Are your Nurse to patient ratios changing

Nurses General Nursing

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Please let us know how your nurse to patient ratios have changed or are changing? What impact have these changes had on patient care and your attitude about the job?

eriksoln, BSN, RN

2,636 Posts

Specializes in M/S, Travel Nursing, Pulmonary.

No, but we have a float nurse less often and the CNAs are cut in half almost.

schack

76 Posts

Specializes in med/surg, tele, OB.

We too, rarely have a float nurse and our CNA's are pulled from our floor.

NBMom1225

248 Posts

Specializes in Surgical/MedSurg/Oncology/Hospice.

Med-Surg/Oncology unit: 7 pts each on afternoons, 8 pts each on MN, and it's a heavy floor acuity-wise...I'm looking into other positions, but it's slim pickings right now...

AnnaN5

429 Posts

Specializes in AGNP.

Ours has changed a bit. I work on a 45 bed cardiac unit. On nights we can get up to 5 patients but most nights we would have 4 or 3 plus a new admission. You could go quite a long time without getting a 5th patient but now they have decided due to budget issues that two nurses must have 5 patients and the charge nurse can take a patient before an extra nurse can be called in.

interleukin

382 Posts

Specializes in Mixed Level-1 ICU.

The same micro management of staffing is widespread. Until and unless there is a scenario wherein a patient dies or almost dies and it is viewed by visitors, this trend will continue. And like many businesses today, once they contract, they often never do business the same way again.

Hospitals will follow suit unless/until something happens(which it eventually will) that forces risk management or lawyers to get involved.

It's a sad situation and one which has nurses thinking, "This is not what nursing was supposed to be."

patman

4 Posts

I work on a PCU unit with very high acuity pts. Our ratio is supposed to be 5:1. Lately we have been going over census with each RN taking 6. This occurs day and night and makes it very difficult to give the pts the care they need, let alone expect. It's risky business!

Specializes in Neuroscience/Neuro-surgery/Med-Surgical/.

Yes, ratios have certainly changed. I work on a 30 bed neuroscience/neurosurgical unit where 10 beds are step-down telemetry/pulse ox/ICP monitored and basically in there every hour type of care.

Step down was 1RN to 3 patients; now more often 1RN to 4.

Acuity level is 3 (highest)

The rest of the unit was 1RN to 4 patients on dayshift; now 1RN to 5patients

Night shift was 1RN to 5; now its 1RN to 6 patients.

Acuity levels range between 2-3....sometimes 5 out of 6 patients are a level 3.

If we have less than 25 beds filled, then we are down to 2 PCTs(CNAs)

If we have a pt that is suicidal/alcohol withdrawl/4 point restraints then the PCT gets pulled from the floor, and the RNs end up doing primary on most of their patients.

Charge nurses take full assignments for both days/nite shifts.

It is indeed scary times working as a floor nurse. There are multiple safety issues, but management doesn't want to hear about it since all they care about is productivity/budget.

We have had several monthly meetings regarding our concerns for safety, but it has fallen on deaf ears.

It will take a sentinel event before things change. Which is why I've put in my transfer; I don't want to be a part of this disaster waiting to happen.

*ac*

514 Posts

Yes.

We are working with a minimum of 25% less staff then we used to. We used to close beds when short-staffed; not allowed anymore. Also, patients that used to be step-down status are now on the floor.

It is incredibly stressful; burnout is rampant; lost staff is not replaced. I know I can't cope much longer.

Lacie, BSN, RN

1,037 Posts

Specializes in jack of all trades.

I think we are seeing this at most facilites whether it be hospital or outpt clinics. Recently was working outpt chronic dialysis and staff were not being replaced as they left. As a result as the DON I ended up working the floor on a daily basis as the only nurse many times 14hr days 6 day weeks. I did this for 4 months until I was at such a burn out stage. They finally hired one per-diem RN but she wouldnt work holidays, weekends or back to back days. She also refused to work more than 2 days per week and most the time only 1. She didnt last long either and I was back to the 6 day weeks. I was expected to do managerial duties after hours and on my one day off (Sunday) lol. Needless to say I left. The replacement DON suffered the same demise and lasted 2 months before she resigned. Note most dialysis facilities are for profit. I used to have 1-2 nurses to cover the floor with 2-3 PCTs for 12 pts per shift for 3 shifts. The are still working at that capacity and they cant figure out why they cant get permanent staff LOL. The company also started hiring pct's only on a per-diem basis although they would schedule the per-diems pcts 40 hour weeks. This was to avoid benefit allowances. They also didnt pay holiday pay. At one point when I was there being paid hourly initially they unexpectedly without notice changed me to salary. Only thing was they took my current hourly wage x 40 (no change in amount) so that I wasnt being paid for any overtime hours and had no raises so was at my initial starting pay after 2 years. Most staff didnt have a raise in more than 3 years.This would have been fine if I hadnt been there 60hr weeks every week. In turn it cut my pay nearly in half. I'm seeing also local hospitals are not replacing staff as they leave or retire and laying off ancilary personell therefore putting the load back onto the nurses increasing the amount of duties and pt:staff ratios. I fear this is going to be something we will have to adjust to and accept unless we bind together to advocate for better ratios. Florida is currently trying to pass mandatory ratios and do away with mandatory overtime. Funny as the FNA is against the issue!! I've not seen it this bad in the 28 years I've been an RN. If I could change my profession at this point in my life I'd do it in a minute.

eriksoln, BSN, RN

2,636 Posts

Specializes in M/S, Travel Nursing, Pulmonary.

Funny, seeing how everyone reports the worsening ratios and corner cutting.

What kills me is how management/administration will, in one breath.......insist the pt. care and achieving "superior survey scores is the goal, everyone focus".......then in the next breath put the whole unit in dangerous ratios. It gets tot he point where just getting the medications out and documenting is all that gets done. No great PG scores earned that way.

meandragonbrett

2,438 Posts

Sicker patients and more of them to take care of is the norm. No secretary or CNAs on nights. Welcome to the future of nursing. We are nothing more than a line on the hospital expense report.

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