What Nurses Really Want

lindarn · Jul 11, 2015

I am really happy for you, that your work in a state, that treats nurses well.

Unfortunately, too many nurse work in states where they are NOT treated well.

Their ONLY recourse, is to unionize with a powerful union, like NNOC.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN (ret)

Somewhere in the PACNW

SC_RNDude · Jul 11, 2015

Thanks herring_rn!
SC_RNDude - I hear your concern, but isn't that the point of including the part in the California law that requires a patient classification system to assess whether the minimum ratio isn't good enough during a particular shift? My understanding is that the patient classification systems in California are supposed to be reviewed... annually, if I remember correctly. IS that being done? Or, like any oversight process, is that something that sounds great on paper but doesn't have the staff or funding to implement effectively?
Granted, cutting other support staff like CNAs would be a likely response... I'm not sure how best to prevent that from happening.

There are a thousand variables that could be used in a "patient classification system". And, each patient can vary greatly over the course of 1 shift. Even where I work, where they try to staff as best they can according to acuity, it often does not work out like you would want.

And, it would be impossible for a regulatory agency to oversee it. In California, where this law is in effect, it takes a current RN from out of state 6 to 8 months just to get a California license. It therefore is doubtful that they have the resources to oversee the acuity plan of each unit in each hospital.

SC_RNDude · Jul 11, 2015

I am really happy for you, that your work in a state, that treats nurses well.
Unfortunately, too many nurse work in states where they are NOT treated well.
Their ONLY recourse, is to unionize with a powerful union, like NNOC.
JMHO and my NY $0.02
Lindarn, RN, BSN, CCRN (ret)
Somewhere in the PACNW

Or, maybe hospitals in non-union places have to treat their nurses well to attract and retain good ones.

In contrast to union places where everything is structured according to a contract that everyone, on both sides, lives and dies by.

allnurses Guide · Jul 11, 2015

Or, maybe hospitals in non-union places have to treat their nurses well to attract and retain good ones.
In contrast to union places where everything is structured according to a contract that everyone, on both sides, lives and dies by.

Some hospitals do provide sufficient staff and supplies. They only assign nurses to patients they are competent to care for.

But others do not.

SC_RNDude · Jul 11, 2015

Some hospitals do provide sufficient staff and supplies. They only assign nurses to patients they are competent to care for.
But others do not.

Yes. What is your point?

Let me ask my previous question in a different way. Where is the data that shows California's nurse to patient ratio legislation has improved patient outcomes and nurse satisfaction?

allnurses Guide · Jul 12, 2015

Yes. What is your point?
Let me ask my previous question in a different way. Where is the data that shows California's nurse to patient ratio legislation has improved patient outcomes and nurse satisfaction?

Implications of the California Nurse Staffing Mandate for Other States

http://www.nursing.upenn.edu/chopr/Documents/Aiken.2010.CaliforniaStaffingRatios.pdf

Impact of Nurse Staffing Mandates on Safety-Net Hospitals: Lessons from California

Impact of Nurse Staffing Mandates on Safety-Net Hospitals: Lessons from California - MCHUGH - 2012 - Milbank Quarterly - Wiley Online Library

State-Mandated Nurse Staffing Levels Alleviate Workloads, Leading to Lower Patient Mortality and Higher Nurse Satisfaction

https://innovations.ahrq.gov/profiles/state-mandated-nurse-staffing-levels-alleviate-workloads-leading-lower-patient-mortality?id=3708

lindarn · Jul 12, 2015

Why exactly do nurses get their knickers in a wad, over having to,"prove", that staffing ratios work to improve patient outcomes, in order to ask for patient ratios? It should be a no-brainer that if nurses take fewer patients, that there will be better outcomes.

Let me ask you a question. Do you see teachers asking if limiting the number of students in their classrooms, produces better outcomes? Where is the data, that shows that teacher-student ratios, improve teaching and student retention?

