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Staffing Ratios - New York

Specializes in Med/Surg - PCU - PeriOp - CDA/Obs.

Good Morning,

I would like to bring your attention to the New York State Assembly Bill A08580 "Safe Staffing for Quality Care Act". It proposes a ratio of 1:3 for Step-Down & Telemetry.

It does not differentiate between night & day staffing ratios.

This bill was passed by the New York State Assembly June 14 2016.

You can read the full bill here:

New York State Assembly | Bill Search and Legislative Information

The bill has been moved to the New York State Senate for input.

It's unfortunate since the original justification for changing the ratios was recognized in 2003 by the Institute of Medicines report "Keeping Patients Safe: Transforming the Work Environment of Nurses " that we still don't have appropriate ratios that are supported by evidence based practice.

Double-Helix, BSN, RN

Specializes in PICU, Sedation/Radiology, PACU.

The problem is that, while "appropriate ratios" are supported by evidence, the evidence is not clear about what an appropriate ratio is. There are studies that show that hospitals with 1:4 ratios have better outcomes than those with 1:8 ratios. But that does not mean that a 1:4 ratio is best practice, or that a 1:5 ratio wouldn't produce the same outcomes. Mandatory staffing ratios also place financial burden on hospital administration to finance the additional staff when reimbursement from the patients and insurance does not match that increase.

Safe nursing staffing needs to account for patient volume, acuity, and the actual hours of nursing care each patient requires. While a 1:3 nurse:patient ratio sounds great, what evidence supports that this specific ratio is necessary to provide safe and cost-effective care?

Spartacvs, BSN

Specializes in Med/Surg - PCU - PeriOp - CDA/Obs.

Thanks for you reply...

It's been made clear that improving ratios improves patient outcomes.

Mandatory ratios are a starting point, a ceiling not to be exceeded.

If it were up to administrators they would have less nurses taking on more patients.

They are constantly pushing on nursing staff to take on more to control costs, do more with less.

Acuity should be the main consideration in giving patient assignments but is 'never' followed.

The hospital is a factory/hotel, when a bed opens up it gets filled, 100% capacity is the goal and leaves no room unoccupied.

The question is how can organizations afford the extra staff?

It's starts by separating the nurse from the room charge as I have discussed in a previous post.

This will enable us to give evidence to the care that's provided and eventually get paid for it.

Medicare & Medicaid do not provide adequate reimbursements and need to be changed to cover the increased acuity of the population served.

Organizations need to do a better job of capturing the costs that are incurred by patients. Every flush, every IV stick, every dressing change, every linen change... the list goes on.

It costs less for someone to stay at a 5-star hotel than in a hospital and you get better service.

If you don't like your room in a hotel the hotel doesn't charge you less do they? So then why should the hospital get paid less when they receive a negative survey?

The idea here is to generate thoughts and ideas for our profession to start driving the bus.

We have the numbers as a profession yet we are not utilizing this leverage with our legislators.

-Matt-

Thanks for you reply...

It's been made clear that improving ratios improves patient outcomes.

Mandatory ratios are a starting point, a ceiling not to be exceeded.

If it were up to administrators they would have less nurses taking on more patients.

They are constantly pushing on nursing staff to take on more to control costs, do more with less.

Acuity should be the main consideration in giving patient assignments but is 'never' followed.

The hospital is a factory/hotel, when a bed opens up it gets filled, 100% capacity is the goal and leaves no room unoccupied.

The question is how can organizations afford the extra staff?

It's starts by separating the nurse from the room charge as I have discussed in a previous post.

This will enable us to give evidence to the care that's provided and eventually get paid for it.

Medicare & Medicaid do not provide adequate reimbursements and need to be changed to cover the increased acuity of the population served.

Organizations need to do a better job of capturing the costs that are incurred by patients. Every flush, every IV stick, every dressing change, every linen change... the list goes on.

It costs less for someone to stay at a 5-star hotel than in a hospital and you get better service.

