[icunurse1955]

Our hospital has a combined ICU/telemetry unit. Staffing is a nightmare. Our administration states that we need to staff by patient/nurse ratios. I think it is almost impossible to staff by anything other than acuity. Does anyone out there have a combined unit?

[Lightning Bug RN]

It is horrible how the hospital uses this method to staff floors. It is an injustice how floors with "walky talky" pts have more staff then floors where everyone on the floor needs complete assistance at all times. If anyone has a solution to this problem, I would absolutely love to hear it, my floor has been begging coordinators with no avail.

[ocankhe]

This will only change when the hospital culture changes. When nursing is no longer looked as a cost that needs to be controlled to nursing can be a revenue generator. Also when the accounting part of the hospital realizes that patient safety and the amount of reimbursements will be dependent upon performance and patient outcomes then you will see a change in nurse patient ratios. This is beginning to happen as Medicare reimbursements get linked to best practices.
Acuity standards for staffing have been tried in many places with mixed results. The definition of a particular patient is open to considerable judgment and can result in just as inadequate staffing as a strict number ratio.
These changes will take longer in large for profit hospital chains and in those right to work state where unions have less influence on employers and lobbing for legislative relief to these problems.

[pickledpepperRN]

In California hospitals that obey the law staff by acuity with the ratio the maximum number of patients that may be assigned to a nurse at any time. That includes breaks.

[Lightning Bug RN]

Originally Posted by spacenurse

In California hospitals that obey the law staff by acuity with the ratio the maximum number of patients that may be assigned to a nurse at any time. That includes breaks.

I just wish there was some way to fix it in my neck of the woods. We don't have what you in CA have, and night shift seems to really be pushed to the max every night.

I wish I could understand the rational to keep us so bear bones at night. The pts do not sleep, are constantly on the bell because the floor I work on, an ortho floor, no one can do anything for themselves.

Night shift is when we get slammed with admissions, it is when the confused pt will attempt to get OOB without assistance, pull out IVs and Foleys. If someone is going to go bad, it happens on night shift as well. Almost every night, someone is SOB, having CP, way Hypertensive, change in mental status, bradycardic, of a combination there of.

It is getting to the point that I leave work an hour late on a consistent basis completely exhausted, and I just don't know what to do anymore.

I think the most infuriating part is the fact that when we do have enough staff that we would not have a horrible night, they staff share them to another floor where the acuity is much less!

Any other ortho nurses out there? What kind of staffing do you guys have at night?

Any insight would be most whole heartedly appreciated!