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Nursing: You Wanna Know What I Think?

New Nurse Staffing Bill: Don’t Stop Believing

Published May 17, 2013 2:05 PM by Pat Veitenthal

The social networks among nurse are all abuzz about the new staffing ratio bill being introduced to congress by Sen. Barbara Boxer (D-Calif.). Like the cicadas, this attempt rolls around every few years when someone in power like the good senator tries to get this done.

Odds are she was recently exposed to a hospitalization situation and saw some things first hand that didn’t sit well with her. Maybe a friend couldn’t get to a CCU bed for 16 hours. Or maybe her daughter had to wait and hour for pain medication, hence the bill. Or maybe California’s strong nursing union just got to her.

Everybody is happy and supportive, and naïvely believes this would be the answer to everything. After all, it’s no secret adding RNs at the bedside improves patient outcomes. The staffing ratios presented in the bill are every nurse’s dream ratios. Go here for an easier read of the bill. You can also track the bill’s progress here. You can also see the projected chance of the bill getting passed at that site: 0%. It’s already doomed.

Now if in some other dimension this bill were to pass, I don’t think everyone would be as happy about it as they think. In my long career, I have never seen an increase of RNs without a more severe decrease in other services. Those darn hospitals have to pay all those “extra RNs” somehow. So you begin to see CNAs and techs disappear, and those left begin to cross-train as unit secretaries. PT/OT/RT services get cut too. Case management staff becomes smaller, with openings not filled. Good news for new grads though, they start getting jobs because they’re cheaper than RNs with experience.

Yeah I know. Here I go again spreading sunshine and cheer. Listen guys, I REALLY hope I’m wrong. I will lead a parade if this bill passes. Hell, I’ll donate more money to Nurses House if it even gets passed through the first committee!

In the meantime, all you optimists out there, we need you to keep believing. Somebody has to!

 

9 comments

Cecile is correct. In fact I am old enough, close to 80, to remember when this was the case. An experienced RN, and in those days she may have been a diploma RN without an advanced degree. She (it was usually a she in those days) would be the DON of a hospital and make hands on decisions regarding staffing, budgeting and all other major decisions. Today, the situation is very different and the top CEO is not a nurse, and those in other management or middle management positions, and there are many, must think first of the "bottom line," and he/she cannot be an advocate for either patients or staff. As another retired nurse commented, new graduates, the majority of whom have BSNs, can only obtain per diem hours and they need mentoring. However, the other RNs who might be willing to do this, do not have the time, due to short staffing and high patient acuity.  New RNs have the technical knowledge needed, as nursing has changed drastically since the mid 1950s, but they do not have the hands on experience and truthfully need a six month plus, "internship." Many are just thrown into situation for which they are not prepared. In college, they had one, or at the most two, patients and they had an instructor at their elbow.

Carla, Pt Education/retired - RN January 11, 2014 5:02 PM
Pittsfield MA

I retired from hospital work in 2007, tired of the stress, demands & lack of supplies available for night shift staff. Medical care will not improve until doctors & nurses advocate for patients & patients are educated about the medical care system in this country. That system includes pharmaceutical companies, insurance companies, Medicare, Medicaid, federal & state laws, & ALL components of medical care. People are living longer but there will be fewer professional caregivers; God help us!

Frances, Home health, private duty - RN May 29, 2013 12:30 PM
Mobile AL

This happened to me.  No union, a bullying supervisor that I chose to do battle with over staffing ratios and his ageism in hiring. I froze admissions until new staff could be trained making it inconvenient for the Docs who were furious but powerless to do anything. I made them accountable for their failure to treat problems that arouse in the indigent patients.  Eventually I was terminated for "irreconcilable differences"  between my boss  and me with the explanation that a Master's prepared director was harder to replace than a BSN Manager.  I sued and won a small compensation.  It was all politics and money.  Job applications ask if there was EVER a termination or request to resign.  No healthcare for nurses.  I should have become a teacher and claimed FREE healthcare for myself and spouse FOR LIFE.  Nursing jobs now offer only per diem at half of what I earned.New grads for cheap, experience not really valued are preferred. I did some staffing and the ratios are dangerous.  It makes no sense to make performance expectations higher and increase patient ratios. I observed nurses faking dressing changes, giving most of the meds at ounce (sometimes double doses of meds) and simply unable to carry out all the care needed for all the patients they were assigned.  I decided to retire rather than risk my license in this environment bit I am angry as well as poor and uninsured.

