staffing issues

[hello0oNurse]

I work at a private chronic dialysis unit in NY with 24 stations. Currently I am the only full time RN and because of that I am also charge nurse when I am scheduled to work. Because of staffing issues, I sometimes, well most of the time, have to take the desk and am assigned to 12 stations with 2 techs, 3 if I'm lucky. I have spoken to my adminstrator but she continues to say, "that's allowed." Does anyone know the state rules and regulations regarding nurse patient ratios in NY? The administrator tells me by law that this is okay. Is it? My license is on the line here. I have patients screaming at me because they have to wait an hour to get their treatment and have to wait again to be taken off. I don't know how much longer I can take working here. I am overworked everyday. Please help.

[Lacie, BSN, RN]

It's all dependant on your state laws. I'm in Florida and run a 12 chair clinic. We operate routinely with 1 RN and 2 PCT's. I have been at other clinics such as Davita and they run the same staffing ratios in fact we had 14 chairs and worked the same amount of staff that I do with 12 chairs. Here it is one staff body to 4 pt's (doesnt matter if licensed or not) as long as one RN is in the building. I have a per-diem LPN that covers the floor as charge on my paperwork days and she also has only 2 pcts to cover 12 pts per shift. That's pretty much the standard in many areas. I'm not saying it's the safest nor acceptable in my own opinion but seems to be the standard. Ideally the RN shouldnt have to take pts but I do along with the rest. I am also the DON and do charge on the clinic floor besides my DON responsibilites.

[anurseadvocate]

I believe your State Board of Nursing can give you the ratios for staffing for dialysis facilities. Indeed, your license might be on the line if something happens. You might also want to check with the BRN in NY and ask them how liable you are in the situation. If the state comes in to inspect and finds negative outcomes that are the result of understaffed situations, you might have a problem. If I were you, I would document each and every time you speak with your Administrator, what you say and what he/she says. Also document date and time so that you have a clear record should something happen. Your situation certainly sounds somewhat overwhelming. Perhaps you can call the state department that inspects your facility. The number should be posted in a conspicuous place for patients as it is the same number that patients call if they want to file a complaint. In fact, for NYC you can call 212-417-5990. If this is not the specific office for your clinic area, they can provide the correct number. That is the best way to find out what you need to know, esp if patients are affected by such. RenalRuth:nurse:

[redknight]

Where I`m at with a FMC unit in NH. They have just told the techs they have to get cert. by a certian time frame and this is being req. by medicare. Now the part that kills me is that the gov . comes in and req. these techs to do this, BUT they want them to be tested and cert. for the job with out any more money, BUT they could care less about safe ratios.I dont get it. How did that one get by. SO LADIES in diaylsis when do the RN`S get hit with that? I don`t want to hear the cramp of being a better prof. because you can pass a test.THEN DON`T GET ANYTHING FOR IT BUT A BUNCH OF LETTERS AFTER YOUR NAME. No you won`t get any more money nor will the ratios improve. There needs to be a nursing front held to this. That if medicare wants you to have this cert. then they have to have ratios. So if we see this happening to us WE NEED TO UNIT.They want something we what something. Fair trade?Who in medicare sets these ruling and how do we find them? Nursing board sure dosn`t do anything to help protect you. How do I find thesepeople?

[anurseadvocate]

The new Conditions specific certification. However, if you review survey findings from states that already have certification in place, versus those that don't, you will not see much difference in the deficiencies that are cited during survey. Presently, there are only a few states, to recall, thatr require tech certification at a state level. The new Conditions were open for public comment (anyone could comment) and that would have been the time for dialysis nurses to send in their comments related to having staffing ratios, etc. Remember the providers have ALOT of power and influence with there millions of dollars going toward lobbyist activities. This is all public information. The best way is to look at state requirements for staffing ratios. In fact, I wonder if there are ratios in some states dependent upon how dialysis facilities are categorized ie ambulatory care, etc. Again, you can always contact the state and file a complaint anonymously regarding staffing. RenalRuth

Those that allow errors to happen without addressing such are as guilty as those making errors ( a wise old nurse)