What do you think will happen if we actually achieve truly safe staffing ratios?

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Meriwhen, ASN, BSN, MSN, RN

4 Articles; 7,907 Posts

Specializes in Psych ICU, addictions.
It is possible to get to the staffing ratios you posted, many hospitals do for select units, but it is generally at the cost of ancillary staff, increased patient costs, etc.

What will happen--besides all the good things--is that nursing salaries will drop and/or LVNs and CNAs/techs will go away. Probably both.

So then the RN will have only 4 med-surg patients, but it will be total care nursing for those 4 patients. No staff to help with passing meds, taking vitals, feeding, bathing, toileting, answering call bells, etc....the RN is going to have to do it all.

California seems to be working out pretty well with some of the highest salaries in the country.

And some California hospitals have done just what I said they would, and gone total care nursing.

Has 21 years experience.
What will happen--besides all the good things--is that nursing salaries will drop and/or LVNs and CNAs/techs will go away. Probably both.

So then the RN will have only 4 med-surg patients, but it will be total care nursing for those 4 patients. No staff to help with passing meds, taking vitals, feeding, bathing, toileting, answering call bells, etc....the RN is going to have to do it all.

And some California hospitals have done just what I said they would, and gone total care nursing.

When I first started nursing I worked on a floor that did total care nursing. It was a total nightmare with 5 totals with a med pass at 0800 when the trays showed up during that med pass. If I was lucky I had some on continuous tube feedings. If not I had to spoon feed every little bite of food along with each one of 20 or so pills for Med pass to all five patients within two hours of start time. For those that were NPO there was still no break because many of them were tap water enemas until clear for a colonoscopy. Not only was it time consuming but for those who had no sphincter control in was more like an unlimited amount of flushing that did nothing but make a major mess. Then there were the IV antibiotics due a 0900 but the IV was nonfunctional so time to start poking everyone during the madness.

Now I have 6 with an aide. However this number means nothing when I discharge the six I start with and end with six admissions within twelve hours because I still have to chart on all 12 of them by the time I leave. In the end I would believe this to be the "safer" assignment, although I can guarantee I will not be leaving when my relief shows up. That is when I will chart.

JadedCPN, BSN, RN

1,476 Posts

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 17 years experience.

In pediatric world, these ratios are fairly prevealant.

Specializes in orthopedic; Informatics, diabetes. Has 11 years experience.

Maybe I'd get lunch once in a while.

Someone has to pay for the increased staff or the staff has to be paid less.

Despite popular belief, hospitals only operate on a 2-4% profit margin which is in line with grocery stores.

It is possible to get to the staffing ratios you posted, many hospitals do for select units, but it is generally at the cost of ancillary staff, increased patient costs, etc.

If you are talking about a universal ideal staffing ratio the costs would be very high but feasible. When you are talking universal however and budgets the debate changes and the current movement is away from care interventions to preventative interventions.

For this reason I am very skeptical you will see universal ideal staffing anytime in the near due to the severe lack of preventative interventions which are far more cost effective.[/quote

Honestly, if my job was a little less hellish, I'd be ok getting paid less. I'm not going to feel like utter crap everyday for less money. The reason I feel I'm under paid now is the stress and the wear and tear of every day. If that went away, I'd take less pay.

beekee

838 Posts

I'd be willing to make less so I didn't have to feel like an utter failure most days too. I was offered a job once. They enticed me with lower nurse to patient ratios than what I was use to. Then I asked about ancillary staff. Frankly, I'd rather have 6 with good support than 5 by myself.

Horseshoe, BSN, RN

5,879 Posts

"What do you think will happen if we actually achieve truly safe staffing ratios?"

Hell will probably then freeze over.

NOTE: I did see above that it says "truly safe staffing ratios," not "truly safe nurse to patient ratios," because as we have seen, safe nurse to patient ratios often go hand in hand with removal of ancillary staff.

Davey Do

1 Article; 10,249 Posts

Specializes in Psych (25 years), Medical (15 years). Has 44 years experience.
"What do you think will happen if we actually achieve truly safe staffing ratios?"

Hell will probably then freeze over.

Yeah... Yeah!

The Statler Brothers had a line from the song, "I'll Be Comin' Home to You", that went like that!

It went:

"When the sun wakes up in the west, and lays it's head down in the east,

When they ordain Madlyn O'hare and she becomes a priest-

When a San Diego sailor, comes home with no tattoo,

When hospitals actually get safe staffing ratios, I'll be comin' home to you!"

Art follows life, or life follows art, once again!

iluvivt, BSN, RN

2,773 Posts

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

I can tell you that how we do in California where I work at a very large corporation and it is great.It took the hospital a bit of time to figure out how to maintain the ratios at all times when RNs took meal breaks.Most units have a flex nurse that has no patient assignment and they help all the nurses They do admissions, dischargea,break relief... just everything .They do not necessarily do them all but they do what they can so ratios are maintained.We also have a Clinical coordinator on each shift and they do not have an assignment and can also assist with break relief The nurses do have time to provide safe and effective care.We also have streamlined communication with use of Vocera.Vocera in my opinion is great as long as nurses use bc a headset .We also have nurses aids on every unit except the ICUs.We have switched to using the heated wipes for bathing so its quicker and easier We do not have any LVNs though...just RNs and aids and that is because an LVN is counted in the ratios and if we had them they would need an RN buddy to provide the care they legally cannot provide..So overall it is great....all the kinks get worked out .

City-Girl

102 Posts

Has 20 years experience.

It's coming up for a vote in Massachusetts this November. I'm not entirely sure how the Massachusetts bill compares to the current law in California. In California they have seen significant improvements in patient outcomes, but at increased cost to the individual institutions. I read that the bill up for vote in Massachusetts has a clause that states that ancillary staff can not be decreased in the case of the law passing. So in a perfect world, better staffing, improved outcomes (which may lead to better reimbursement rates) and happier nurses = improved retention.

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herring_RN, ASN, BSN

3,651 Posts

Specializes in Critical care, tele, Medical-Surgical. Has 51 years experience.
Yeah... Yeah!

The Statler Brothers had a line from the song, "I'll Be Comin' Home to You", that went like that!

It went:

"When the sun wakes up in the west, and lays it's head down in the east,

When they ordain Madlyn O'hare and she becomes a priest-

When a San Diego sailor, comes home with no tattoo,

When hospitals actually get safe staffing ratios, I'll be comin' home to you!"

Art follows life, or life follows art, once again!

We sang this often when rallying for our ratio law:

Oh when we win our ratio law

When we win our ratio law

I'll be marching with the nurses

When the saints go marching in