State Staffing Plan Legislation- What do you think?

[RN Power Ohio]

With so many state nurses associations and hospital associations racing to the gate to introduce staffing plan legislation it is high time we have a comprehensive discussion about this on allnurses.

It would be great to hear from nurses where this legislation has passed. Tell us what you really think.

Some questions:

• Has the developement of a staffing plan improved patient care in your facility?
  
• How are nurses chosen or elected to be on the staffing committee?
  
• Is the committee comprised of at least 50% direct care nurses?
  
• Are patients aware of the plan? How do they get a copy? Do they get a copy?
  
• Are staffing concerns truly addressed?
  
• Does the facility follow their own plan? If not- do nurses point this out? How are criticisms of deviating from the plans dealt with?
  
• Do you feel that patient care, patient safety and working conditions have improved since the plans have been implemented.

Those are just a few questions. I would be interested in hearing any and all feedback from nurses who have experience with these laws including specific examples of successes or failures.

This AHA article lists different plans by state: http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/04APR2008/0804HHN_FEA_Staffing&domain=HHNMAG

[lpnflorida]

http://www.seiu.org/health/nurses/safe_staffing/fed_leg_summary.cfm

I just found this link from 2005 while it appears to directly address Rn to patient ratio. It is vague as to what the LPN role will be. I for one believe as an LPN I also play a part in patient care and do not wish to be ignored as a viable member of the health care team in a hospital. I will support Rn's in their concerns.

[RN Power Ohio]

all members of the healthcare team are vital components to quality patient care. ohio recently passed a staffing plan law that imo falls drastically short of offering the life-saving intervention that is desperately needed in our hospitals.

this is why nnoc ohio hopes to introduce the ohio hospital patient protection act that calls for acuity based staffing - minimum mandated rn-patient ratio's and increases in lpn and other care providers as the patient needs.

our bill is a comprehensive approach, it would require appropriate staffing of support personnel based on the patient classification system.

ohppa

(1) "acuity-based patient classification system" or "system" means a standardized set of criteria based on scientific data that acts as a measurement instrument that is used to predict registered nursing care requirements for individual patients based on the severity of patient illness, the need for specialized equipment and technology, the intensity of required nursing interventions and the complexity of clinical nursing judgment required to design, implement and evaluate the patient's nursing care plan consistent with professional standards, the ability for self-care, including motor, sensory and cognitive deficits, the need for advocacy intervention, the licensure of the personnel required for care, the patient care delivery system, the unit’s geographic layout, and generally accepted standards of nursing practice, as well as elements reflective of the unique nature of the acute care hospital’s patient population. the system determines the additional number of direct care registered nurses and other licensed and unlicensed nursing staff the hospital must assign, based on the independent professional judgment of the direct care registered nurse, to meet the individual patient needs at all times.

© hospital unit staffing plans based on individual patient need as determined by valid patient classification system (pcs) and direct care professional nurse patient assessments – unit-specific competency standards required - patient classification system.

in addition to the direct care registered nurse-ratios requirements in subsection (b), each hospital shall assign additional direct care registered nurses and other licensed or unlicensed staff through the implementation of a patient classification system for determining patient care needs of individual patients that reflects the assessment made by the assigned direct care registered nurse of patient nursing care requirements and provide for shift by shift staffing based on those requirements.

(d) general requirements.

each hospital shall provide minimum staffing by direct care registered nurses in accordance with the general requirements of this section and the clinical unit direct care registered nurse-to-patient ratios specified in subsection (b) above. staffing for patient care tasks not requiring a direct care registered nurse is not included within these ratios and shall be determined pursuant to the patient classification system described in subsection © above.

(f) restriction.

(3) a hospital may not impose mandatory overtime requirements to meet the staffing ratios imposed in subsection

(h) consumer protection.

a hospital subject to this section shall post on a day-to-day, shift-by-shift, in a conspicuous place visible to the public the ratios of direct care registered nursing staff to patients on each unit, additional staffing requirements as determined by the patient classification system for each unit, the actual staff and staff mix provided, and the variance between required and actual staffing patterns.

summary

this bill imposes minimum staffing requirements for direct care registered nurse-to-patient staffing on all hospitals with an increase of direct care registered nurses and other licensed and unlicensed nursing staff required based on the individual acuity of the patients.

