Should I agree to binding arbitration?

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hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 20 years experience. 4 Articles; 4,625 Posts

9 hours ago, NurseSpeedy said:

 

Deleted - already been said

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 20 years experience. 4 Articles; 4,625 Posts

To the OP - Is the facility in question a Psych facility. If so California state mandate for nurse to patient ratios may not apply 

Hppy

@hppygr8ful Last I checked nursing ratios in psych facilities in CA is 1:6, rather than 1:5 for M/S or 1:2 for ICU.

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 20 years experience. 4 Articles; 4,625 Posts

6 hours ago, psych nurse in training said:

@hppygr8ful Last I checked nursing ratios in psych facilities in CA is 1:6, rather than 1:5 for M/S or 1:2 for ICU.

@psych nurse in training

The ratios that you are quoting apply to psych units in acute medical facilities. The rules governing free standing psych facilities are different. I have been working in free standing psych facilities for the past 20 years and staffing is determined by patient acuity. A good charge nurse in such a facility knows how to massage the acuity numbers to keep the unit appropriately if inadequately staffed. Psych patients which are mostly "Walkie-talkies and do not require the same level of care as an acutely medically ill person does so they don't need as many hands on deck so to speak. 1 RN with a competent crew cosisting of a medication nurse and two behavioral aids can easily manage a unit with 14 to 16 patients of moderate acuity. I love the place I work but there have been times over the years when certian supervisors have tried to get me to reduce acuity levels on patients for staffing purposes. "What, you have 9 3's you can't have more than 5 3's. I am pretty good standing my ground. . Our facity hold approx 160 patients in three buildings. Call a code an help comes running. So even when staffing is low there are always plenty of hands to help.

It's not clear if you are still a student as your user name suggests or a rew grad or new to psych, but facilities especially privately owned "For Profit" hospitals have a cardinal rule that no talks about being understaffed. So when you said that when you mentioned what you saw as short-staffing - they appeared to not even know that they were understaffed. Believe me we know we could give better care with better staffing but it is what it is. These patients still have to be cared for and refusing to work because of preceived understaffing is not advocating for the patient. Advocating for the patients means using your voice to effect change when you can but also giving your patients safe, compassionate care at all times. It does not help the patient to leave the unit with even fewer staff to care for the patient load. 

Like in nursing homes staffing is determined by the number of RN hours each patient requires to be kept safe. There is a formula for figuring this out. Which is why nurses have to know how to massage acuity numbers. For example there are the following acuities in our facility 

level 3: Acutely psychotic, agressive, or patients in their first 24 hours on the unit.

Level 2: Patent's who are medication and behaviorally compliant, going to groups, non-aggressive or actively trying to hurt themselves.

Level 1: Pt's who are stable and ready to be discharged that day

There are 1:1 patients who require their own behavioral staff (not an RN) to be with arm's reach at all times including while showering and toileting. These can be eith ATC aroud the clock or WA while awake. 

then there are LOS Line of sight which as the name states patient is with the line of staff at all times but not required to be within arms reach. 

So if I have my unit at capicity (14) with 5 3's, 6 2's and 3 1's I get 1 medication nurse and two floor staff. Two many staff on the unit can actually have an agitating effect on the patient population. 

This was probably way more explanation than you needed or wanted but I would never refuse a patient assignment and leave both the remaining staff and patients in greater danger. 

Hppy

@hppygr8ful That is actually very helpful information, thank you! While I've done acuity lists and coordinated care as an RN at an inpatient psych facility during my preceptorship I never had it explained that way. My job will be as an outpatient RN in psych, but will probably get to work in the inpatient wing some as well.

I'm probably making out the staffing ratios and binding arbitration to be more of an issue than it really is. I want to be prepared and not blindsided. As I get to work in the facility, I'm sure it will make more sense or at least not be a problem.

I appreciate the feedback from you and the other nurses in this forum.

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 20 years experience. 4 Articles; 4,625 Posts

11 hours ago, psych nurse in training said:

@hppygr8ful That is actually very helpful information, thank you! While I've done acuity lists and coordinated care as an RN at an inpatient psych facility during my preceptorship I never had it explained that way. My job will be as an outpatient RN in psych, but will probably get to work in the inpatient wing some as well.

I'm probably making out the staffing ratios and binding arbitration to be more of an issue than it really is. I want to be prepared and not blindsided. As I get to work in the facility, I'm sure it will make more sense or at least not be a problem.

I appreciate the feedback from you and the other nurses in this forum.

If you want to to know more about this check Title 22 California code of regulations

https://www.dhcs.ca.gov/services/adp/Pages/CA_Code_Regulations.shtml.aspx

It's a ponderous document to weed through but has all the laws pertaining to this issue. 

Hppy