Arlene, dialysis - BSN,Manager May 22, 2013 11:07 PM
NJ

Dan, because if the RN goes into middle management, she/he loses his/her ability to stay in the union. He/she, also, loses her seniority in many facilities. If she/he does not go along with the bidding of upper management and loses his/her position in mid level management she/he goes to the bottom of the pay scale and must apply, anew, for a position with a commitment of hours so she/he can retain their insurance coverage. It is a no win situation.

I know one nurse, with a years of experience and advance degrees who would not take a management role, although she would be excellent.  She has seen what happens and she is the sole breadwinner in her family and could not walk that tightrope.

Carla, retired - RN May 22, 2013 1:32 PM
MA

I will never work a hospital again for the reasons noted above!!! Once an R.N. gets "promoted" to mgmt. level--they identify with that group and forget all about being a "Nurse:((" Have seen that in many hospitals, over the years, in many states, etc.

Dan , Both - R.N, R.T.(R), School May 22, 2013 1:21 PM
Many NC

The bill H.R. 1907 introduced by Rep. Schakowsky and S. 739 introduced by Sen. Boxer have both been introduced this year. There are many articles supporting the need for an increase in registered nurses at the bedside to reduce patient mortality and improve safety and overall outcomes(H.R. 1907, 2013; S. 739, 2013).

However, both these bills also include a provision requiring an increase in reimbursement from Medicare to alleviate the 'financial burden' for hiring more RNs (H.R. 1907, 2013; S. 739, 2013). However, there should be a penalty for a reduction in ancillary staff as well. The purpose of an increase in RNs is not to replace existing staff but to add to the team in order to improve the quality of care and nurse satisfaction. Could you imagine? Nurses might actually stay working on the floors.

Tina D. BSN, RN

Tina, RN May 22, 2013 11:41 AM
IL

I saw this happening when I was employed. Even if an experienced RN became a director or was in middle management she or he walked a tightrope.  If she/he advocated for the staff or tried to help the staff when the patient acuity increased or the unit was slammed with admissions, he/she was excoriated by  upper management.  Cecile is correct, what is needed is experienced RNs in upper management, as this is where the ultimate decisions are made. As it is now, these decisions, especially regarding staffing and treatment of both RNs and ancillary staff are in the domain of those who never actually worked in the areas over which they are making decisions.

Carla Skidmore, Retired - RN May 22, 2013 11:16 AM
Pittsfield MA

I saw this happening when I was employed. Even if an experienced RN became a director or was in middle management she or he walked a tightrope.  If she/he advocated for the staff or tried to help the staff when the patient acuity increased or the unit was slammed with admissions, he/she was excoriated by  upper management.  Cecile is correct, what is needed is experienced RNs in upper management, as this is where the ultimate decisions are made. As it is now, these decisions, especially regarding staffing and treatment of both RNs and ancillary staff are in the domain of those who never actually worked in the areas over which they are making decisions.

Carla, Retired - RN May 22, 2013 11:15 AM
Pittsfield MA

UNTIL  A  REAL NURSE THAT HAS ACTUALLY WORKED AS A NURSE IN THOSE CONDITIONS STARTS TO MANAGE IN HOSPITALS AND HAS SOME REAL SAY THE CONDITIONS IN HOSPITALS AND NURSING HOMES WILL CONTINUE TO BE HORRIFIC. A PRETTY PLACE DOES NOT ALWAYS MEAN A+ CARE.

CECILE, RN May 22, 2013 8:38 AM
AL

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    Pat Veitenthal, BSN, RN
    Occupation: Per diem nursing supervisor and cruise ship nurse
    Setting: Community hospital and cruise ships
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