[RNPATL]

I know this is a hot topic, but I am interested is some debate as well as healthy discussion on nurse to patient ratios on a general mixed medical & surgical unit.

As most of you know, I am a nurse manager and my unit is 40 beds. We have a total of 20 surgical beds and 20 medical beds. Most of the time, the medical census remains pretty stable, while the surgical census fluctuates all the time.

We have a general nurse to patient ratio of 1:5-6 on days and 1:7-8 on nights ..... with this we also have a secretary and nursing assistants with a CNA to patient ratio of 1:12 on days and 1:16 on nights. I think these are pretty decent staffing ratios and am interested in getting some feedback on what your med-surg unit is doing.

Thanks!

[jax]

1:4 on days, 1:5 on evenings and 1:10 on nightshift. No nursing aids. Secretary for the day and half of the evening shift. One RN team leader for each shift who has no patient load. We are a 48 bed orthopaedic unit.

[RNPATL]

Your unit sounds wonderful. Ortho patients are pretty heavy, so I would imagine that a lighter ratio without aides probably helps out a lot. However, sometimes having an aide can really be helpful.

[Spidey's mom]

Two RN's (or one RN and an LVN). Ward Clerk from 6:30 a.m. to 10:00 p.m. most days. One or two CNA's. Our ratios are 6:1 max all the time due to California ratio law and that will change to 5:1 in January.

steph

[SweetnurseS]

I work on a 20 bed med/surg floor where we have one charge nurse who works days 6:30 to 3 mon thru friday. We work 12 hr shifts. Our patient ratio varies depending on the census. Usually we have around 15 patients most days. Our average is 3 primary staff with atleast 4-5 patients each. I've never had more than 6 patients and with most of them being ambulatory. No CNA's. We have only one LPN full time on days and nights has 2. RN's are responsible for signing off their charts if a RN didn't have that patient in 24hrs. We also have a unit secretary who works 8 hrs, 2 per day. Night shift has 3 nurses working most nights, sometimes 2 if the census is down. Most of the time if we are busy and happen to be short staffed usually we get a float from either OB or ICU.

[General E. Speaking, RN]

I work on a 28 bed med-surg floor. We have 10 pedi beds and use them as MS overflow when the pedi census is low. We work 12 hr shifts. This is the only hospital I have worked at where the night nurses have the same amount of patients as day shift. Five or six patients each. One charge nurse w/o patients. During the day we have 2 aides at night they have 1.

Too bad I can't hack night shift.... More money for less work.

[pnkprincess]

The floor I work on we do team nursing. Either an RN with and LPN or an RN with a CNT (certified nurse tech, a nursing student with at least one semester under their belt). The teams that contain an RN and LPN take more pts. usually 6-8 sometimes more when census is up. The teams that have an RN with CNT are not suppost to have more than 6. Basically because the student can't pass meds which means the RN has to do the IV and po meds, along with making sure that the CNT is doing their job right since they don't have a license.

[starcandy]

We have modular nursing on my floor. On afternoons the ratios are 2:7-8 . This is a team of RN and one PCA or the RN has 4 patients alone. Modular nursing is when you have a set assigned group of patients regardless of acuity. I think this sucks sometimes when you have a heavy set and someone else is playing games on the computer.

[cheerfuldoer]

Originally Posted by stevielynn

Two RN's (or one RN and an LVN). Ward Clerk from 6:30 a.m. to 10:00 p.m. most days. One or two CNA's. Our ratios are 6:1 max all the time due to California ratio law and that will change to 5:1 in January.

steph

That info makes me want to move back to Cali come January! Which hospital would you recommend? Any travel nurses in your area?

[schroeders_piano]

Originally Posted by kriso

Too bad I can't hack night shift.... More money for less work.

I almost let this comment go by, but I can't. I used to work Med/Surg on the night shift. Just because is it night, it does not mean it is less work for the nurses. I find it funny that a Med/Surg unit had to have a 1:5 ratio for the day shift, but one minute past 7:00 p.m. it is alright to have a 1:8 or 1:10 ratio. I realize that a patient's status change, but not that quickly. I have been reading throughout these boards about nurse retention. One of the reasons my Med/Surg unit couldn't keep nurses, was the day shift kept telling us how overworked they were and how we, the night shift nurses, didn't do anything all night. These statements were coming from a dayshift staff that had 15-20 patients. 3 or 4 RNs, 3 CNAs, a ward clerk, and case management nurses who covered lunches and breaks. Night shift had 2 or 3 RNs or LPNs and that was it. Sometimes we would get a ward clerk until 11 p.m. or we might get a CNA, but not always. The night shift also had to do the daily "chores" of the unit such as cleaning the nurse's station, checking the crash cart, restocking the rooms, etc. I was suppose to squeze this in between assessing 10 patients (or all of them if I was working with a LPN), passing meds, providing hygiene care, helping patients ambulate in the hallway (because dayshift was to busy) and doing doctor rounds with that one doctor that waits until 10:30 at night to come and see his patients. I don't normally get on my high horse, but for some reason this comment rubbed me the wrong way today. I will just apologize now to the people I might offend.


Schroeder