Ratios

Seems like your patients are too sick for this staffing.
There should be a patient classification system (PCS) that allows additional staff based on the assessment made by a registered nurse.

Your patients get less care because you are assigned too many tasks by the RN.
Her patients get less care because he or she is forced to assign you tasks for his or her patients because the RN is responsible for the entire nursing process, including the assessment and care plan.

Perhaps each of you should have 4 or even less patients.

On the medical- surgical unit at my hospital "core staffing is 1 RN for 6 patients and a nursing assistant for 2 RNs.

Telemetry has 1:3 for patients needing a ventilator or having unstable vital signs.
For the "regular" telemetry patients each RN is assigned to 5 patients with an LVN to assist both. Those LVNs are excellent in both clinical skills and communication. They are friends (mostly).

There is a charge nurse without patients to assist and to provide break relief.

The problem comes when there are more than usual admits or when someong calls in sick.
Then RNs do not get breaks. They go to the lounge to eat, but get called back to talk with family or doctors, and if there is a change in the patients condition.
This has only happened a couple times on nights and last weekend.
Days the manager provides break relief if the charge nurse has a patient assignment. The nursing assistants have been re assigned to med/surg.
Sometimes they sit with patients for safety so restraints are needed less.

Hope this helps. Try the CNA web site:
www.calnurse.org
or the DHS links on other threads in this forum.

Supportive managers can be a gift! Many do not go for the misinterpretation of the CHA! They can tell when care is unsafe.
I praise them and all nurses and other caregivers in all settings.
Long term care, board and care, and home health need safe staffing too.
Bless the family caregivers who do 24 hour a day care for their loved ones.
On t

It doesn't sound like a good situation, but it is still better than most. When I worked med-surg, I had 9-10 pts by myself, no LPN, no CNA, no unit sec'y. Notice I say I *used* to work med-surg.

It must take the RN an awful long time to assess and document on all the pts.

Hellllllo Nurse:
That is what our committee explained to the med/surg manager. She actually said on the record that it would take an average of 15 minutes per patient for report, assessment, chart check, and preliminary planning of interventions.

We pointed out that for 12 patients with no interruptions it would be THREE HOURS before any care could be given. Even longer before charting can be started. You KNOW how important documentation is? To management it is more important to chart well than care for your patients well.
Anyway the committee recommended that every time a nurse could not care for patients as he or she believed was in the best interest of the patient an Incident Report would be filled out describing what did or could have happened. The fact that when patient care duties prevent charting until after the shift would be written on the incident report. We even made stickers for the report stating, "Treatments and/or medications, pain relief measures, and assessments were not done in a timely manner. Documentation was incomplete due to insufficient time for charting until after reporting off to the next shift."


Now no RN takes more than 6 patients ever. (so far!). The charge nurse has no patients.
There is a CNA for every 12 patients and a secretary from 7:00 am to 11:00 pm.
Assertive nurses also get extra staff when patients are sicker than usual and start with less patients so they can take admits.

The RN legally has to do the physical assessments on 12 patients. I love the LVN's I work with, they do a great job but the RN is still responsible for 12 patient assessments.

How does this equate to the new ratio law of 6:1?

Also, our supervisor is also the ER nurse, so if she has 4 patients in the ER, how is she supposed to be our break nurse?

This ratio law was not, as I've stated before, well thought out.

steph

The ratio law clearly states that a nursing supervisor, manager, or charge may not be included in the count unless performing direct patient care.

It is neither fair for the nursing supervisor nor safe for the ER patients if that same person is required to care for patients and perform supervisory responsibilities at the same time.

Of course a nurse with other duties may not relieve for breaks. The patients need a nurse to take responsibility, not just someone whose name is on a paper to show regulatory agencies.

That said there are provisions for waivers or program flexibility to meet the special needs of rural hospitals. Perhaps your hospital qualifies.