Safe Staffing Ratios for Massachusetts?

Boston-RN, RN · Jul 14, 2005

as a student nurse in MA, this is good to see

What's with the "patients first" ads against staffing ratios? Can anyone explain it?

pickledpepperRN · Jul 14, 2005

as a student nurse in MA, this is good to see
What's with the "patients first" ads against staffing ratios? Can anyone explain it?

I googled it.

It is a cynical attempt to confuse the public. Massachusetts Hospital Association (MHA) seems to be fighting safe staffing.

Here in California the CHA wanted to be trusted with great flexibility. Well if they could be trusted we wouldn't have had to work so hard educating politicians about nurse staffing.

It is the industry. Remember patients are admitted to the hospital for NURSING CARE. That is all!

The moment they no longer need the care of a nurse they are discharged. Minimum nurse to patient ratios ensure the minimum required. Don't fall for this smokescreen!

http://www.patientsfirstma.org/

http://www.patientsfirstma.org/about.shtml

pickledpepperRN · Jul 14, 2005

Oh my, the American Nurses Association is part of the smokescreen!

http://www.massnurses.org/News/2002/safestaff/survey.htm

MNA Takes Issue With ANA's Response to Crisis

Opposes ANA's Industry-Friendly Staffing Legislation

The MNA is concerned about model legislation that was unveiled by the American Nurses Association in conjunction with the release of its survey data.

Specifically, the MNA is concerned that the ANA has not joined them in calling for legislation mandating safe staffing levels and nurse-to-patient ratios, similar to what has been proposed on the state level in Massachusetts and passed in California.

Instead, the ANA is proposing that its member states file a staffing bill that not only is very weak, but that also contains a provision that could accelerate the current staffing crisis.

First, the ANA-proposed staffing bill merely calls for health care facilities to establish their own patient classification systems, with no mandate to adhere to the standards they create. The bill appears to codify into law requirements similar to those already made of hospitals by the Joint Commission on the Accreditation of Health Care Organizations (JCAHO).

"This is a weak and totally ineffective approach to the problem their own survey so poignantly demonstrated," said Garlick. "Their suggested staffing legislation only calls upon the industry to develop their own standards for measuring staffing. This approach amounts to putting the fox in charge of the hen house. If we could trust the industry to staff safely and appropriately, we wouldn't be in the crisis we are in. Hospital staffing must be regulated."

The MNA is joined in their position by Dr. Lucien Leape, the nation's leading authority on preventable medication errors, and one of the authors of the Institute of Medicine's groundbreaking report on medication errors. Leape has stated his support for regulation of staffing ratios to prevent medical errors, and has called for a legal ban on mandatory overtime.

Even more concerning to the MNA is the inclusion of a clause in the proposed ANA staffing bill that would allow hospitals to experiment with "alternative methods of assuring adequate staffing." The MNA is appalled that such language has been included as it is specifically designed to allow hospitals to reintroduce workplace redesign "schemes" that result in the replacement of licensed nurses with lesser qualified unlicensed aides and technicians.

It was the introduction of these types of "alternative methods" of staffing that caused the deskilling (replacing licensed nurses with unlicensed personnel) and the subsequent speed up of the RN workforce, which has created this unprecedented shortage of nurses throughout the U.S.

The MNA has spent more than a decade successfully fighting against these plans, which have been proven to have disastrous results for nurses and, more importantly, for patients.

"If passed into law, this could be the most dangerous piece of nursing legislation in the history of our profession," said Julie Pinkham, RN, MNA Executive Director who is a nationally recognized expert and speaker on the dangers of so called "alternative models of care.

"We are talking about sanctioning by law the health care industry's right to experiment with patient care models that do away with nurses. This legislation is so objectionable and anti-nurse, one would have thought it was written by the American Hospital Association, not the American Nurses Association.

Boston-RN, RN · Jul 19, 2005

Oh my, the American Nurses Association is part of the smokescreen!

I'm not sure if you're being sarcastic or not. I am new to the field and live in MA and plan on staying here. I would love to get some honest opinions of those in the field without the spin.