Again, it is a no brainer. Better nurse patient ratios are better for the nurse and the patient. If nothing else, better nurse patient ratios, is better for your license.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN, (ret)

Somewhere in the PACNW

SC_RNDude · Jul 12, 2015

Why exactly do nurses get their knickers in a wad, over having to,"prove", that staffing ratios work to improve patient outcomes, in order to ask for patient ratios? It should be a no-brainer that if nurses take fewer patients, that there will be better outcomes.
Let me ask you a question. Do you see teachers asking if limiting the number of students in their classrooms, produces better outcomes? Where is the data, that shows that teacher-student ratios, improve teaching and student retention?
Again, it is a no brainer. Better nurse patient ratios are better for the nurse and the patient. If nothing else, better nurse patient ratios, is better for your license.
JMHO and my NY $0.02
Lindarn, RN, BSN, CCRN, (ret)
Somewhere in the PACNW

I think we all agree (and there is research to back it up) that in general, lower patient to nurse ratios lead to better patient outcomes. That isn't the question I asked.

SC_RNDude · Jul 12, 2015

Implications of the California Nurse Staffing Mandate for Other States
http://www.nursing.upenn.edu/chopr/Documents/Aiken.2010.CaliforniaStaffingRatios.pdf

Impact of Nurse Staffing Mandates on Safety-Net Hospitals: Lessons from California
Impact of Nurse Staffing Mandates on Safety-Net Hospitals: Lessons from California - MCHUGH - 2012 - Milbank Quarterly - Wiley Online Library
State-Mandated Nurse Staffing Levels Alleviate Workloads, Leading to Lower Patient Mortality and Higher Nurse Satisfaction
https://innovations.ahrq.gov/profiles/state-mandated-nurse-staffing-levels-alleviate-workloads-leading-lower-patient-mortality?id=3708

Thank you.

FloridaBeagle · Jul 16, 2015

Any data of the effects of California's law?
Everywhere I've worked (in a non-union state) the ratios are the same or better the California's. I'm not impressed by California's law.

I guess you haven't worked in FL, where ratios on med-surg floors are from 6-10. Totally unsafe. I just quit my job in FL due to this. FL needs a law like Cali's.

Or, maybe hospitals in non-union places have to treat their nurses well to attract and retain good ones.
In contrast to union places where everything is structured according to a contract that everyone, on both sides, lives and dies by.

Now you've got me rolling on the floor laughing. I quit my job in a non-union FL hospital that had high ratios and low pay. I was just hired at a hospital that will give me a 4:1 ratio and $10 an hour more, plus a pension. (Yup, it's a union hospital!)

My non-union hospital bleeds nurses. Our charge nurses have 8 months experience because everyone quits so quickly. Give me a union hospital anyday.

Editorial Team / Admin · Jul 16, 2015

I guess you haven't worked in FL, where ratios on med-surg floors are from 6-10. Totally unsafe. I just quit my job in FL due to this. FL needs a law like Cali's.

Many states have this issue, and I'm frankly surprised the other poster hasn't seen it. My facility's policy is that on a tele floor, the ratio on days is 1:4, 1:6 on nights. Wanna know how often that policy is followed? Pretty much never because there isn't enough staff to pull it off.

toomuchbaloney · Jul 16, 2015

It would be difficult for any person to peruse threads on AN and not understand that critical staffing issues are not rare or confined to certain states or regions, IMHO.

I also have worked in an acute care hospital which was not unionized while the next closest inpatient facility was. As a result we enjoyed all of the benefits of the union without having to pay the dues.

In the absence of that direct competition for professional nursing staff, my experience is that if management is not pro-nursing then the nursing departments will be chronically understaffed and asked to do more with less. The nurses will be viewed as a cost rather than an asset and treated accordingly.

I see that the mean wage of RNs in South Carolina is less than $60k per anum and the median income of all workers is about $45k. Is that a good wage there?