How did California achieve the ratio law? I'm curious because I think that poor staffing is one of the reasons that new and old nurses are leaving the bedside. Now really, who doesn't want to run around for 14 hours without peeing or eating, having NM after NM complain about protocol, "you're not doing it right". I'll try to leave poor management out of the equation. Yes, they are another reason that nurses leave the bedside. Right now I'm focused on patient safety.
I want to hear from nurses in the know: why can't the other 49 states have the same staffing laws as California? I think if Indiana had a staffing ratio I would jump back into nursing school. I work with nurses now who have 7 or 9 patients. ICU nurses routinely take care of 3-4 pts on drips that need titrated with no help from me because I'm too busy on med surg to help ICU.
I wish they had staff ratio laws for aides. Sometimes I'm on the floor alone with 27 patients, of that, 2 are getting blood and need vitals routinely, another 6 are on tele and I have to monitor that and get vitals every 4 hours, BS, vitals all day long. Not to mention bed changes and baths on those 27 patients - most of whom are a 2 assist. I can adequately take care of 10 at a time (by myself). Anymore than that and they don't get the car they so deserve. And then what happens?? Press Gainey shows up and we get lousy scores.
So, what steps need to be taken to implement safer staffing laws? I'm not expecting it to be quick or easy. I'm willing (if I'm allowed as an aide) to spend years on this.
I am a nurse from California and I work in a hospital with union. My hospital does follow the patiet nurse ratio concept (5:1 for primary care and 7:1 for team) but they always find other ways to screw us....we only have one PCA for 24 patient....if one of our patient needs one to one observation the PCA is pulled away to watch that patient....somedays we dont have any PCA period!!
Hospital administrations and their union, the Hospital Association, are relentless. The scheme and conive ways to misinterpret their requirements.
It is NOT OK to pull a caregiver to sit with a patient. They are required to increase staffing. That is the law in California and where nurses are educated, unified unit based action works.
We don't sit around now because we truly spend time with our patients and their loved ones.
Thjis took a LOT of work and we still have to stop some dumb scheme they think up.
Petitions are a great start. Do it after work. Don't make your a[ppointment until everyone has signed it. Sometimes there is a new nurse afraid or not yet educated to safe staffing so that one doesn't sign.
Then have as many as possible go to meet with management and hand in the petition. Take a picture.
Often they won't let you all in but the numbers show you are serious.
The SNF at my hospital staffs at 1 RN and 1 LVN to 8 patients with a nursing assistant! And they don't have a ratio law!
The LVN born leader is their spokesperson. THAT is education and unit based unified action.
many nurses think that UNION is a dirty word, but until you present a united front: within a hospital, hospital across the state, you need leaders and you need nurses who will back up those leaders
until then it will get worse until we have no experienced nurses in the hospitals
i do not see any light at the end of this very long dark tunnel
Hospital administrations and their union, the Hospital Association, are relentless. The scheme and conive ways to misinterpret their requirements.
It is NOT OK to pull a caregiver to sit with a patient. They are required to increase staffing. That is the law in California and where nurses are educated, unified unit based action works.
We don't sit around now because we truly spend time with our patients and their loved ones.
Thjis took a LOT of work and we still have to stop some dumb scheme they think up.
Petitions are a great start. Do it after work. Don't make your a[ppointment until everyone has signed it. Sometimes there is a new nurse afraid or not yet educated to safe staffing so that one doesn't sign.
Then have as many as possible go to meet with management and hand in the petition. Take a picture.
Often they won't let you all in but the numbers show you are serious.
The SNF at my hospital staffs at 1 RN and 1 LVN to 8 patients with a nursing assistant! And they don't have a ratio law!
The LVN born leader is their spokesperson. THAT is education and unit based unified action.
What is the real law re: ratio anyway in California?? This is how they staff us at the hospital I work. Its a med/surg unit. If I am doing primary I get 5 patients. If I am teaming with a LVN I get 7 patients. Usually 2 RN's team with one LVN. One RN who has the less acuity gives 2 patients to the LVN and the other RN who has higher acuity gives 3 patients to the same LVN. We share one PCA for the whole floor (24 patiets) if there is a PCA assigned for that day!!! Is it the way supposed to be done in California??
Every patient in the hospital MUST be assigned to a registered nurse.
The ratio is the maximum number that may be assigned to a nurse. Therefore if you have seven patients your hospital is violating the minimum ratio.
We love to work with our LVN colleagues but the LVN should be assigned to an RN NOT to patients.
Having LVNs working can allow RNs to care for the maximum number of patients.
Our step down unit has 1:4 staffing. Patients who are intubated or have a trach need a lot of suctioning, patients with tube feedings, and those with time consuming dressing changes need a large volume of care. No RN can do all this for four patients safely. The acuity system on that unit calls for an additional RN or LVN for those patients. Of course the hospital would rahter pay an LVN and ours are excellent nurses.
We will NOY accept a registry LVN whose competency has not been validated so for registry on tele they have to send an RN.
Hospitals must add staffing to meed the needs of each patient.
I think your hospital is violating the spirit of the ratio law. I would let them know in writing that it is not possible to perform the nursing process as required by Title 22 Section 70215 on 7 or 8 patients. Any adverse effect on patient care is the responsibility of the facility not the nurses when they violate the ratios.
Now if in your professional opinion the acuity of your patients is low enough that the staffing is safe then I wouldn't fight it.
Do you have meal and break relief?
