I am a nursing student in Leadership class. My group has to write a persuasive paper topic "mandated nurse-patient ratio." I live in California, where we have mandated nurse-patient ratio. On the surface, we think the ratio is a good idea, but our professor does not agree with us. After some research, we learned some set backs about the mandated ratio. We are also required to interview nurses. The problem is that we mostly got a positive response about the ratio, and we are supposed to be writing a paper against it. Many people we interviewed said that it is important to have it mandated. We need more opinion on this. Do you suggest other method of ensuring reasonable patient loads if it is not mandated? We propose our thesis that it should not be mandated (it can serve as a guideline but should not be mandated).
All input is appreciated! By sharing your opinion, the input will be used for our paper, kind of like an informal interview.
Specializes in ED, Telemetry,Hospice, ICU, Supervisor.
[quote=brandy1017;7605365
The only real downside is that I've heard there is a 47% unemployment rate among new grad RN's in CA because the hospitals are now fully staffed and apparently there is a lot less turnover since working conditions have improved. You may have to relocate to another state to get a job. I hear Texas has job openings!
The health care system I work for still hires new grades. Out of my graduating class of 40 people my hospital hired 12 of us.
We work 40 hours a week per diem with no benefits. So your looking at about $50 an hour. No health insurance, no retirement, no sick days, nothing.
We are expendable, if we get sick no one cares because we dont get sick days. My floor hasnt hired anyone in a benefited positions in 3 years. Union got involved, told us our options were to work our regular hours with no benefits or for 8 hours a week. Guess telling my rep about the situation was absolutely useless.
In short I learned to keep my mouth shut until my one year is up and I can transfer somewhere else.
As for staffing issues. We are not fully staffed on the floors, we have an internal float pool, they get called in to fill empty spots on shifts. Problem is they only stick around for a few hours and then they get pulled somewhere else. Its complicated.
In any case my hospital wont hire anyone else unless they per diem. They dont want to pay for benefits. So we have to buy our own health insurance, save for our own retirement plan, and put a little away in savings for that rainy day when i am laid out with a broken leg.
If we break an ankle while working on our roof, well were screwed. Hopefully you have enough saved to pay your mortgage and utilities until you can jump back onto the floor.
Well, south Texas is a really sick population and acuity is very heavy. So many total care patients. I have worked in ER and you hit the floor running, but in south Texas, they probably admit 45% of what comes into the ER and working the floor is tough. Patients missing limbs, poorly controlled diabetics, head to toe wound care, incontinent, unable to turn self. You get handed 5 of these patients and the very first room you walk into, you spend a minimum of 45 minutes and then you have patients already complaining because you are not answering your call lights and your nurse manager talking down to you about patient satisfaction. This does not include the confused, 1:1 and patients in restraint and some of which have been downgraded from an ICU admit to a floor admit just to place them in a bed?! Really!! Yet it is amazing that when they try to show administration how bad it really is...suddenly for a day or so staffing is perfect, no heavy patients, maybe 1-2 admissions and yes the same for when state or Joint Commission arrives and if this were not true, then why do they have special codes to announce to the floors and hospital administration that state or Joint Commission is in the house? I agree there does need to be a limit set on how many patients a nurse can take care of. Nurses don't stay around long in south Texas if they have worked elsewhere prior. The nurses that have always lived in south TX and have never worked elsewhere, don't understand because this is the only nursing they know. No one wants to complain because everyone is just thankful to have a job. Even doctor's that come from elsewhere don't stay long. It's tough and there has to be a solution to this.
It's interesting that your professor is so set against the ratios. Did she/he not allow anyone to write a paper supporting the ratios? If not this feels very dictatorial, you have come across the reality of the ratios and that is practicing Nurses welcome he ratios as they are the ones who still nurse human beings.