[Julia RN]

Noticed they do not mention New York or Michigan- and only a passing mention to Minnesota. Those state Nurses Association's unions are proposing ratio legislation with mandated minimum numbers that are upwardly adjustable for acuity and other factors.

I do not have any experience with the various forms of the staffing committee/hospital association endorsed legislation which has been passed in a number of states, but can comment on my experiences with this issue in collective bargaining.

I have participated in many labor/management staffing committees that were mandated by contract and found them to be minimally effective at improving staffing.

The first problem is just getting the staff nurses to be able to attend the meetings as part of their workday. Many meetings are cancelled, because of- you guessed it- short staffing. These meetings never seem to be a priority when the staffing decisions are made. Management often expects the staff nurses to attend them on their own time and/or days off- now that's empowering!

The accuracy of the information often becomes a focus of disagreement. Management says there were 6 nurses and the staff reports that there were five. By the time the information is sorted out- it doesn't matter anymore- the damage has been done.

Management usually seeks a "range" or "staffing guidelines" type of agreement and will consistently staff to the lowest of number of nurses allowable- or violate the agreement altogether. Again, you can file a grievance and go all the way to arbitration- which may be heard 6 months to a year from when the "unsafe" conditions occurred.

If you do succeed at getting numbers in a contract- even a range- just agreeing on numbers for the staffing can take up many negotiating sessions- I don't think a year is an unusual amount of time.

But we still persist- because any improvement, no matter how small is still worth it.

So unless the minimum numbers are spelled out in the legislation, the process, as this article points out will take a very long time. And in some states, including Washington, management can still get out of staffing according to the plan they agreed to.

Seems like a big waste of time and effort in my opinion- and more importantly- a lot of time that unsafe conditions continue for nurses and the patients they care for. Legislation, must have the ratios spelled out, and be upwardly adjustable, in order to really address the issue of staffing.

I've had my fill of stall tactics- and so have my patients- thanks AHA and ANA!

[lindarn]

Noticed they do not mention New York or Michigan- and only a passing mention to Minnesota. Those state Nurses Association's unions are proposing ratio legislation with mandated minimum numbers that are upwardly adjustable for acuity and other factors.

I do not have any experience with the various forms of the staffing committee/hospital association endorsed legislation which has been passed in a number of states, but can comment on my experiences with this issue in collective bargaining.

I have participated in many labor/management staffing committees that were mandated by contract and found them to be minimally effective at improving staffing.

The first problem is just getting the staff nurses to be able to attend the meetings as part of their workday. Many meetings are cancelled, because of- you guessed it- short staffing. These meetings never seem to be a priority when the staffing decisions are made. Management often expects the staff nurses to attend them on their own time and/or days off- now that's empowering!

The accuracy of the information often becomes a focus of disagreement. Management says there were 6 nurses and the staff reports that there were five. By the time the information is sorted out- it doesn't matter anymore- the damage has been done.

Management usually seeks a "range" or "staffing guidelines" type of agreement and will consistently staff to the lowest of number of nurses allowable- or violate the agreement altogether. Again, you can file a grievance and go all the way to arbitration- which may be heard 6 months to a year from when the "unsafe" conditions occurred.

If you do succeed at getting numbers in a contract- even a range- just agreeing on numbers for the staffing can take up many negotiating sessions- I don't think a year is an unusual amount of time.

But we still persist- because any improvement, no matter how small is still worth it.

So unless the minimum numbers are spelled out in the legislation, the process, as this article points out will take a very long time. And in some states, including Washington, management can still get out of staffing according to the plan they agreed to.

Seems like a big waste of time and effort in my opinion- and more importantly- a lot of time that unsafe conditions continue for nurses and the patients they care for. Legislation, must have the ratios spelled out, and be upwardly adjustable, in order to really address the issue of staffing.

I've had my fill of stall tactics- and so have my patients- thanks AHA and ANA!

AMEN!!!

Lindarn, RN, BSN, CCRN

Spokane, Washington