Posted at Backstage Pass ER Doctor blogs on the down side, as she sees it, of California’s Nursing Ratios effect on Emergency Departments and patient care. A lot of this is venting but worthy of ED Nurses review and consideration. I have seen this opinion expressed widely among my EM Physician Colleagues. Organized initiatives such as diminishing the RN’s role in Triage and other corner cutting measures are a reflection of it. So the question, Is there a backlash forming against Nursing's success in healthcare and patient advocacy and job protections? I'm feeling it!!
5.12.2007
Nursing ratios
4:1 nursing ratio...sounds like a good idea on the surface.But I tell you what - if you're in the ED waiting room, dying of a brain bleed; or if you're sitting in triage with an open fracture in excruciating pain, you'd appreciate one tenth of a nurse if it meant basic treatment......
...."Basically, nursing ratios are not good for the patients when there are already not enough nurses.......unless, of course, you're one of the first 4 to arrive".
Posted by ER doctor at 11:05 AM
I have been on both sides of this issue, formally against ratios while in ED Nursing Management, and now very much for them working at the Staff Level. I am convinced I am on the right side now, more evidence here. I made comments on ED Doctor's post regarding my support of ratios and got an interesting comment that followed. Worth a read.
ER Doctor in this post and another on Nursing Unionization express anger that Physicians and their organizations did not take an earlier stance on this issue and others and are not organized like the Nurses which advocates the balance of power to Nursing. Hey, thanks for the complement or at least acknowledgement that were kicking your butts. Were used it. We have to every day just to keep things flowing and our patients safe. Hopefully, after you vent you will realize that our advocacy is to your benefit and patients benefit. Yes, some Nurses do take advantage of the ratio's but the overall effect is good for patients. I do sense your anger and see some of your points. Others are just plain wrong like a RN can be cooked up from scratch in 2 years.
In another post ED Doctor writes
5.23.2007
Letter to my peers on unionizing
(I will kindly *not* include myself in this)Doctors are stupid, because they have allowed this to happen.Still living in an era of the rich, private practice mentality...not accepting the fact that most physicians today are employees in one way or another. And instead of turning up their noses to unionizing, perhaps they should realize that they are now more like the average worker. They've allowed the nursing union to be the be the sole legislative voice on healthcare policy, to their detriment, and to the detriment of their patients.As the nursing union shouts "patient advocacy," they are trying to implement healthcare policy that actually hurts the poorest, sickest, neediest members of our society (I'll elaborate as needed). The whole while, the AMA/CMA (made up of mostly people who are completely out of touch with young physicians) asks for money, but does nothing to help their cause. Time after time, taking "no position" on matters that make a huge difference with regard to modern physician's issues. Case in point - the Governor's proposed tax on doctors and hospitals. The doctor's are getting fucked, and there is no unified voice advocating on their behalf. Therefore, patients are getting fucked, and healthcare is a complete mess. And where are the doctors? Where is their voice. What solutions are *they* offering?Doctors need to change their thinking, hold the medical societies accountable, (or refuse to join), participate in the legislative process, and drop the arrogance against unionizing. Or we can all prepare for complete chaos as healthcare continues to fall apart, without a legitimate beacon of leadership. As the doctors bury their heads in their arrogant asses, allow everyone else to take control, and then wonder why they are (directly) paying for a shitty healthcare system, run by nurses/chiropractors/optometrists/herbalists/and the 'people at the healthfood store.'Get a clue.
Posted by ER doctor at 1:50 PM 4 comments
Labels: Issues
Nurses need to be aware that a Physician backlash is taking place and be prepared to defend our practice and ability to perform patient advocacy.
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2 comments:
Wow...once again I see that those that preach something have a hard time dealing with others asking why they are not consistent with their argument.
I wonder why you feel that the powerful nurses union could not have a say in this issue. If you are going to make a public argument that ratio's in healthcare a crucial to good care then you must take the logical path that there should be ratios for every part of the "healthcare" team. I am not against ratios, the problem I have is with one group trying to say they are the patients advocates but stop advocating for patients once it falls out of the scope of work that their union represents.
If you want a ratio to ensure higher pay and job security (just like the correctional peace officers received in California by backing 3 Strikes and ensuring that there would be inmates for 20 years to life [isn't it funny that 20 years is the magic number for retirement...if their crimes are so bad why not 30 years to life or just life] then just come out and say that. I am not against that...but don’t run around California and say we are for patients when that had very little to actually do with the reasons you wanted a RN ratio. Hey by the way what about LVNs? What about CNAs? Maybe if they were apart of your union, you would have gotten them a ratio to.
The other problem I have with the nurses union in California is the fact that why they say they are the patients advocate they stand against capping health insurance premiums. In every contract that they go into, they always say they are ok with their members health insurance premiums going up. The problem with that is that when they agree to that, it put unions that represent less skilled labor in a weak position to keep health insurance premiums down for their members. The reason you don’t want to cap health insurance premiums is because you need those increases to ensure that the members of the nurses union are able to get 25% pay increases from providers like Kaiser in their recent contract. So I guess nurses are the patients advocate as long as they can afford the increasing health insurance premiums.
And before you go all crazy telling me that the nurses are backing universal healthcare legislation with SB 840 in California, why sell the rest of us out in labor while we wait for at least another decade for the political climate to become right for that type of reform? We know because the nurses need to ensure there is enough money coming into Kaiser to get that 25% raise.
For those of us in other labor movements, yes I work for a union, watching the nurses have their cake and eat it to is disgusting. If you want to be the moral do gooder in California, and want everyone to treat you that way, then you better step up and be consistent in what you are asking for.
Looking forward to seeing your response.
I see the backlash is not limited to Physicians. I'm not sure what your profession is but I make no apologies for success of Nursing advocacy and the failure of other professions to be equally as successful. Other healthcare profession need to address this issue within their organizations and through regulation and legislation. Blaming nursing does not address it, just makes you sound bitter. Many members of the healthcare team do not need ratios because their role is limited to performing a narrow set of specific tasks then their relationship with the patient is over (such as a lab tech, rad tech, and many others) That is not the relationship Nursing has with patients despite the fact that many Physicians view it that way. I do believe some Physician types need some sort of ratio protection. Private physicians have informal ratios, its called a schedule. They set it themselves based on how much time they have and how much income they desire.
As far as the Nursing Unions go, I do not support most of their political agenda, its way to the left of mine. Occasionally they get it right such as with ratio's
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