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Old 11-20-2015, 08:21 AM
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Default Nurse-to-Patient Staffing Ratios

Proponents of mandatory, inpatient nurse-to-patient staffing ratios have lobbied state legislatures and the United States Congress to enact laws to improve overall working conditions in hospitals. Proposed minimum, nurse-to-patient staffing ratios, such as those enacted by California, are intended to address a growing concern that patients are being harmed by inadequate staffing related to increasing severity of illness and complexity of care. However, mandatory ratios, if imposed nationally, may result in increased overall costs of care with no guarantees for improvement in quality or positive outcomes of hospitalization. The costs associated with the additional registered nurses that will be needed for the higher, mandated ratios will not be offset by additional payments to hospitals, resulting in mandates that will be unfunded. An alternative approach would be to provide a market-based incentive to hospitals to optimize nurse staffing levels by unbundling nursing care from current room and board charges, billing for nursing care time (intensity) for individual patients, and adjusting hospital payments for optimum nursing care. The revenue code data, used to charge for inpatient nursing care, could be used to benchmark and evaluate inpatient nursing care performance by case mix across hospitals. A nursing intensity adjustment to hospital payment, such as that described above, has already been endorsed by national nursing organizations. Efforts to implement this model nationwide within the next few years have already been initiated.

Mandatory Hospital Nurse to Patient Staffing Ratios: Time to Take a Different Approach
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Old 11-20-2015, 08:54 AM
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In certain circumstances, I believe that if nurse-to-patient ratio's are not implicated, nurses will start turning away from hospital nursing. Where I was working there were no nurse-to-patient ratio's except on the adolescent and military units. It was basically okay for the first 3 years I was there. The last year, I was there, we had a new psychiatrist on the dual floor. He wrote orders out the whazoo and hourly protocols on nearly every patient. We two nurses were so overworked to the point it became dangerous. I complained. One supervisor who was mostly there when I was would send us an extra nurse but the others no. So it was two nurses for 15-20 patients with hourly protocols.

I quit 3 months sooner than I had planed because I felt like I was putting my license at risk with up to 10 patients to care for for 12 hours, hourly protocols, plus everything else that needed to be done, including charting. I talked to the powers that be with no response. The nurse manager tried her best to get us a mandatory third nurse but they ended up letting her go so that went out the window and I decided to give a 2 weeks notice.

Mind you they had nurse-to-patient ratio's on adolescent and military because they had to (state & federal rules). I floated many times to adolescent and military and found myself bored. Especially on adolescent. There were 4 patients a piece. The adolescents had maybe one or two pills in the morning. The entire day they were busy with certified teachers and planned activities with psych counselors such as movies, games etc....So with 16 patients they had 4 RN's plus at least two techs. That's where the super would pull from to help us during med passes and/or admissions. I have to say the nurses were super and never complained about helping us. Said they were just glad they didn't work on that floor on a permanent basis.

The military had more meds but they were not med seeking like the dual patients and there were no hourly protocols. Their nurse-to-patient ratio was 1 to 5. What pissed me off was that we shared a unit (nurses station were open back to back) with military and they would sit back and yack, laugh, surf the net, goof off and watch us run our asses off without offering to help. There was a door between the two stations and sometimes we would have to "slam" it shut to keep their laughter out of our station while we were working.

Since I have been gone there is not a single nurse that I worked with left on that unit. Apparently the doc has stepped up the orders and protocols plus added duties such as prior authorizations. They just cannot keep nurses on that floor anymore. I can only say I am so happy not to be there anymore. My co-workers were awesome but that wasn't enough to make me feel like my license was safe. It won't change until something bad happens.
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Old 11-20-2015, 09:17 AM
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What the apologists for the hospital industry don't ever mention while they're screaming "Unfunded mandate!" is that a higher nurse-patient ratio (or a lower patient-nurse ratio, same thing) is demonstrably the cause of lower incidence of infection and other complications, and thus shorter stays AND fewer penalties for things like pressure ulcers, nosocomial infections, and early readmissions. This, in turn, means more profit when hospitals are paid per admission, not per day. So they may not make as big a profit, but they aren't losing so much money "just to pay for more nurses" as if it would be putting them in the red. Not.
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Old 11-20-2015, 09:58 AM
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This, in turn, means more profit when hospitals are paid per admission, not per day. So they may not make as big a profit, but they aren't losing so much money "just to pay for more nurses" as if it would be putting them in the red. Not.


Yes mame! The greedy just get more greedy....
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Old 11-20-2015, 10:55 AM
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California has proven mandated ratios work. I get it that no one else wants to do this because it costs money and reimbursements are down. Still, it scares me when I see RNs assigned 7-8 patients and they don't even get time to have their lunch break (which they are working through and not getting paid for), and not even having time to pee.

Why do we put up with this? We are only hurting ourselves. I get it no one wants to ask another nurse to watch their patients while they take a break. It truly is sad. Sometimes ya just gotta eat or go... I cannot go over 6 hours without eating. I get migraines and will get physically sick. That in itself is a whole other ball game....
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Old 11-20-2015, 09:18 PM
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The nurse I talked to in ICU concerning Mom told me that ICU was full [8 pts 2 nurses] I called her about 1030 and she hadn't had time to read the lab results on any of her pts. She works 12 hr shifts and I could hear the stress in her voice.

Is it any wonder Mom was back after 2 weeks at home?

It is 100% BS that hospitals can't afford mandates! They don't want to shell out the $$$$ for good quality nurses. Yet they REQUIRE that all nurses have their BSN. Down here that doesn't equal more pay, it just gives the hospital 'Magnet Status' whatever the hell that means!!
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Old 11-20-2015, 09:36 PM
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I can't complain about the ratios where I am. This is the best ratios I have ever experienced and I love it. Maybe that is part of the reason I love my job so much. I have the time to go the extra mile for my pts, I have time to pee, I have time to just listen to my pts and I even get to eat lunch. Our surveys are excellent and pts routinely come back to the floor to thank us. I sure feel I make a difference.

You just cannot go above and beyond for your pts if the ratios suck.
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Old 11-21-2015, 12:04 AM
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I can't complain about the ratios where I am. This is the best ratios I have ever experienced and I love it. Maybe that is part of the reason I love my job so much. I have the time to go the extra mile for my pts, I have time to pee, I have time to just listen to my pts and I even get to eat lunch. Our surveys are excellent and pts routinely come back to the floor to thank us. I sure feel I make a difference.

You just cannot go above and beyond for your pts if the ratios suck.
I want to come work with you, Meli!
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Old 02-11-2016, 04:50 PM
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In New Mexico, the staffing ratio is 5:1 for SAC and 3:1 for ICU. The nursing homes can be 50 :1. Definitely not safe.
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Old 02-11-2016, 11:30 PM
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The nursing homes can be 50 :1. Definitely not safe.
Holy smokes.
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