What your professor might not be telling you is that there is much opposition to the ratios from the healthcare industry, why? Because they fear it cuts into their short term profit. The sad truth is that there has been a lack of critical thinking from "nurse leadership" on this issue why? Because nurse leadership wants to be employed by the healthcare industry one way of assuring continued employment is to not rock the boat. For example one criticism leveled at the ratios frequently is that they are rigid... not so... the ratio law clearly states that the numerical ratios are the maximum patients any one nurse can care for, an acuity system also has to be used to determine whether the RN takes care of even less patients if the patients acuity warrants.
Your professor forcing you all to write a thesis against the ratios is showing a complete lack of integrity. You should all question what she/he does and tells you... The ratios as fought for over a lengthy period by the nurses in California are the best example working RNs have seen of nurse leadership in modern times. The nurses in California were not afraid of their professors, managers and the hospital industry trying to dictate to them how they should provide nursing care. Historically nurses have been employed by the healthcare system for their extensive knowledge, accountability and responsibility. Never forget that only you are accountable for the patient outcomes...easy for nurse managers to tell you to get by with less, easier still for a nursing professor to tell you ratios are not a good idea. The sad truth is that our profession still lacks self confidence as a whole as exemplified by your professors hostility to the ratios.
The American organization of nurse executives (AONE) claims that they are the nursing leadership organization in the country. When the ratio law was passed in California, the actual numbers still had to be determined. The department of public health was charged with setting the numbers based on research and advice/recommendations. AONE recommended a ratio of one nurse to ten patients on med/surg floors....... So revealing their disdain and distance from the bedside nurse role...
Listen to bedside nurses not professors when seeking wisdom about the art and science of nursing!
I work in CA. I worked med/surg, and ICU for 10 years. Then I was the 11 pm to 7 am administrative/supervisor for the entire hospital.
We did not have mandated staffing. An supervisor nurse on the prior shift would judge and staff for the next shift. The administrative/supervisor nurse in management would review the staffing ratios each day. The chief administrative nurse for the hospital would review it weekly. We were all nurses who had done bedside nursing. We did NOT need some legislative law telling us what the nurses needed on the next shift!
Of course these has to be some (watch out bad word) common sense about how many nurses your can afford to have working each shift versus how many patients you have. Wouldn't we all love to have every patient be 1:1 or 2 : 1. Yeah.....not realistic.
Slow nights one nurse could be fine with 8 patients and a CNA. Regardless of what some representative in Sacramento thinks? I am not saying 8 : 1 should be the ratio written in stone. I'm saying the supervisor on the floor sees and knows how the patients are doing, how the acuity is, how the nursing staff is dealing with what is in front of her nose!
Soon it will against the law to be out of compliance with the minimum nurse staffing requirement.
An excerpt from the bill:
“(A) One patient in trauma emergency units.
(B) One patient in operating room units, provided that a minimum of 1 additional person provided that a minimum of 1 additional person serves as a scrub assistant in such unit.
C) Two patients in critical care units, including neonatal intensive care units, emergency critical care and intensive care units, labor and delivery units, coronary care units, acute respiratory care units, post anesthesia units, and burn units
(D) Three patients in emergency room units, pediatrics units, stepdown units, telemetry units, antepartum units, and combined labor, deliver, and postpartum units.
(E) Four patients in medical-surgical units, intermediate care nursery units, acute care psychiatric units, and other specialty care units.
(F) Five patients in rehabilitation units and skilled nursing units.
G) Six patients in postpartum (3 couplets) units and well-baby nursery units…”
Write your congress representation to support the bill ASAP. Thank and join the ANA (American Nurses Association) for working on this issue and getting nurses this far!!
Soon it will against the law to be out of compliance with the minimum nurse staffing requirement.
I did Google it. Nothing has happened with this bill since May.
Skimming over it, I didn't see anything that would discourage hospitals from cutting down CNA staff, transporters, etc. I could see some improving the ratios, but giving more for nurses to do to make up for it.
