Patient ratios progressive care units
Register Today!-
This is a discussion on Patient ratios progressive care units in Cardiac Nursing, part of Nursing Specialties ... I work on a progressive care unit which had a pt:RN ratio of 3:1 when I started 3 years ago and now...
by kaylasmommy Jan 10I work on a progressive care unit which had a pt:RN ratio of 3:1 when I started 3 years ago and now we are moving to 4:1 ratios now. The facility/mgmt has stated that 4:1 is the national standard for progressive care units now.
They have decided to off-set this increase in patient loads by increasing the number of CNAs on the floor. So now each CNA also only has 4 patients.
The problem I am seeing is that the nurses are way over worked, stressed out, skipping lunch etc. while the CNAs walk around complaining about how bored they are.
On our unit all patients are on cardiac monitoring, (which we monitor ourselves, no tech, and alarms hooked to a pager) we do some titratable gtts (cardizem, nitro, heparin and insulin). We have some respiratory patients including chronic and/or stable ventilators, rescue bipap, and hi flow 02. We also have pre and post cardiac catheterization pts, and also post open heart (usually day 2) when they still have external pacer wires, chest tubes, insulin gtts, etc. Needless to say, the assignments are busy and adding an extra patient seems unmanageable.
The union was of very little assistance with this transition. It seems to me that patient safety and satisfaction are at risk here. I'm just wondering what others find in similar units.
Print and share with friends and family.
Compliments of allnurses.com.
http://allnurses.com/showthread.php?t=807545©2013 allnurses.com INC. All Rights Reserved. -
-
Jan 11 by turnforthenurseRNnot all PCUs are created equal. I work on a PCU and the ratio is 1:4 but for awhile we were going to 1:5-6 because of staffing. A ratio of 1:3-4 seems to be common. I did my preceptorship my senior year on a cardiac stepdown/VICU and the ratio there was 1:3. in the VICU, it was 1:2. And ICU stepdown at that same hospital (where they had patients on ventilators and titratable drips) also had a ratio of 1:3.
My unit does not accept patients on (invasive) ventilators. I realize some PCUs do but as I said, not all PCUs are created equal. We have patients on continuous BiPAP. We have pre/post cardiac cath patients. We have patients with a lot of cardiopulmonary problems (UA/NSTEMI, chest pain, CHF exacerbation, PE, pneumonia, COPD exacerbation, acute respiratory failure) in addition to acute/chronic renal failure patients, DKA/HHNKS (usually once they can come off an insulin gtt, our ratios are too high but once in a great while if our ICU is full, we will get a patient on an insulin gtt), patients with electrolyte imbalances (typically hyponatremia and hyper/hypokalemia), anemia, coagulopathies (we have gotten several patients with critically elevated PT/INR). We get patients with chest tubes and all sorts of drains. We do not get open-hearts because that is not done at my hospital. We also do not get patients with VADs and I have never seen patients with pacer wires.
As for our CNAs, we have 1-3, depending on staffing. With one, they have the whole floor (up to 24 patients). With two, they have 12 patients each and with three, 8 patients each. I find some nights are worse than others...there are certainly nights where we literally hit the floor running and other nights are very uneventful. I find patient SAFETY is at risk because management seems to care more about SATISFACTION thanks to HCAHPS... - Jan 15 by kaylasmommyWow thanks for your input. I guess it does kind of depend on pt acuity. I am really surprised to hear how few CNAs you work with. I think we are going through an adjustment period, 4 patients seems like a lot to me right now especially when they are busy assignments not a lot of walkie-talkies. I guess I probably needed a place to vent but I am interested in how other units operate too. Thanks for your response.