Here is a FAQ the DHS put on their web site. The questions are from nursing management at various hospitals:
We get a 30 min lunch and two 15 min breaks. But we seldom take those 15 min break as we never have enough time. When one RN in the team is taking his/her break, the other RN in the team will cover for him/her. Most of the time the teams have at least 2 acuity 4 patients meaning they need lots of care and attention. Most of the time we get 3 acuity 4 patients, one might be on restrained!! The LVN's in our hospital are very limited to what they are allowed to do and and consequently the RN's feel overwhelmed when they team.
We are documenting, our union has given us to fill up these forms, so that when they do bergain with the management they will have some evidence that the management is breaking the law.
First, a ratio law does not automatically fix the problem. That is why the other states have not followed CA. One patient can keep you extremely busy and 5 may not, depending on many factors. Also, nurse:patient fixed ratios may result in support staff not being available, since the hospital will have to pay higher wages to nurses. Texas law states that the ratio must be SAFE, and is dependent on skill mix and patient acuity. Therefore, the NURSE decides. There is safe harbor for when the nurse is over-ruled. Rarely does a rule work in every situation and patient safety is impt. More staff who are better educated is the answer, but not always achieveable budget-wise.
(my bolding)
If ratios solved the problem or not, the reason there are no ratio laws in other states is $$$, and to prevent nurses from gaining power over their own practice. It has nothing to do w/ whether or not it would "fix the problem."
Safe Harbor is a crock. Any nurse who fills it out is basically resigning from her job and asking to get black-listed.
I have had 13 pts by myself in a med/surg unit in TX, no CNA, no LPN, no unit clerk. This is not safe by any standards. I protested. I was told that I was the only nurse who had ever complained about such an assignment, and to get back to work. I learned that nurses at this unit were able to take such high loads, because they didn't do assesssments, or give all their meds. I was even told by a charge nurse "stop doing assessments. you are disturbing the pts, and you don't have time, anyway. just copy was the last nurse wrote. That's how we do it."
The nurse decides? In Texas, I have never seen a bedside nurse allowed to decide anything, except maybe when to quit.
The light at the end is your own "flame". Seek out others who share your views and their flames will combine with yours...the light is there you just need to fan it and it has the potential to be a HUGE RAGING FIRE!! As nurses we NEED to stick together...find like minded colleagues and begin the process of change TOGETHER. Hospitals and administrators WILL NOT change UNLESS WE INSIST by letting them know we mean business.
If you need help or encouragement, go to the CNA/NNOC website...ask for help and it will be offered...
We get a 30 min lunch and two 15 min breaks. But we seldom take those 15 min break as we never have enough time. When one RN in the team is taking his/her break, the other RN in the team will cover for him/her. Most of the time the teams have at least 2 acuity 4 patients meaning they need lots of care and attention. Most of the time we get 3 acuity 4 patients, one might be on restrained!! The LVN's in our hospital are very limited to what they are allowed to do and and consequently the RN's feel overwhelmed when they team.
We are documenting, our union has given us to fill up these forms, so that when they do bergain with the management they will have some evidence that the management is breaking the law.
Yes they ARE breaking the law and they know it!
When someone "covers" a break that nurse has a double patient assignment. The ratio law clearly states "at all times"
Fill out a form every time staffing is unsafe in YOUR professional opinion.
I don't know why you need to wait until contract time to confront the criminal activity of your hospital.
Specializes in Cardiothoracic Transplant Telemetry.
Regarding decreasing nursing assistants, secretaries, and other caregivers it is NOT allowed.
Title 22 licenses hospitals. It requires that Hospitals must provide staffing in accordance with the nurse-to-patient ratios.
Staffing for care not requiring a licensed nurse is not included within these ratios and MUST be determined pursuant to the patient classification system.
Unfortunately there are not enough inspectors to ensure compliance so nurses, other hospital staff, patients, and visitors must report a hospital that does not obey the law.
Have the information such as the name & address of the hospital, the unit, what was unsafe, assignments and room numbers, any harm to patients (med errors, late treatments, incomplete charting, and all the regular what? why? when? how? where? and who?
Did patients miss their bath?, was anyone injured because of insufficient staff?, were there complaints due to slow answering of call lights? What did staff do to improve it? Who did they tell? What did management say?
If the nurses get together to plan what to do and are unified in supporting each other for the sake of the patients a lot can be done.
Some of these administrators don't mind being criminals. They have to be forced by unified nurses, hospital workers, and the community to obey the law so patients get the care they need.
If everyone agrees you may want to document that you told management that the assignment is unsafe in your professional opinion. Keep a copy of the ADO attached to this post.
It takes courage but may safe your license.
Now I want to start by saying that I am in favor of staffing ratios. I now work in Oregon, and we have a bill in the state legislature that would institute ratios. When I worked in California they abided by the ratios, but did cut support staff. When arguments were made, they pointed out that every action in the CNA job description was also included in the job description of the nurse, so in effect they were within their rights to make us do "our jobs". It was also amazing how many hospitals were suddenly working towards magnet status and were suddenly pro-total care and pushing for a all RN floor staff.
Shantas
149 Posts
I am a nurse from California and I work in a hospital with union. My hospital does follow the patiet nurse ratio concept (5:1 for primary care and 7:1 for team) but they always find other ways to screw us....we only have one PCA for 24 patient....if one of our patient needs one to one observation the PCA is pulled away to watch that patient....somedays we dont have any PCA period!!