How to Find Staffing Guidlines

Nurses General Nursing

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Specializes in ED.

Just wondering how other hospitals come up with their staffing numbers. We recently had a situation on my floor that we all felt was quite dangerous. We would like to develop a new policy but are not sure where to go to find hard data to support our suggestions.

Now some background. I work on a telemetry/oncology floor. We are all expected to be Basic Coronary Certified (some of us are also ACLS), we are also chemo competent. We have 24 telemetry beds and 35 beds total. There is no monitor tech and the charge nurse on each shift is expected to watch the monitors along with her other duties. She does not take a patient assignment. We do run several gtts, Natrecor, dobutamine, heparin, integrilin, insulin. We don't run cardizem or nitro gtts. We also run all chemo drugs. Our patient population is quite elderly, alot of confused patients and our fall rate is the highest in the hospital. Currently, our staffing ratios are target 4:1 days, minimal 6:1 days; target 7:1 evenings, minimal 9:1 evenings; target 7:1 nights, minimal 10-11:1 nights. We are usually staffed to the minimum.

Recently we had a medication that required the nurse to do q15 minute vs thru out the duration of the infusion. This was about 12 hours. All patients are also required to be checked hourly and most are assessed q4hr. We feel that when a patient is monitored that closely, the nurse should have less patients, or the patient should be in the ICU. We asked the doc to actually write an order that the nurse could only have 4 patients, but they said they couldn't do that. So we are taking matters into our own hands. Anyone have any idea where to find some kind of guideline or evidence supporting nurse to patient ratio when infusing critical medications? The more data and evidence we can gather, the stronger our arguments can be.

Thanks!

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Specializes in ICU/ER.

I dont understand why the Dr wouldnt/couldnt write that order? We have Drs who will write 1:1 care.

One of our Docs may be the exception though as he totally rocks, one time one of his pts was driving us crazy with his confusion and climbing out of bed. After 2 calls to the Dr in the night/early morning to get something anything to calm this guy down, 0500 rolls around and here strolls Doc with 2 cups of coffee in hand, he went and sat in pts room till 0700 so we could catch up. And of course let charge nurse know this pt would need 1:1 during the day!! I LOVE THAT MAN.

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Specializes in ED.

I have no idea why they refused to write the order. You're right, they have no problem writing for a 1:1 watch for patient safety. I guess they only consider the patient unsafe if they are suicideal, or jumping out of bed. Monitoring infusions for reactions doesn't count. Just one more thing us supernurses should be able to do!

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Specializes in vascular, med surg, home health , rehab,.
I dont understand why the Dr wouldnt/couldnt write that order? We have Drs who will write 1:1 care.

One of our Docs may be the exception though as he totally rocks, one time one of his pts was driving us crazy with his confusion and climbing out of bed. After 2 calls to the Dr in the night/early morning to get something anything to calm this guy down, 0500 rolls around and here strolls Doc with 2 cups of coffee in hand, he went and sat in pts room till 0700 so we could catch up. And of course let charge nurse know this pt would need 1:1 during the day!! I LOVE THAT MAN.

Wow, that doc deserves a medal! So nice to see an attitude like that.

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Specializes in tele, oncology.

Holy crap, I work on a similar floor (tele/oncology, drips, chemo, etc.) with 25 beds and the absolute max we'll take is a 6:1 ratio, with the techs having 12-13:1 (unless we get screwed on nights and have one tech for the floor). They have recently tried having us go up to 7:1 but we all threated to call our manager, the hospital administrator, and the BON if that happened, as well as filing an incident report as a Sentinal event if ANYTHING went wrong. I cannot fathom how in the heck they expect safe patient outcomes with a 10:1 ratio! How many patients have to die from unsafe staffing ratios before some management wakes the heck up?

Guess I'll quit complaining about when we're 6:1 instead of 5:1....

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A quick look at the Oncology Nursing Society website did not offer much in the way of help with this issue. From what I see, they do not take a position on staffing ratios and their legislative advocacy program does not mention any staffing bills which they support. Hmm... the variations in staffing evident in the responses suggests to me that the professional specialty organization needs to take a look at the issue of staffing.

You could still try to write to them- are you a member? Contact them here:

http://www.ons.org/contact.shtml

I see you are in NY. You might want to contact the New York State Nurses Associaiton. Here's a link to one of their position papers (2007) related to chemotherapy/oncology nursing- the contact number and email for the nursing practice dept is at the bottom of the page.

http://www.nysna.org/practice/positions/position23.htm

The staffing legislation that NYSNA supports has a 1:3 ratio in tele and 1:4 in med/surg.

http://assembly.state.ny.us/leg/?bn=A06119&sh=t

You say your fall rate is the highest in the hospital. That should be a red flag to your administration- they should be listening to you!

Hope this is helpful. Let us know how you make out.

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Specializes in Community Health, Med-Surg, Home Health.

Let me just say that this is a great thread and thanks for initiating it. This subject was one of the wonders of my wandering mind and I await responses.

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