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Staffing ratios

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by MickiSkibinski MickiSkibinski (New) New

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You are reading page 3 of Staffing ratios. If you want to start from the beginning Go to First Page.

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Even with these numbers, which sound good, there need to be exceptions, as we all know. You never know when something will go wrong and a routine matter is no longer routine.

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herring_RN specializes in Critical care, tele, Medical-Surgical.

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Even with these numbers, which sound good, there need to be exceptions, as we all know. You never know when something will go wrong and a routine matter is no longer routine.
I agree. In addition to the required acuity tool I think there should be a requirement for a rapid deployment of nursing personnel to respond to staffing emergencies.

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Even with these numbers, which sound good, there need to be exceptions, as we all know. You never know when something will go wrong and a routine matter is no longer routine.

The bill has minimum staffing ratios, and they're as good as or better than what California passed. I know that's the case with the hospitals I've had clinicals at.

You still have a duty to your patients, and if your patient(s) require a higher ratio than exists, and Safe Harbor isn't an option in your jurisdiction, I don't know what you do. Then again, what do you do now?

These bills don't supersede state laws that provide for ratios that exceed the minimums in this law. If your ratios are already better, your ratio shouldn't change.

Read for yourself (From the Senate version, S. 864):

‘‘(b) MINIMUM DIRECT CARE REGISTERED NURSE-TO-PATIENT RATIOS.—

‘‘(1) IN GENERAL.—Except as otherwise provided in this section, a hospital's staffing plan shall provide that, at all times during each shift within a unit of the hospital, a direct care registered nurse shall be assigned to not more than the following number of patients in that unit, subject to para- graph (4):

‘‘(A) One patient in trauma emergency units.

‘‘(B) One patient in operating room units, provided that a minimum of 1 additional person serves as a scrub assistant in such unit.

‘‘© Two patients in critical care units, in- cluding neonatal intensive care units, emer- gency critical care and intensive care units, labor and delivery units, coronary care units,acute respiratory care units, postanesthesia units, and burn units.
‘‘(D) Three patients in emergency room units, stepdown units, pediatrics units, telem- etry units, antepartum units, and combined labor, delivery, and postpartum units.

‘‘(E) Four patients in medical-surgical units, intermediate care nursery units, psy- chiatric units, and other specialty care units.

‘‘(F) Five patients in rehabilitation units, and skilled nursing units.

‘‘(G) Six patients in well-baby nursery units and postpartum (3 couplets) units.

‘‘(3) RESTRICTIONS.—

‘‘(A) PROHIBITION AGAINST AVERAGING.—

A hospital shall not average the number of pa- tients and the total number of direct care registered nurses assigned to patients in a hospital

unit during any 1 shift or over any period of time for purposes of meeting the requirements under this subsection.

‘‘(B) PROHIBITION AGAINST IMPOSITION OF MANDATORY OVERTIME REQUIREMENTS.—A hospital shall not impose mandatory overtime requirements to meet the hospital unit direct care registered nurse-to-patient ratios required under this subsection.

‘‘© RELIEF DURING ROUTINE ABSENCES.—A hospital shall ensure that only a direct care registered nurse may relieve another direct care registered nurse during breaks, meals, and other routine, expected absences from a hospital unit.

‘(4) ADJUSTMENT OF RATIOS.—

‘‘(A) IN GENERAL.—If necessary to protect

patient safety, the Secretary may prescribe regulations that—

‘‘(i) increase minimum direct care registered nurse-to-patient ratios under this subsection to further limit the number of patients that may be assigned to each direct care nurse; or

‘‘(ii) add minimum direct care registered nurse-to-patient ratios for units not referred to in paragraphs (1) and (2).

Edited by kspi355
adding to my argument

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Overland1 has 22 years experience as a RN.

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Please, tell me about all the meaningful legislation that has come from the petitions signed on that White House website.

