Staffing Ratios Condemn Patients To Inferior Care

Published

By John R. Graham and Robert E. Hertzka

Sunday, August 22, 2010 at midnight

In 1999, Gray Davis signed a law mandating a statewide ratio of one nurse to five patients in surgical wards, one to six in psychiatric wards, one to four in pediatric wards, one to three in maternity wards, and one to two in intensive care. The law was strong-armed to enactment by the California Nurses Association, an activist union with national ambitions. Today, the union wants Congress to make this a federal diktat, and U.S. Sen. Barbara Boxer now carries the union's water on Capitol Hill.

Full story here:

http://www.signonsandiego.com/news/2010/aug/22/ratios-condemn-patients-to-inferior-care/

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This is a bunch of baloney from people who profit by having nurses overworked and under-payed. It doesn't make any sense, even to people who are not RNs. I'm not even sure what their point is, except to 'carry water' for health care executives and financial managers.

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I am not a total fan of staffing ratios. At least not in the ER. In my experience...in order to adhere to ratio, pts waiting to be seen are sitting in waiting room for hours. And inside the nurses don't turn over their pts because they know they will immediately get slammed with the ones in the waiting room. I find nurses tend to move their pts a lot faster when they know there is not really a limit to the amount of pts assigned to them. In the end ratios benefits the nurses, but not the pts who may be waiting 6-7 hours in waiting room, some of them a lot sicker then they look.

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Specializes in Psych , Peds ,Nicu.

Staffing ratios simply set a floor upon the minimum number of nurses there can be to a population of patients . If patient needs dictate that certain patients need a greater number of nurses , there is nothing to stop managemEnt staffing to meet that need , but they cannot simply cannabilise the present assignments to put a greater load upon the rest of the nurses on a floor . Frankly I can't see how a bedside nurse would argue against a system that ensures that there are a minimum number of nurses to a particular type of patient , but that in accordance with increased acuity more staff would be used rether than crunching the assignments , so that nobody is able to provide adequate care .

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Specializes in Psych , Peds ,Nicu.
I am not a total fan of staffing ratios. At least not in the ER. In my experience...in order to adhere to ratio, pts waiting to be seen are sitting in waiting room for hours. And inside the nurses don't turn over their pts because they know they will immediately get slammed with the ones in the waiting room. I find nurses tend to move their pts a lot faster when they know there is not really a limit to the amount of pts assigned to them. In the end ratios benefits the nurses, but not the pts who may be waiting 6-7 hours in waiting room, some of them a lot sicker then they look.

If what you describe is the case ie. holding onto patients ( don't turn over pts..) , then your managers should be managing and ensuring the patients are properly disposed of eg. discharge or transfer to the floors . It is not the fault of the ratios

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If what you describe is the case ie. holding onto patients ( don't turn over pts..) , then your managers should be managing and ensuring the patients are properly disposed of eg. discharge or transfer to the floors . It is not the fault of the ratios

While I agree with you that it is a management issue ...it is easier said than done. Especially in a very large, very busy ER with maybe one charge nurse. I see it all the time. Nurses will come up with excuse after excuse to keep the pt there. I have seen often in more than one hospital. I was constantly moving my pts and therefore getting slammed while other nurses would have the same 4 pts all night. I am not opposed to ratios on principle...but knowing a nurse can never have more than 4 pts removes the incentive to get the pt out of the ER. Doctors do it too. Take their time to dispo pts cuz they know there are 20 in the waiting room.

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Graham is director of Health Care Studies at the Pacific Research Institute in San Francisco. Hertzka, a former president of California Medical Association." Ha, "Health Care Studies at the Pacific Research Institute", funded by who I wonder? Probably the same people who benefit financially from the horrible staffing that is the norm in the USA, except where there are staffing ratios enforced by law that is. Like most docs he only know nurses are alive when they are doing something he does not like. When things are going the way he likes we are cockroaches under his feet.

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Specializes in Burn, CCU, CTICU, Trauma, SICU, MICU.