I seems obvious that staffing ratios would be a good thing. I've just heard these radio ads about "letting nurses care for patients their way" or something to that effect. When I get out and vote on whatever legislation gets put together I would like to know from the trenches which is actually the best bet.

pickledpepperRN · Jul 19, 2005

As a California nurse I think ratios ensure at least a minimum standard.

I hope and pray that patients everywhere get the nursing care they need. I think safe staffing ratios should be required everywhere. Thus I support nurses who work for ratios through their organizations.

I get notices from my search engine when articles including the words "nurse to patient ratios" or "Nursing ratios" are new on the web.

When reading about your state doing this I was VERY pleased.

Then the hospital industry put out its own lame bill that would allow the "flexibility" the industry wants. That way they could continue to staff to the budget instead of patient needs.

We in the CNA voted for independance from the ANA because they supported restructuring and deskilling. Ine recent years I've been reading very good policies and opinions from the ANA so yes, I was surprised and disappointed they would publicly side with the industry against safe staffing ratios.

I had hoped direct care nurses would have control of policy, not just a "voice".

Here is what the industry is doing - http://www.massnurses.org/News/2005/07/july13_2.htm

gizelda196 · Jul 27, 2005

WE also broke off from the ANA.(MA)I have followed what the ANA has been advocating and at this point I believe our break was the correct decision.

I have been emailing legislators regarding the MHZ bluff about patients first blah blah I also emailed the MHZ about my own issues with there campaign after my own father was admitted to a surgical floor after emergent surgery (at my own hospital)And I was shocked to here that they all still cared for 7-8 patients at a time.I left the "floors" for ICU 3 1/2 years ago. I left the floors because of the patient load and the crap that went on at Pam when half the nurses where on 8 hour shifts and the other half were on 12 hours shifts and at Pam you where told to float to another floor to fill a gap( 4p-8p). So by Pam you had already dc,transferred,admitted and cared for a total of 8-10 patients .and now you have to document on all them,report off, and go to another floor and start with a whole new assignment for 4 hours. I couldn't do that "kind "of nursing any longer.The icu is no better .At times we are tripled.We have no ancillary staff,We provide all care for our patients,labs,EKG's,transport,baths. meds and we have to answer the phone and buzz people into our unit and put orders into the computer.Some times we are blessed with a secretary or a tech and they are soooooooooo appreciated when we get them.Most time it is just 3 nurses and 6-8 patients.

Any hoot I was just wondering how the ratios are going in CA. Ma typically follows right behind Ca. Is it better? Are the ratios enforced? Have the hospitals provided ancillary staff? thanks

As a California nurse I think ratios ensure at least a minimum standard.
I hope and pray that patients everywhere get the nursing care they need. I think safe staffing ratios should be required everywhere. Thus I support nurses who work for ratios through their organizations.
I get notices from my search engine when articles including the words "nurse to patient ratios" or "Nursing ratios" are new on the web.
When reading about your state doing this I was VERY pleased.
Then the hospital industry put out its own lame bill that would allow the "flexibility" the industry wants. That way they could continue to staff to the budget instead of patient needs.
We in the CNA voted for independance from the ANA because they supported restructuring and deskilling. Ine recent years I've been reading very good policies and opinions from the ANA so yes, I was surprised and disappointed they would publicly side with the industry against safe staffing ratios.
I had hoped direct care nurses would have control of policy, not just a "voice".
Here is what the industry is doing - http://www.massnurses.org/News/2005/07/july13_2.htm

pickledpepperRN · Jul 27, 2005

I went to critical care more than 20 years ago because they had the ratio of 1:2 or fewer patients per licensed nurse at all times.

At our hospital, and I hear at others most units are staffed adequately on most unit and most shifts.

We have a secretary from 7:00 am to 11:00 pm. We have two aides day shift and one on nights. Our charge nurse has no patient assignment. When census id high we get a break relief nurse.

I often float to telemetry. Before the ratios our Professional Practice Committee (PPC) worked for years to try to get that unit and the med-surg units staffed safely.

For a few months before the law went into effect my hospital prepared. Most shifts were staffing to the ratios from the start. We did prevent a plan to eliminate LVNs and nursing assistants so as to "afford" RNs to meet the ratios.

We wrote a letter basically quoting the law and asking management to respond to our recommendations in writing as they must do per our contract.

