Staffing Ratios Condemn Patients To Inferior Care

[DoGoodThenGo]

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/

[Sg0223RN]

I work in ICU, when we have more than 2 patients everyone can see that it becomes a dangerous situation!! I wish Georgia had this law. Let's cut staff and give more critical patients to less nurses. Smart idea!!! :hdvwl:

[a6fan1127]

Staffing ratios must be dictated or the hospitals will continue to provide inadequate care at the expense of nurses. The acuity level of pts nowadays and the pressure to get them out the door and back on the street does not help either. Our sister hospital already has a 5:1 ratio (implemented on their own!) and their reputation for care is head and shldrs above ours where we regularly get six and sometimes seven! Recently a night shift nurse got 9 d/t call offs! While I am not a fan of unions, or govt edicts I think in this case our hospital will not do it on their own since the nurses seem to think that thats the way it is and move on when a better job opens up elsewhere.

[nicurn001]

A common misconception regarding the ratio law is that , the ratio takes the place of an acuity tool , wheras in practice it is a safe guard for the acuity tool .The bedside nurse still assesses the patient and sets an acuity level for their patients , what cannot happen with the ratios in place , is that when there are changes in patients acuity , management cannot ignore their acuity tool to crunch the asignments ( thereby creating unsafe assignments ) , they must either transfer the higher acuity patient to a floor (eg. ICU )that can provide the proper care or find the staff to provide care within ratios .

Heaven forbid but the nurse manager might remember that part of their title is nurse and maybe they could either take the high acuity patient or if uncomfortable with that take some low acuity patients to fre up a nurse .( this course of action to only be considered if all else has failed )

[groanup]

Here is the link to the bill in the U.S. Senate.

Unfortunately it's been pigeonholed in a committee

and will probably never come out. I wrote an email

to both of my state's Senators in support of the bill.

One hasn't responded, the other one said, in part,

Thank you . . . for contacting me about increased funding for nurse education. I share your view.

Huh?

Anywho, here's the link. Write to your Senators to get this thing out of committee and onto the Senate floor!!!

Bill Text - 111th Congress (2009-2010) - THOMAS (Library of Congress)

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[goingCOASTAL]

Wow! A page from the "opinion" section becomes news! I guess everyone is taking cues from Fox, eh?

[prairiecat]

Let me ask; would YOU, a nurse enter the hospital being very ill, or requiring a serious surgery and have confidence that you would be taken care of properly. My mother was in the hosp. in NJ (she was an RN) and was very ill with cancer. She would not let me leave her side for fear they would kill her as unorganized and chaotic as the place was. I think, rather I know I would want one of my trusted friends/colleagues with me. How about you?

[goingCOASTAL]

A common misconception regarding the ratio law is that , the ratio takes the place of an acuity tool , wheras in practice it is a safe guard for the acuity tool .

In my practice, I've never seen an "acuity tool" used for anything other than justifying the "house" ratios - I've never seen them used to create flexibility according to need. One manager told me several years ago at the hospital I was working at, "Oh, we just use those to prove to JCAHO that we staff by acuity."

Did we? No. Our float book had a copy of our unit's house prescribed ratio - and it never varied.

I don't understand the sudden hatred of ratios - it's already the default position of most hospitals, but they're the ones writing them.

[HM2VikingRN, RN]

Thread moved.

[Chico David, BSN, RN]

Here is the link to the bill in the U.S. Senate.

Unfortunately it's been pigeonholed in a committee

and will probably never come out. I wrote an email

to both of my state's Senators in support of the bill.

One hasn't responded, the other one said, in part,

Thank you . . . for contacting me about increased funding for nurse education. I share your view.

Huh?

Anywho, here's the link. Write to your Senators to get this thing out of committee and onto the Senate floor!!!

Bill Text - 111th Congress (2009-2010) - THOMAS (Library of Congress)

=========================

*

Others here have done such a great job of exposing the idiocy of the original article, I don't feel the need to chime in on that one.

Here's my take on the national bill: The California law moved when our union developed enough clout at the state level to make it move. I love the way the original propaganda piece says the law was "strong-armed" through by CNA. They try to make that sound negative, but it was "strong-armed" through by thousands of nurses who showed up in Sacramento every time there was a crucial hearing on the bill, who wrote their legislatures and their local paper and attended meetings around the state. That's what it takes to move legislation against the entrenched clout of a powerful industry. Legislators at all levels and of both parties hate to go up against powerful industries and will only do so when an enormous amount of people power forces them to it. The national bill will move in Congress when the NNU has organized enough nurses nationally to exercise that sort of power on a national level - and not before. Meanwhile, the very existence of the bill continues to be a powerful tool to get nurses thinking about issues like this.

[RN4MERCY]

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.

So, why is that a problem with the ratios? Let's be honest here and consider the fact that what ever hospital it is you happen to be talking about, the problem is most-likely deliberate short-staffing to increase profitability and/or pushing the existing staff to meet some cookie cutter productivity benchmarks.

Why are you so quick to absolve the hospital of blame for not following the law, because the ratio law says hospitals must "staff up" from the minimum based on the needs/acuity of the patients?

Most hospitals get preferential tax treatment so they should be using the money to call in additional nurses to take care of those patients and actively lobbying for a more just healthcare system. Have you organized your ER colleagues as advocates and demanded, on behalf of those patients, that additional staff be called in? What was management's response? What have you done to notify the press, the community, the regulatory agencies that such an unsafe condition exists and what was their response?

Ratios make hospitals safer for patients just like having brakes on cars makes driving them safer for passengers. Don't whine to me about the additional expense of having brakes on cars and the fact that there are standards for manufacturing and maintaining them. Your car might go slower when you apply the brakes heading down a hill, but at least you'll live to see another day if they're in good working order.

[Not_A_Hat_Person, RN]

I'd like to see mandatory ratios for long-term care. It's just not safe for 1 nurse to have 30, 40, or 50 patients.

[Chico David, BSN, RN]

I'd like to see mandatory ratios for long-term care. It's just not safe for 1 nurse to have 30, 40, or 50 patients.

Especially since the acuity there has increased too in recent years. Long ago when I worked in LTC, most patients were more or less custodial and were kept in the acute hospital until pretty stable. Now people are being discharged to LTC earlier and with more complex needs.