If you don't like your room in a hotel the hotel doesn't charge you less do they? So then why should the hospital get paid less when they receive a negative survey?

The idea here is to generate thoughts and ideas for our profession to start driving the bus.

We have the numbers as a profession yet we are not utilizing this leverage with our legislators.

-Matt-

A very fascinated read. I am quite a distance a way from becoming a nurse, which is why I am trying to get as a fuller picture of nursing as I can so I can be a well-rounded and more prepared nurse. I do agree, though, that the strength is in numbers and you (I cannot include myself yet, since I am not a nurse at this moment) should fight for what is right.

NYU has safe ratios...Then a hospital like Montefiore abuses RN's with unsafe ratios.

Spartacvs, BSN

Specializes in Med/Surg - PCU - PeriOp - CDA/Obs.

Thanks for your reply.

What are the ratios at NYU?

What are the ratios at Monte?

Thanks,

Matt

herring_RN, ASN, BSN

Specializes in Critical care, tele, Medical-Surgical.

California ratios define telemetry and step-down by patient needs. Other units and corresponding ratios are also included in the linked document

... Commencing January 1, 2008, the licensed nurse-to-patient ratio in a step-down unit shall be 1:3 or fewer at all times. A step down unit” is defined as a unit which is organized, operated, and maintained to provide for the monitoring and care of patients with moderate or potentially severe physiologic instability requiring technical support but not necessarily artificial life support. Step-down patients are those patients who require less care than intensive care, but more than that which is available from medical/surgical care. Artificial life support” is defined as a system that uses medical technology to aid, support, or replace a vital function of the body that has been seriously damaged. Technical support” is defined as specialized equipment and/or personnel providing for invasive monitoring, telemetry, or mechanical ventilation, for the immediate amelioration or remediation of severe pathology...

... Commencing January 1, 2008, the licensed nurse-to-patient ratio in a telemetry unit shall be 1:4 or fewer at all times. Telemetry unit” is defined as a unit organized, operated, and maintained to provide care for and continuous cardiac monitoring of patients in a stable condition, having or suspected of having a cardiac condition or a disease requiring the electronic monitoring, recording, retrieval, and display of cardiac electrical signals...

View Document - California Code of Regulations

This section of hospital regulations is important for patient safety too:

View Document - California Code of Regulations

It took us a long time to achieved ratios in California. Now that the bill has moved to the New York State Senate I think it is time for nurfses to write, call, and email your state senators, attend whatever senate committee or other meetings are planned, demonstrate your concern, and educate voters about how safe staffing will help them and/or their loved ones.

Boy, I'd love to see that bill go through. My "step down unit" regularly has 5 :1 on days and eves, and 7: 1 on nights. One of those pt s was on titratable meds, 2 chest tubes and other meds q2-3 hours; 2 confused pts with no sitters, and the rest cardiac pts . I pittied the nurse with that assignment

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro.

Boy, I'd love to see that bill go through. My "step down unit" regularly has 5 :1 on days and eves, and 7: 1 on nights. One of those pt s was on titratable meds, 2 chest tubes and other meds q2-3 hours; 2 confused pts with no sitters, and the rest cardiac pts . I pittied the nurse with that assignment

Those are med-surg ratios!!

The first hospital I worked for had one PC room, so would give a day/PM RN those two patients and potentially a floor pt; and a noc RN took the two PC pts and 2 floor pts. Every other place I've been with dedicated stepdown/PC units have been 3:1.

I don't necessarily agree with the OP that tele needs to be 3:1, as I have worked on tele units (my final practicum in school, and in LTACH) where typical ratios are 4-5:1. I found it very doable *most* of the time. LTACH assignments could be overwhelming with those ratios, but that was more to do with the ventilators and 2-hour complex dressing changes than about the cardiac monitors.

Those are med-surg ratios!!

. Every other place I've been with dedicated stepdown/PC units have been 3:1.

.

We used to be 3-4:1 d/e and 5-6 :1 on nites until they changed the ratios :(

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