Doesn't matter, because "signing" petitions for bills with excruciatingly long names feels good. Both those who sign and those who dream up and sponsor such bills will feel good about them (the latter getting some political longevity from them).

Maybe those bills need longer names so they can gain even more political traction. ;)

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BDOGGRN has 15 years experience and specializes in Internal Med, Primary Care, Ambulatory.

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Is anyone familiar with any nursing/clinical ratios outside of hospitals or LTC's? I work in an ambulatory/clinic setting, and many such locations have had a very drastic reduction in staffing, both clinical and clerical, in recent years. In the primary care setting, we often see some of the sickest patients, some of whom stop by the office not knowing what else to do, or where else to go, when they are having a potential MI, TIA, or other life threatening condition. There may or may not be a provider, or even clinical staff, present during such situations. I would appreciate any thoughts or insight on this!

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1,982 Posts; 33,662 Profile Views

I would document all incidents, on a separate log for your self, and another to present to the higher ups, and move up the food chain.

Document all negative incidents, and don't forget about near misses. I would refuse to do another departments job (s),stick to the job description you were given when hired.

Refer all complaints to your supervisor, don't get caught up in unhappy patients complaints. Move up the foodchain.

If it doesn't get better, look for another job.

JMH0 and my NY $0.02

Lindarn, RN, BSN, CCRN, (ret)

Somewhere in the PACNW

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vintagemother specializes in Med-Surg, Psych, Geri, LTC,.

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Staffing ratios in CA are pretty dang good, compared to what I've read other states do.

However, I think staffing ratios need to exist to CNAs, also.

I've recently found out some acute hospital post surgical units are placing 1 RN to 5 pts with no aides. The pts aren't able to walk or do ADLs independently.

Kind of defeats the purpose of RN:Pt ratios, I think.

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RN_SummerSeas has 5 years experience and specializes in Home Care, Hospice.

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Please, tell me about all the meaningful legislation that has come from the petitions signed on that White House website.

Honestly, I don't have time to with 4 kids, working full time and school I am lucky I get on the internet for anything "fun" and I certainly opt to spend it not arguing with people over politics, waste of time IMHO!

For those who think petitions do nothing, a great example (maybe not from the website that you are discussing as this is state level) is Compassion and Choices advocacy for death with dignity in California-largely due to public awareness and education, petitions-regular people getting their words heard. You don't like petitions, simply don't do them.

Safe staffing saves lives folks and I applaud everyone that has done even the smallest bit of advoating for it!

Have a lovely day all!

Edited by RN_SummerSeas
spelling and grammer with little sleep!

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1,982 Posts; 33,662 Profile Views

Staffing ratios with no aides, was ploy that health care industries uses to prevent staffing ratios from being applauded for improving patient outcomes.

If the staffing ratios did not improve patient outcomes because the nursing staff had no aides to assist patients with mundane things, that will still increase the workload for the nursing staff, and might still impact positive patient outcomes.

If patient outcomes did not improve because the nursing staff was still overworked without the assistance of the aides, then the hospital industry could use that as a reason to prevent staffing ratios from being enacted in other states.

I know that other states want to prevent staffing ratios from being enacted in their states, as well.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN, (ret)

Somewhere in the PACNW

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herring_RN specializes in Critical care, tele, Medical-Surgical.

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The first paragraph of the California regulations states, that staffing for care not requiring a licensed nurse is not included within the ratios and must be determined pursuant to the patient classification system.

https://govt.westlaw.com/calregs/Document/I8612C410941F11E29091E6B951DDF6CE?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=%28sc.Default%29

Page 20 of the "Final of Reasons" includes:

"In order to clarify that a hospital cannot reduce overall staffing by assigning licensed nurses to duties customarily and appropriately performed by unlicensed staff, it is stated that staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system.

At 22 CCR 70053.2 and 70217(b), the PCS is defined as a system that is established to determine the amount of nursing care needed by each unit, on each shift, and for each level of licensed and unlicensed staff.