The letter was signed by all but one RN, our terrific LVNs, CNAs, monitor techs, secretaries, some physicians, respiratory therapists, and one housekeeper (Oops EVS technician).

Now the tele unit has a charge nurse without patients for each nurses station. The ratio is 1:5 or 1:4 according to acuity for telemetry patients and 1:3 for "step-down" patients who are usually on a vent.

For each two RNs a CNA or LVN will be assigned by the charge nurse. Sometimes for extra high acuity an RN-LVN team will care for 3-5 patients depending on acuity.

When the floor is full there will be a break relief nurse. I've done this when my critical care unit had a low census because we sent our patients to tele.

I did the checks. Then took report and made rounds on all the patients of one RN. I was able to do whatever was needed. When she returned I gave her a short report about what happened.

Next took report on another patient. After everyone had taken a meal break and a rest break I admitted two patients from the ER. Of course all of us help with IV starts, pulling up patients in bed or to the bathroom and so on.

We have a GREAT night supervisor who works for safe staffing. If a unit is not staffed according to regulations she always finds someone, whether one of our own or registry.

Nurses on one unit complain that when ***** is off they are short staffed. They even try to find out her schedule to work when she is on.

The PPC members try to teach these nurses that they can insist like tele did. None of them have even attended a PPC meeting yet. They complain among themselves but since most nights they do have the minimum safe staffine they just keep quiet.

This is sad for them and their patients.

I imagine some hospitals are complying quite well. Others are not. It is hurtful that the governot continues to behave as though the need to staff safely is an emergency. His attack on nurses encourages the greedy hospital administrations.

Dave11, BSN, RN · Jul 28, 2005

can someone explain something to me?

what happens when the floors reach the patient-staff ratios mandated by the law and more patients that need to be admitted come into the ER? what happens to the nurse-patient ratio in the ER? the 1:3 ratio mentioned in the article is a nice dream, but that is all it is. setting ratios like that is only going to do one of two things. increase the wait time or get everybody calling 911 for the most minor problems to try and circumvent the wait.

as it is, the floors slow us to a crawl more often than not because of staffing issues. we end up tying up 25-35% of our beds with admission holds. meanwhile, the city ambulances, private ambulances and walk-ins keep pouring in.

maybe i'm just super dense, but i dont see how mandated ratios are going to make life any better.

pickledpepperRN · Jul 28, 2005

I don't have a copy of your bill.

In California we have a 1:4 ratio for ER. The triage RN may assist but not have a patient assignment. Same with the 'radio nurse' if your hospital is a base station. Critical care and other patients held in the ER awaitind admission must be staffed by competent nurses at the same ratio as if they were in theunit they are to be admitte to. Acute trauma is 1:1.

Hospitals need to show they staff to historical need.

That includes planning for the flu season.

There is a temporary relaxation of the ratios during a staffing emergency. This is defined as and unpredictable, unplanned, unavoidable emergency. This emergency must be reported to the DHS. They may decide to temporarily divery ambulances or have the hospital postpone elective surgery.

It is NOT considered an emergency if there are empty beds in the ICU, a nurse is cancelled (whether an extra shift or expen$ive regi$try), and ICU patients are held in the ER. Then when patients come in to the ER the nurses have no choice but to care for the ER patients AND the ICU holds.

There is NO excuse to hold patients in the ER when there are beds upstairs.

I don't believe it when management sayd they "can't" find a nurse.

Does that ever happen during a JCAHO visit?

Oh hospitals are now creating "clinics" near the ER. The triage nurse may send those who don't need nursing care there.

One HMO run ER used to have a "Surgical Trauma" where the most common diagnosis was "ingrown toenail". This diagnosis without co-morbidities, as assessed by the triage RN, is part of the clinic staffed by an MD, a tech, and a clerk.

If a patient needs to be assigned to a nurse they are admitted to the ER and must be staffed according to the ratios.

I hope and believe your bill also has ER ratios. The ER must not become the holding area because they won't staff the units adequately.