I realize this is an older thread and the paper has long since been turned in...but why in the world is someone assigning a persuasive paper dictating what the writer's position on the argument is?? Why wouldn't you have students research BOTH sides, come to their own conclusion, and write with the intent of persuading the opposition? Are students there to learn to think critically or to be indoctrinated? Sheesh.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I realize this is an older thread and the paper has long since been turned in...but why in the world is someone assigning a persuasive paper dictating what the writer's position on the argument is?? Why wouldn't you have students research BOTH sides, come to their own conclusion, and write with the intent of persuading the opposition? Are students there to learn to think critically or to be indoctrinated? Sheesh.
Writing a paper and assigning the least popular side teaches students to do thorough research and to look at an issue from both sides. It was a popular exercise when I was in high school and college. When I had to write an argument in favor of something I vehemently OPPOSED, it was hard work. But to be honest, there were always SOME arguments in favor of just about anything.
I know this is an old post but I wanted to weigh in.
Let me start of by saying I'm opposed to government involvement in anything. Way on the libertarian side of things.
Here's why I support mandated nurse staffing ratios.
1) The state requires RNs to practice under a license and the nurse practice act.
2) Unsafe staffing ratios lead to nurses practicing outside the nurse practice act and puts patients and licenses at risk.
3) RNs have no control over the staffing situation in which his/her employer places them.
Now the root of the problem here is the state requires you to purchase a nursing license from them. If the state didn't require a state-controlled nursing license, I wouldn't believe in mandated staffing ratios. But because the state ultimately controls YOUR nursing career, they should also provide protections for your license from circumstances beyond your control. But that's a topic for another thread.
At the end of the day mandated staffing ratios make no real difference in hospital costs. For example, if you try to run the ICU with a skeleton crew, you're gonna end up with pressure ulcers. With no nurses to help turn patients, it will and does happen. Every so often a patient will sue, the hospital will settle out of court, but still end up paying $$$millions$$$. And that's just the start of how hospitals are financially penalized for poor staffing.
Someone mentioned that some assignments end up being "easy" patients that should fall outside mandated ratios. Thus unnecessary staff is used and money "wasted." I invite them to look at the perspective that in life, we often "waste" money "just in case" - health insurance, homeowners insurance, etc. Stuff we might never use but we still buy... because it could cost us a fortune if we didn't. Full staffing should be looked at as an insurance policy.
Patient safety is the ultimate concern here, but that concern amazingly enough falls on deaf ears. So I'm just presenting this from a fiscal and philosophical standpoint.
kalevra, BSN, RN
530 Posts
[quote=brandy1017;7605365
The only real downside is that I've heard there is a 47% unemployment rate among new grad RN's in CA because the hospitals are now fully staffed and apparently there is a lot less turnover since working conditions have improved. You may have to relocate to another state to get a job. I hear Texas has job openings!
The health care system I work for still hires new grades. Out of my graduating class of 40 people my hospital hired 12 of us.
We work 40 hours a week per diem with no benefits. So your looking at about $50 an hour. No health insurance, no retirement, no sick days, nothing.
We are expendable, if we get sick no one cares because we dont get sick days. My floor hasnt hired anyone in a benefited positions in 3 years. Union got involved, told us our options were to work our regular hours with no benefits or for 8 hours a week. Guess telling my rep about the situation was absolutely useless.
In short I learned to keep my mouth shut until my one year is up and I can transfer somewhere else.
As for staffing issues. We are not fully staffed on the floors, we have an internal float pool, they get called in to fill empty spots on shifts. Problem is they only stick around for a few hours and then they get pulled somewhere else. Its complicated.
In any case my hospital wont hire anyone else unless they per diem. They dont want to pay for benefits. So we have to buy our own health insurance, save for our own retirement plan, and put a little away in savings for that rainy day when i am laid out with a broken leg.
If we break an ankle while working on our roof, well were screwed. Hopefully you have enough saved to pay your mortgage and utilities until you can jump back onto the floor.