Setting a minimum level of staffing for licensed nurses is not intended to alter the

current requirement of the PCS to determine needed staffing levels for licensed and unlicensed staff.

http://www.cdph.ca.gov/services/DPOPP/regs/Documents/R-37-01_FSOR.pdf

At our hospital and many others we had to struggle to keep our nursing assistants. The same anti ratio management that complained the ratios were "One size fits all" wanted ton staff the minimum each and every shift.

We prevailed.

At more than one hospital there had to be a report to the state before they got their CNAs back. And they didn't get their long time friends and trusted colleagues back. They had tom orient new people.

The current bills for national ratios includes the requirement for an acuity system that includes on page 7 this language:

"Staffing levels and services provided by licensed vocational or practical nurses, licensed psychiatric technicians, certified nurse assistants, or other ancillary staff in meeting direct patient care needs not required by a direct care registered nurse."

https://www.congress.gov/114/bills/s864/BILLS-114s864is.pdf

When the bills are passed and signed into law it will be illegal for a hospital to eliminate othjer staff because they must staff sufficient registered nurses.

My hospitals telemetry and medical-surgical units include the addition of an additional LVN or RN for patients who require frerquent suctioning, tube feedings, dressing changes, accuchecks, or other treatment that can be done by an LVN and not a CNA.

For patients who take a long time to feed, have diarrhea, or who need aextra time to walk to the bathroom or other care not requiring a licensed nurse the acuity system required one or more additional CNAs, LVNs, or RNs.

Of course they use the less costly staff member. Our few remaining LVNs float a lot because they are not needed on any one unit for every shift.

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SC_RNDude has 7 years experience.

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Honestly, I don't have time to with 4 kids, working full time and school I am lucky I get on the internet for anything "fun" and I certainly opt to spend it not arguing with people over politics, waste of time IMHO!

For those who think petitions do nothing, a great example (maybe not from the website that you are discussing as this is state level) is Compassion and Choices advocacy for death with dignity in California-largely due to public awareness and education, petitions-regular people getting their words heard. You don't like petitions, simply don't do them.

Safe staffing saves lives folks and I applaud everyone that has done even the smallest bit of advoating for it!

Have a lovely day all!

Your "Compassion and Choices" example is not even close to the same. People were actually taking action and accomplishing something. The petition discussed here is an example of slacktivism at it's best. That is, people taking all of 30 seconds to log their info into an internet blackhole and then feeling all warm and fussy for themselves because they think they ae doing something meaningful.

What percentage of those people who signed that petiton have done anything else to improve staffing levels?

It might seem like people signing this internet petition and rallying friends and family to do the same could do no harm, even though it might not be effective either. I disagree.

For example, many people here and in another similar thread said they posted the link to this petiton on their Facebook page. If you are like me, almost on a daily basis someone in my Facebook world is posting something in relation to a cause. Be it climate change, GoFund links, "like" this page, internet petitions, etc. It's too much! I don't even pay attention to most of them anymore.

If I'm going to encourage family, friends, and co-workers to support a cause, I want them to do it in a meaningful way. If I ask them once, to sign this petiton for example (the petitons on this website have been proven to be ineffective), they may not pay attention the next time I ask them to act on this issue.

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herring_RN specializes in Critical care, tele, Medical-Surgical.

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Here is a "Statement of Deficiency" issued to a hospital in California where a patient fell and died.

Unsafe staffing was a major factor.

The hospital was fined and forced to write a "Plan of Correction.

That plan began, "The nurse to patient ratio in the critical care units will be 1: 2 or fewer at all times."

http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567PalomarMedicalCenter-SanDiego-Event-GZ3P11.pdf

 

I was told nurses and other employees had been documenting unsafe and illegal staffing for a while. Because there was written documentation regarding staffing this day no staff was disciplined for this horrible harm to as patient.I pray that management of this and at facilities listen when nurses report that in their professional judgment a situation is unsafe and puts patients at risk.

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