation of the law. There would be fewer nococomial infections and deaths due to "Failure to Rescue" if hospitals obeyed the law.

Title 22 Section 70217: https://govt.westlaw.com/calregs/Document/I8612C410941F11E29091E6B951DDF6CE?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=%28sc.Default%29

Section 70215: https://govt.westlaw.com/calregs/Document/IFD69DB90621311E2998CBB33624929B8?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=%28sc.Default%29

With decreased CMS compensation for readmissions within 30 days, ventilator associated pneumonia, bloodstream and other nosocomial infections, and other complications safe staffing ratios save lives and are cost effective

These hospitals may think they are saving money when following the law, including the requirement to provide additional staff to meet the needs of each patient (ACUITY) is more cost effective:

Quality and Cost Analysis of Nurse Staffing, Discharge Preparation, and Postdischarge Utilization
Marianne E. Weiss, Olga Yakusheva, and Kathleen L. Bobay; Health Research and Educational Trust, April 2011
This study extends previous health services research on the impact of nurse staffing on patient outcomes of hospitalization by linking the unit-level nurse staffing directly to post discharge readmission and indirectly through discharge teaching process to patient readiness for discharge and subsequent ED visits. Findings support recommendations to (1) monitor and manage unit-level nurse staffing to optimize impact on post discharge outcomes, (2) implement assessment of quality of discharge teaching and discharge readiness as standard pre-discharge practices, and (3) realign payment structures to offset costs of increasing nurse staffing with costs avoided through improved post discharge utilization.
The Impact of Medical Errors on 90-Day Costs and Outcomes: An Examination of Surgical Patients
William E. Encinosa and Fred J. Hellinger, Health Services Research, July 2008
A new study published in the journal Health Services Research found that the large difference in calculations for medical error expenses might mean that interventions to increase patient safety â€” like adding more nursing staff â€” could be more cost-effective than previously reported. The study found that insurers paid an additional $28,218 (52 percent more) and an additional $19,480 (48 percent more) for surgery patients who experienced acute respiratory failure or post-operative infections, respectively, compared with patients who did not experience either error. Preventing these and other preventable medical errors would reduce loss of life and could reduce healthcare costs by as much as 30 percent, the researchers said. Many hospitals are struggling to survive financially,â€ study co-author William Encinosa, senior economist at the Agency for Healthcare Research and Quality, said in a statement. The point of our paper is that the cost savings from reducing medical errors are much larger than previously thought.â€ Pointing to previous research that looked at the business case for improving RN staffing ratios, the researchers concluded: It is quite possible that the post-dscharger costs savings achieved by reducing adverse events might just be enough for the hospital to break-even on the investment in nursing.â€
Nurse Staffing and Patient, Nurse and Financial Outcomes
Lynn Unruh, PhD, RN, AJN, January 2008
This report provides a comprehensive literature review of more than 21 studies published since 2002 that, according to the author, underscore the importance of hospitals acknowledging the effect nurse staffing has on patient safety, staff satisfaction, and institutions' financial performance.â€ According to the report, the evidence clearly shows that adequate staffing and balanced workloads are central to achieving good patient, nurse, and financial outcomes. Efforts to improve care, recruit and retain nurses, and enhance financial performance must address nurse staffing and workload. Indeed, nurses' workloads should be a prime consideration. If a proposed change would improve care and also reduce excessive (or maintain acceptable) workloads, it should be implemented. If not, it shouldn't be.â€
Hospital Nursing and 30-Day Readmissions Among Medicare Patients With Heart Failure, Acute Myocardial Infarction, and Pneumonia
Medical Care: January 2013
Improving nurses' work environments and staffing may be effective interventions for preventing readmissions. Each additional patient per nurse was associated with the risk of within 30 days of readmission for heart failure (7%), myocardial infarction (9%), and pneumonia (6%). In all scenarios, the probability of patient readmission was reduced when nurse workloads were lower and nurse work environments were better.â€
State-Mandated Nurse Staffing Levels Lead to Lower Patient Mortality and Higher Nurse Satisfaction
Agency for Healthcare Research and Quality, September 26, 2012
The California safe staffing law has increased nurse staffing levels and created more reasonable workloads for nurses in California hospitals, leading to fewer patient deaths and higher levels of job satisfaction than in other states without mandated staffing ratios. Despite initial concerns from opponents, the skill mix of nurses used by California hospitals has not declined since implementation of the mandated ratios.
Nurse Staffing and Inpatient Hospital Mortality
New England Journal of Medicine, March 17, 2011
"Studies involving RN staffing have shown that when the nursing workload is high, nurses' surveillance of patients is impaired, and the risk of adverse events increases." "â€¦ We found that the risk of death increased with increasing exposure to shifts in which RN hours were 8 hours or more below target staffing levels or there was high turnover. We estimate that the risk of death increased by 2% for each below-target shift and 4% for each high-turnover shift to which a patient was exposed."
Implications of the California Nurse Staffing Mandate for Other States
Health Services Research, August 2010
The researchers surveyed 22,336 RNs in California and two comparable states, Pennsylvania and New Jersey, with striking results, including: if they matched California state-mandated ratios in medical and surgical units, New Jersey hospitals would have 13.9 percent fewer patient deaths and Pennsylvania 10.6 percent fewer deaths. Because all hospitalized patients are likely to benefit from improved nurse staffing, not just general surgery patients, the potential number of lives that could be saved by improving nurse staffing in hospitals nationally is likely to be many thousands a year,â€ according to Linda Aiken, the study's lead author. California RNs report having significantly more time to spend with patients, and their hospitals are far more likely to have enough RNs on staff to provide quality patient care. Fewer California RNs say their workload caused them to miss changes in patient conditions than New Jersey or Pennsylvania RNs
Overcrowding and Understaffing in Modern Health-care Systems: Key Determinants in Meticillin-resistant Staphylococcus Aureus Transmission
Lancet Infectious Disease, July 2008
This study finds that understaffing of nurses is a key factor in the spread of methicillin-resistant Staphylococcus aureus (MRSA), the most dangerous type of hospital-acquired infection. The authors note that common attempts to prevent or contain MRSA and other types of infections such as requirements for regular and repeated hand washing by nurses are compromised when nursing staff are overburdened with too many patients.