Anyone have a link to the actual bill?

gizelda196 · Jul 28, 2005

It is NOT considered an emergency if there are empty beds in the ICU, a nurse is cancelled (whether an extra shift or expen$ive regi$try), and ICU patients are held in the ER. Then when patients come in to the ER the nurses have no choice but to care for the ER patients AND the ICU holds.
There is NO excuse to hold patients in the ER when there are beds upstairs.
IN our ICU we have 15 beds. 2-3 nurses on(we have no staff,we have international nurses and travel nurses making up the bulk of our staff).We are maxed at 4-6 patients. Most of the time we have no secretary,no tech, not even an aide. we have empty beds ,but this are no nurses to take care of patients that would be put in them.As a staff nurse at times I am the only staff person their. This means I am in charge I have a 2 patient assignment,I am also the ONLY resource available to the travel nurse who needs to know where everything and who to call and so on. and the international nurse who depending on who it is I cant understand. the doctor cant understand or the pharmacist cant understand so guess who picks up that slack with a 2 patient assignment already and no tech and the phones are ringing off the hook .So I think that would be a reason why the ER needs to hold that ICU patient. WE are in need of a safe patient nurse ratio that also includes ancillary staff to pick up things we cant.

pickledpepperRN · Jul 29, 2005

It is NOT considered an emergency if there are empty beds in the ICU, a nurse is cancelled (whether an extra shift or expen$ive regi$try), and ICU patients are held in the ER. Then when patients come in to the ER the nurses have no choice but to care for the ER patients AND the ICU holds.
There is NO excuse to hold patients in the ER when there are beds upstairs.
IN our ICU we have 15 beds. 2-3 nurses on(we have no staff,we have international nurses and travel nurses making up the bulk of our staff).We are maxed at 4-6 patients. Most of the time we have no secretary,no tech, not even an aide. we have empty beds ,but this are no nurses to take care of patients that would be put in them.As a staff nurse at times I am the only staff person their. This means I am in charge I have a 2 patient assignment,I am also the ONLY resource available to the travel nurse who needs to know where everything and who to call and so on. and the international nurse who depending on who it is I cant understand. the doctor cant understand or the pharmacist cant understand so guess who picks up that slack with a 2 patient assignment already and no tech and the phones are ringing off the hook .So I think that would be a reason why the ER needs to hold that ICU patient. WE are in need of a safe patient nurse ratio that also includes ancillary staff to pick up things we cant.
You are right. Your staffing is not safe. I don't know what it's like in the ER. The patients need to be cared for somewhere.
I was rewferencing a hospital that before ER ratios would call off a nurse who was scheduled to work in ICU. They would make the ER hold the patient all day.
With ratios the ER has to staff critical care patients at 1:2 too. The hospital has to use it's staff. No more calling off expensive registry nurses or those willing to work an extra shift.
Here are the proposed ratios for Massachusetts:
http://www.massnurses.org/safe_care/toolkit/story2.htm
Intensive Care Unit: 1:2
Critical Care Unit 1:2
Neo-natal Intensive Care 1:2
Burn Unit 1:2
Step-down/Intermediate Care 1:3
Operating Room RN as Circulator 1:1
RN as monitor in moderate sedation cases 2:1
Post Anesthesia Care Unit Under anesthesia 1:1
Post Anesthesia 1:2
Emergency Department 1:3*
Emergency Critical care 1:2*
Emergency Trauma 1:1* * The triage, radio, or other specialty registered nurse shall not be counted as part of this number.
Labor and Delivery Active Labor 1:1
Immediate Postpartum 1:2 (one couplet)
Postpartum 1:6 (three couplets)
Intermediate Care Nursery 1:4
Well-Baby Nursery 1:6
Pediatrics 1:4
Psychiatric 1:4
Medical and Surgical 1:4
Telemetry 1:4
Observational/Out patient treatment 1:4
Transitional Care 1:5
Rehabilitation Unit 1:5
Specialty Care Unit, any unit not otherwise listed above shall be considered a specialty care unit 1:4
These ratios shall constitute the minimum number of direct-care registered nurses. Additional direct-care registered nurses shall be added and the ratio adjusted to ensure direct-care registered nurse staffing in accordance with an approved acuity-based patient classification system. Nothing herein shall be deemed to preclude any facility from increasing the number of direct-care registered nurses.