As nurses, we are the front line of patient safety. These days, hospitals are run as corporations and tend to put profits ahead of patients. We need to change this. People come first!
Because hospitals are now run like businesses, productivity experts and personnel who are not nurses, ask us to do so much more with less. Administration is squeezing nurses to put their patients’ lives at risk and their licenses on the line.
I am all for mandatory nurse patient ratios. While I think it is important for nurses to have safe staffing, putting a number on the nurse-to-patient ratios can have adverse effects which protections need to be added to the legislation. I would love to see mandatory staffing based on acuity. The recommended staffing ratios for a medical/surgical unit is 1 to 4. However, if you have 4 fresh postop patients, it would be impossible to take vital signs every 15 minutes on those 4 patients!
The proposed staffing ratio in critical care is 1 nurse to 2 patients. Again, if you have a patient who is extremely unstable, that patient should be a 1 to 1. By requiring mandatory staffing, the ratios should be a maximum meaning the most a medical/surgical nurse should have is 4 patients.
Legislation in California requires minimum staffing levels. However, there have been some unintended adverse effects of the legislation. For example, although there is mandatory nurse-patient staffing, many hospitals have cut support staff to balance out their budgets. We need staffing legislation and whatever requirements are promulgated should ensure that there are no unintended side effects.
Something needs to be done to ensure that nurses are not putting their licenses on the line or putting patient lives at stake. Our voices need to be heard and we need to fight for our profession and our patients. I would also love to see minimum staffing at long term care facilities.
What are your experiences with safe staffing? Do your institutions have their own mandatory staffing requirements. Please share your thoughts with us in the comments below.
beth hawkes says
I’m in California and nurse-patient ratios work extremely well. Before ratios I had up to 8 pts on Tele. Now it is 4.
Ratios are upwardly adjustable. In no way do ratios mandate that acuity cannot be taken into consideration. When a MedSurg nurse receives a fresh CBI, the ratio immediately goes to 1:3 until that patient is stable (no frank bleeding). A fresh heart is a 1:1 in ICU, as is a balloon pump patient. Just a few examples.
Please understand that to tell nurses that acuity is not taken into consideration is highly misleading. It’s simply not true.
By the way, a fresh post-op requiring q 15 minute vitals would still be in Recovery, not on the floor. Recovery nurses do not have 4 patients, they have 2 patients in California.
You must differentiate facts from propaganda and realize the source. What you are hearing and repeating is from the AHA and ANA. Unfortunately the ANA and the AHA appear to be in bed together. The AHA and ANA are also proclaiming that ancillary staff will be slashed as a result of ratios. This is fear mongering as it is not true and it is intended to get nurses to oppose minimum mandated nurse-patient ratios. They are vehemently opposing minimum mandated nurse-patient ratios (why is that, do you think? the bottom line, not patient safety).
As an example, on our 40 bed Tele we have a clinical on- the- floor pharmacist, 2 monitor techs, a secretary, 3 CNAs, a Charge Nurse who does not take patients and a throughput nurse not included in the ratios, and myself, a unit Educator. Our nurses do not do their own EKGs or blood draws or respiratory treatments. My hospital is not unique by any means.
Ask any nurse in any state- ancillary staff are being cut everywhere. Please give examples of how they are being cut more in CA as a direct result of ratios.
The AHA and ANA have introduced opposing legislation calling for “hospital committees” to determine staffing. They permit hospitals to arbitrarily set any staffing ratios they decide and are driven by pre-set budgets. How is this different or an improvement from current state? In other words. Florida nurses would continue to have 5-8 pts on MedSurg.
Illinois has this “staffing committee” legislation and it failed miserably. It is not pro-nurse or pro-patient. It puts the wolf in charge of watching the hen house. Please re-consider your position on this.
S 1063 and HR 2392 support minimum nurse-patient ratios and include skilled nursing facilities. This what the event in Washington is about. I respectfully hope you’ll reconsider your stance.
