Safer staffing? Your wish is my command.

[Joe V]

Nurses are desperate for safer staffing. Which is more impossible: Asking a Genie in a bottle to grant your wish or getting State and Federal legislators to pass safer staffing laws?

[BeenThere2012, ASN, RN]

Safe staffing laws have been in place in California. Somehow, it still feels like we are understaffed. Most hospitals where I have worked, do not utilize CNAs on the floors or in ICUs...I don't know if that is good or bad but I believe because of other issues we still feel under-staffed.

I hope that other states will adopt safer staffing laws. If so, I hope they do not compensate by eliminating other staff to make up the difference in cost as has been done in California.

[BeenThere2012, ASN, RN]

I should give examples: Because of the safe staffing laws, they provide a break relief nurse. One nurse to provide all breaks cannot

provide all the breaks during the shift unless someone takes their break 45 minutes after starting their shift or 45 minutes before the end. Does that make sense? Then, you must take your break when the relief nurse comes around, no matter what you are in the middle of, or else she writes you down for refusing your break (that is so the hospital is not fined for failure to provide break relief). In theory, the relief nurse is supposed to take over your duties, but obviously they can't do your charting for you, and frequently are also used to help with other things, and therefore rarely does any of the work left behind. In any case, we were also floated either 4 hours after the start of shift, or for the last 4, and often weren't told until the last minute, so charting became an urgent issue and then report, before you could float, so no breaks then.

As any experienced nurse knows, floating in the middle of a shift is very difficult. You already did all your assessments, and then have to re-assess in the new unit. They were constantly switching up assignments, in order to utilize nurses with the least amount of staff possible, while fitting into the "safe" ratios. Compared to the ratios in other states, I'm sure we CA nurses seem spoiled, but somehow, it never felt that way.

Anyone out there have perspective on this?

[Joe V]

Joe V said:

Nurses are desperate for safer staffing. Which is more impossible: Asking a Genie in a bottle to grant your wish or getting State and Federal legislators to pass safer staffing laws?

Not even a genie could get you safe staffing.

[DNPStudy, MSN]

Sometimes legislators are willing..then come in a powerful healthcare organization that throws in a tantrum, and legislators give up...in the case of Minnesota safe staffing laws and Mayo Clinic...

[Bug Out, BSN]

DNPStudy said:

Sometimes legislators are willing..then come in a powerful healthcare organization that throws in a tantrum, and legislators give up...in the case of Minnesota safe staffing laws and Mayo Clinic...

Everyone supports safe staffing until the legislatures have to find the funding for it. 

[toomuchbaloney]

Bug Out said:

Everyone supports safe staffing until the legislatures have to find the funding for it. 

Most healthcare staffing and budgeting is a private business decision, not a legislative issue. VA hospitals are an obvious exception to that reality.  

[Bug Out, BSN]

toomuchbaloney said:

Most healthcare staffing and budgeting is a private business decision, not a legislative issue. VA hospitals are an obvious exception to that reality.  

There are good reasons why the DRGs were introduced in the early 80's and why nursing was lumped into the bed rate. Control expense. 

A way to control cost was to provide facilities incentives to control staffing by providing a single base rate of reimbursement. 

When you look at the arguments hospitals put forward against safe staffing it typically revolves around the DRG and reimbursement. The hospitals tell the legislatures that if they want more staffing, the hospital needs more reimbursement. 
 

[toomuchbaloney]

Bug Out said:

There are good reasons why the DRGs were introduced in the early 80's and why nursing was lumped into the bed rate. Control expense. 

A way to control cost was to provide facilities incentives to control staffing by providing a single base rate of reimbursement. 

When you look at the arguments hospitals put forward against safe staffing it typically revolves around the DRG and reimbursement. The hospitals tell the legislatures that if they want more staffing, the hospital needs more reimbursement. 
 

Yep. I was managing a critical unit and transport team when the bean counters reduced nursing care to a number and took over the decision making for bedside staffing of nursing units.  Our health outcomes have been falling ever since.  Big health systems made lots of money though. 

[Bug Out, BSN]

toomuchbaloney said:

Yep. I was managing a critical unit and transport team when the bean counters reduced nursing care to a number and took over the decision making for bedside staffing of nursing units.  Our health outcomes have been falling ever since.  Big health systems made lots of money though. 

Agreed. Hospitals bear a significant amount of guilt. The problem though is that they are doing what the system wants them to do and hospitals simply remind our elected officials of that. 

If our elected officials actually cared about staffing and outcomes all they would have to do is separate nursing from the DRG bed rate and allow hospitals or nursing to bill for services rendered. Physicians can use RBRVS for compensation, why not nurses? If you could have billed for nursing time for the units you managed and that eliminated the cost of staffing to the hospital, or even allowed them to make a profit, do you think staffing would have increased or decreased?

Hospitals today are like badly behaved children. While they bear their own responsibility the real responsibility lays with the parents (the government) who literally designed the system to work the way it does. 

[toomuchbaloney]

Bug Out said:

Agreed. Hospitals bear a significant amount of guilt. The problem though is that they are doing what the system wants them to do and hospitals simply remind our elected officials of that. 

If our elected officials actually cared about staffing and outcomes all they would have to do is separate nursing from the DRG bed rate and allow hospitals or nursing to bill for services rendered. Physicians can use RBRVS for compensation, why not nurses? If you could have billed for nursing time for the units you managed and that eliminated the cost of staffing to the hospital, or even allowed them to make a profit, do you think staffing would have increased or decreased?

Hospitals today are like badly behaved children. While they bear their own responsibility the real responsibility lays with the parents (the government) who literally designed the system to work the way it does. 

Our government wants we the people to forget that the government is supposed to see to the health and general welfare of we the people.  Instead, fiscal conservatism and trickle down champions have convinced the masses that the government is supposed to protect business interests while the people pull themselves up by their bootstraps. 

[klone, MSN, RN]

Oregon just passed staffing laws and even does one better than California - they have written in mandatory ratios into their legislation (L&D is 1:1 for active labor and 1:2 for not active; med/surg is 1:5 but will go down to 1:4 I believe in 2025).