What one law would most improve nursing?

umbdude, MSN, APRN · May 28, 2019

36 minutes ago, myoglobin said:
To me the California nursing ratio law should be the "minimum" to satisfy the requirement. I believe that this is something that most nurses (and even MD's) could get behind.

It would be logical wouldn't it? Except MDs, hospitals, and many nurses would not get behind it. Massachusetts is a great example (read MA 2018 ballot: Safe Patient Limits).

The ANA (and a local NP association) sided with hospital and medical groups to defeat Massachusetts Nurses Association's patient ratio ballot initiative. These organizations out spent the MNA by a considerable margin and caused the voters (including many nurses) much confusions, who ultimately voted against the law fearing that hospitals will close or premiums will skyrocket.

myoglobin, ASN, BSN, MSN · May 28, 2019

That's too bad because Mass. is one of the states that I believe would be most likely to pass ratio legislation. However, I believe that it could also be successfully supported in other states like Vermont, Maine, Pennsylvania, and New York (to name but a few). However, it should have the full backing of the ANA and other nursing organizations and indeed should be a requirement for "magnet" status at any hospital seeking the designation.

Asystole RN · May 28, 2019

50 minutes ago, umbdude said:
It would be logical wouldn't it? Except MDs, hospitals, and many nurses would not get behind it. Massachusetts is a great example (read MA 2018 ballot: Safe Patient Limits).
The ANA (and a local NP association) sided with hospital and medical groups to defeat Massachusetts Nurses Association's patient ratio ballot initiative. These organizations out spent the MNA by a considerable margin and caused the voters (including many nurses) much confusions, who ultimately voted against the law fearing that hospitals will close or premiums will skyrocket.

Staffing ratio laws are great but unintelligent blind staffing ratios that take nothing into account are not. ANA had a pretty good explanation as to why they did not support this law but supported and proposed others.

panurse9999 · May 28, 2019

Due process in all job terminations. Not this whimsical phone call you get 10 minutes before you leave for work. "....DO not report to work....."

Mandatory full time hours if full time

Mandatory Part time hours if part time

Tenure after 3 years

myoglobin, ASN, BSN, MSN · May 28, 2019

I would argue that the "unintelligent blind staffing ratios" via the California model should be the "entry point". ICU should never be more than two to one, and PCU should never be more than three to one, and medical tele should never be more than four to one. There are of course times it should be even less. The problem with flexibility is that the "suits" will lie, cheat, steal and misrepresent the facts of patient acuity (and their lackey MD's and nursing administrators will support their prevarications) in order to make the "flexible girds" appropriate, when they are not. Even when everyone is acting in good faith, these grids will more often than not "morph" into higher acuity scenarios "mid shift" and management will say "well we couldn't obtain more staffing". Only the sort of highly structured laws that California has (with significant penalties for non compliance) will significantly mitigate this behavior (although corners are still cut even in California).

Jedrnurse, BSN, RN · May 28, 2019

Don't be surprised by the ANA undercutting staffing ratio laws. They are pseudo-corporate paper pushers, not nurses. Their "flexible staffing ratios" still amount to "make due with the staffing management gives you" a.k.a. suck it up, buttercup. Not all the toothless/powerless staffing committee meetings in the world will change that.

umbdude, MSN, APRN · May 28, 2019

22 minutes ago, Asystole RN said:
Staffing ratio laws are great but unintelligent blind staffing ratios that take nothing into account are not. ANA had a pretty good explanation as to why they did not support this law but supported and proposed others.

There are solutions to the so-called blind staffing ratios once the regulation is implemented. The mandatory ratio forces management to take staffing ratios seriously, which simply won't happen if left to the management.

We have facilities here with highly acute psych patients and staffing ratio of 1:12 (both RNs and Techs). Injuries and deaths have occurred. The law was undoubtedly great for patients and nurses, but not for the bottom line of hospitals, that's why hospital and physician organizations were against it; and ANA/MCNP went along - think about this, when hospitals' profits decrease who gets hit? Administrators and providers.

myoglobin, ASN, BSN, MSN · May 28, 2019

Well I understand the hospitals opposing and even some providers. However, the ANA should be pro nursing as the AMA is pro MD. However, this is one issue worth "spending PR money on" especially during election years since political candidates (at least many of them) would likely be inclined to go "on record" in support of such measures. It might be worth paying for a Gallup poll to see how much support these measures would get. I would wager it would be upwards of 70%, and those are the type "bi partisan" numbers difficult to obtain for almost any issue.

Ruby Vee, BSN · May 28, 2019

How about making it a felony (in ALL states) to assault a health care worker doing her job? Staffing ratios are controversial, but surely it shouldn't be argued that it's a GOOD thing to throw a chair at your nurse because she brought you green jello instead of red, or shoot your physician because you don't like Mom's diagnosis.

Asystole RN · May 28, 2019

18 minutes ago, Ruby Vee said:
How about making it a felony (in ALL states) to assault a health care worker doing her job? Staffing ratios are controversial, but surely it shouldn't be argued that it's a GOOD thing to throw a chair at your nurse because she brought you green jello instead of red, or shoot your physician because you don't like Mom's diagnosis.

Assault is a crime in every state of the union already. If you are saying to elevate the class of the crime would you choose? Class E felony carries a minimum 1 year prison sentence.

Asystole RN · May 28, 2019

40 minutes ago, umbdude said:
There are solutions to the so-called blind staffing ratios once the regulation is implemented. The mandatory ratio forces management to take staffing ratios seriously, which simply won't happen if left to the management.
We have facilities here with highly acute psych patients and staffing ratio of 1:12 (both RNs and Techs). Injuries and deaths have occurred. The law was undoubtedly great for patients and nurses, but not for the bottom line of hospitals, that's why hospital and physician organizations were against it; and ANA/MCNP went along - think about this, when hospitals' profits decrease who gets hit? Administrators and providers.

If only life were that simple. I recommend you read the ANA statements on the subject. I would be more than happy to discuss their reasons, not the reasons you make up.