Jalil Johnson says
My experience is that healthcare facilities will not allow nurses to dictate the staffing needs based solely on an acuity model, and if they do it’s extremely rare. Healthcare facilities will push nurses to care for as many patients as possible. This contributes to burnout and medical errors. Every bedside nurse knows this. Many of the nurses who make policy do so from ivory towers and have forgotten what it’s like to be a bedside nurse. Airlines and daycare providers both have a laws detailing the safe MAXIMUM number of people a person should be responsible for. Would it be ok for an jumbo jet to have one pilot and no other crew; or one person care for 50 infants? Of course not. Yet people are ok with 1 nurse caring for up to 30 patients in long term care; or up to 8 patients in med surg. Why don’t we have a law detailing safe patient limits on the maximum number of patients a nurse can safely care for? Hospital associations and lobbyist have purchased all of the conversations around this topic, that’s why. It is simple logical for there to be a limit to the number of patients a nurse has. Big money controls this conversation, but that is changing as nurses wake up and realize they can do something to change this. Also, please talk to the thousands of satisfied nurses in California, where you will find the happiest nurses in the country. They have better pay, safe environments, and great outcomes….and the safe ratio law didn’t bankrupt the state or hospitals. Who wouldn’t want that for the entire country.
Catherine Stokes says
It surprises me to see a Nurse Attorney has not actually read the bills for mandated ratios S.1063 and H.R. 2393 The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017.
If you had, you would know that the bill actually DOES include Acuity. Hospitals would be required to form the same “staffing committees” that the ANA legislation about. The main difference between the bill (though there are many that are better for nursing on the mandated ratios bill) is that there would just be a set limit to prohibit management from forcing nurses to take more patients then what is set. They of course can always take less as they do now in CA.
I find this article to not be supported by any facts, only propaganda that is misleading to those who are reading that do not actually know the legislation, which is in question. And most find bills overwhelming to read and tend not to do it.
Cutting of support staff is occurring across the US, in states without mandated ratios. The legislation proposed for mandated ratios actually includes provisions so that support staff is not able to be just dropped. I have seen/heard many CA nurses who deny that they do not have support staff. Actually quite the opposite… some hospitals actually have “lift teams” to help turn patients. And they still have their CNAs, secretary, housekeeping, and dietary services plus others.
“These findings suggest most hospitals did make upward adjustments to RN staffing in response to the mandated nurse- to-patient ratios, by increasing use of employee RNs and reg- istry nurses. However, this adjustment did not decrease use of nonnurse staff who could have been vulnerable to cost reduc- tion strategies. “ https://docs.wixstatic.com/ugd/6004d0_9e94c5349ec84e3986bd6b35adc0f9d1.pdf
If you look at the income of CA hospitals they are thriving.
Studies are showing a cost benefit to having more nurses for patients: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543286/
Those are just a couple but more studies can be found: https://www.nursestakedc.com/research-support
For further accurate research on the bills.
Link to bills: https://www.congress.gov/115/bills/hr2392/BILLS-115hr2392ih.pdf
One of my colleagues made a great comparison of the two bills. Maybe this would help you with your articles. You can find it on https://www.facebook.com/nursestakedc/
We will be having a Rally in Washington DC this April 26, 2018. Area 1 in front of the Capitol. Many nurse leaders, bedside nurses, and supporters of getting legislation that does “set a limit” to the amount of patients that a nurse is forced to take. Acuity based legislation is not enforceable and is easily manipulated by management. There needs to be accountability of Hospitals.
It would be great to have your support. Hope to see you there. #NursesTakeDC
Poor staffing BREEDS poor staffing…..it would be great if administrators could be trusted to keep the safety of the nurses and the patients as the bottom line.
Acuity is the only way to safely do staffing. I have worked Med/ Surg ( with fresh postops/ q 15 min VS) and long term Care night shift and had 50 residents with 2 CNA. Patient safety has to be top priority with everyone
Love My Patients says
The comments are the best part of this post. I have a question that maybe California nurses can answer: how will the mandate affect Lpns? In the LTC world LPNs are the major beside nurses and the acuity levels are increasing. Will these bills include the LPNs or just RNs?