Working in a hospital without ratios - and now working in california where we have them - its the literal difference between life and death.

I was working on a step down unit in PA and regularly had 10-12 patients per RN - trachs, dopamine gtts, and we had to do our own peritoneal dialysis on people. One night, we were very short, had an almost full house and kept admitting. 1 CNA, 2 RNs, no secretary and a unit full of patients who were sick. One patient died that night because no one was at the nurses station to know that the tele battery had died hours before and since it was a "stable" patient, that nurse was busy with her OTHER 10 patients. She found the patient when she was doing AM rounds and he was cold.

Ratios save lives against hospitals that just want to save their profits. No room to admit? You will be sent to another hospital, call in agency staff, managers can (and DO) come in to take patients, use of safe harbor, offering staff time and a half and double time to come in extra - it always works out. I have yet to see a bleeding, dying person outside the hospital because there is no room at the Inn because of ratios. I have seen people die because of the LACK of ratios.

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Specializes in being a Credible Source.
Allowing the state or federal government to establish a one-size-fits-all rule for nurse staffing ignores real causes of the nursing shortage.
Any editorial that's still pushing the "nursing shortage" crap has no credibility in my book. California is drowning in nurses... in part BECAUSE of mandated ratios.
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graham is director of health care studies at the pacific research institute in san francisco. hertzka, a former president of california medical association." ha, "health care studies at the pacific research institute", funded by who i wonder?

sally pipes identifies herself as founder & ceo of pacific research institute and author of the truth about obamacare - what they don't want you to know. greenpeace at exxonsecrets.org tracks people and organizations funded by exxon-mobil and says she served on arnold schwarzenegger's transition team.

in radio interviews on conservative-leaning broadcast networks such as wjr detroit, pipes says she is a canadian economist who moved to the u.s. because "the united states has the best healthcare in the world", whereas canadians "have to wait four months to see a specialist". she does not clarify that canadians are universally covered for healthcare treatment compared to millions of uninsured americans, or that one in four americans have had to cut back on medical care due to the recession, compared to one in twenty canadians.

pacific research institute's main goal appears to be defunding the u.s. healthcare reform bill if republicans regain control of congress. patients, nurses and ratios will just be collateral damage.

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Specializes in being a Credible Source.
In radio interviews on conservative-leaning broadcast networks such as WJR Detroit, Pipes says she is a Canadian economist who moved to the U.S. because "the United States has the best healthcare in the world", whereas Canadians "have to wait four months to see a specialist". She does not clarify that Canadians are universally covered for healthcare treatment compared to millions of uninsured Americans, or that one in four Americans have had to cut back on medical care due to the recession, compared to one in twenty Canadians.
Neither does she point out that - even with insurance - sometimes Americans must wait many weeks to see a specialist or to have semi-elective surgeries.
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Specializes in Critical care, tele, Medical-Surgical.

hospital claims aside, ratios save lives

when i started in nursing 33 years ago, my first years were in a medical surgical unit being the only rn responsible for 24 patients. nurses didn't last long, and i spent the remainder of my career in intensive care where we've had safe ratios mandated by law since 1976.

contrary to hospital industry rhetoric, the ratios aren't just about the numbers. the ratios are minimum safety standards that, the law says, must be augmented by a documented system that assesses each patient, so that all patients get the care they need.

a colleague at a major long beach hospital noted the dramatic shift: "a majority of our patients are diabetic and require lots of teaching and monitoring.

our night-shift rns used to have nine to 12 patients. we could never keep a core nursing staff on nights. as a result of the law we don't have more than five patients, giving us the time we need for patient teaching and dramatically improving patient outcomes and nurse retention."

now the scientific evidence is in, too. a recent study led by the nation's most prestigious nurse researcher, linda aiken, rn, of the center for health outcomes and the policy research director at the University of Pennsylvania school of nursing, provides unassailable evidence: the law reduces patient deaths and assures nurses more time to spend with patients....

http://www.signonsandiego.com/news/2010/aug/22/hospital-claims-aside-ratios-save-lives/

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