Mandated Nurse-Patient Ratios - page 3

Ashley sank into a chair in the breakroom on her MedSurg unit in a large hospital in Florida. It was 0330, 8 ½ hours into her shift. She had not yet taken a break of any sort, including a bathroom or... Read More

  1. by   LadysSolo
    Re: patient deaths, I had a medical resident tell me one time confidentially that hospitals have panels that decide based on usual lawsuit payouts how many nurses they can cut and save salary versus what they would have to pay out in a lawsuit. It is a cost/benefit ratio. All well and good unless yours is the family member who is expendable due to desire to cut nursing salaries. I believe it is the truth.
  2. by   BedsideNurse
    Ratio laws need to be written in a way that hospitals can't skirt them. Nurse-patient ratios have been made meaningless in many Massachusetts ICU's because hospitals started using bogus acuity tools to bring the actual nurse-patient ratio numbers down on paper. On our unit it says we average 1.5 patients a day, but rare is the day we don't have 2 patients a piece, and we often take a 3rd. It is commonplace to have transferred and admitted to where we've had 4-5 patients in an eight hour shift in ICU (including 2 sick admissions), yet on paper it says 1.3 or 1.5 patients per nurse month after month. I can count on one hand how many times I've had one patient this last year, and a couple of those were actual one to one's, which we have to fight over now as well. It's very disappointing they can do this. Ratios should not be able to be manipulated. 5 patients should mean 5, 2 should mean 2, etc...Not, well, he isn't that sick according to these calculations so he counts as as 1/3, or whatever. And then there's the "we can't turn anyone away" story. It's overwhelming and I'll be glad to retire, quite honestly.
  3. by   BedsideNurse
    (Oops, meant to reply to someone and inadvertently posted again under my own post)
    Last edit by BedsideNurse on Jan 4 : Reason: error
  4. by   Julius Seizure
    "The difference between 4:1 and 8:1 patient-to-nurse staffing ratios is approximately 1,000 patient deaths (Aiken, Clarke, Sloan et al., 2002)."

    Could you clarify? 1,000 patient deaths...per year? Or something else?
  5. by   JKL33
    Quote from LadysSolo
    Re: patient deaths, I had a medical resident tell me one time confidentially that hospitals have panels that decide based on usual lawsuit payouts how many nurses they can cut and save salary versus what they would have to pay out in a lawsuit. It is a cost/benefit ratio. All well and good unless yours is the family member who is expendable due to desire to cut nursing salaries. I believe it is the truth.
    Of course it is.

    I'm not even sure there's much of an effort to conceal it. I've had a number of conversations where relevant numbers were thrown out as a reason something was/wasn't going to change despite a safety concern, and I've been told point blank the same information you mention above.
  6. by   lmgst30
    Quote from Julius Seizure
    "The difference between 4:1 and 8:1 patient-to-nurse staffing ratios is approximately 1,000 patient deaths (Aiken, Clarke, Sloan et al., 2002)."

    Could you clarify? 1,000 patient deaths...per year? Or something else?
    The cited article says,

    "Staffing hospitals uniformly at 8 vs 4 patients per nurse would be expected to entail 5.0 (95% CI, 2.4-7.6) excess deaths per 1000 patients and 18.2 (95% CI, 7.7-28.7) excess deaths per 1000 complicated patients."

    So it's an extra 1000 deaths per 200,000 patients, apparently, but some math is required.
  7. by   Julius Seizure
    Quote from lmgst30
    The cited article says,

    "Staffing hospitals uniformly at 8 vs 4 patients per nurse would be expected to entail 5.0 (95% CI, 2.4-7.6) excess deaths per 1000 patients and 18.2 (95% CI, 7.7-28.7) excess deaths per 1000 complicated patients."

    So it's an extra 1000 deaths per 200,000 patients, apparently, but some math is required.
    Thank you!
  8. by   Beldar_the_Cenobite
    Seeing some of these comments with nurses quitting due to burn out or excess patient workload, doesn't it kind of hurt the other nurse who isn't quitting because they have bills to pay that you were working with? I've worked with some pretty awesome people non-health care related and I hated the fact they were quitting because our job was so intense during certain hours.

    You know, one way to slit the bears throat up close, since it thinks it's incontestable, is if ALL nurses left that worked at that specific facility that's so toxic. Then what would the facility do?
  9. by   Nurse Beth
    Quote from kcochrane
    I haven't finished reading all the posts...but will that mean they will do away with techs or CNAs in order to cut costs?
    We have CNAs in CA although they keep giving them more and more patients. Healthcare organizations are cutting back on unlicensed personnel everywhere. It's a poor choice to cut back on CNAs who do so much to make patients feel better! My Dad would call it "stepping over a dollar to pick up a dime"
  10. by   rnbabyzoo
    My patient tonight asked me why the nurses had so many patients, she was concerned she hasn't been taught what she needed to know to take her preemie baby home. How do you explain that management doesn't care if we are under staffed and over worked. I have on average 5 to 6 couplets a 12 hr shift at night. That's 10 to 12 patients, teaching is the furthest thing on my mind. Which should be the first thing I should be doing. We are told there is a hold on hiring due to the end of the fiscal year. Our patients are suffering and recently people are quitting or going prn to get away from the stress. Our spirits are breaking but we're told to stop talking about it. It's bringing the moral down.
  11. by   CardiacDork
    Quote from ICUman
    With all the expenses lost in replacing burnt out nurses, fines for hospital acquired pressure ulcers, medication errors, and everything else listed above, etc., how come hospitals haven't realized reducing nurse to patient ratios will actually *save* the hospital money?

    Is it more expensive really just to hire a few extra nurses? All the hospital scores and safety numbers would rise, including HCAHPS.

    It would be a win-win for everyone. What am I missing?
    This is exactly what baffles me as well! Perhaps it's time that those with business degrees listen to those bedside clinicians and nursing theorists and researchers.

    Also, it's just ... common sense in my opinion.
  12. by   Sunshine.nurse
    The push to prevent "return to hospital" in the sub-acute/long term care setting is unbelievably dangerous. The nurse to patient ratios (for Florida) can be legally as high as 40:1. The acuity is basically the same as acute care on the units I have worked. And post acute nurses work without the simplest equipment.. no pedal dopplers, no bladder scanners and 4 to 6 hour stat return time tables. It is just too much. I was talking to an acute care nurse who said, "but those patients really aren't really unstable. And all they really need is medications." Now, how many acute care nurses here have shook their head at a dc'ing patient that clearly was being dc'ed too early? I agree with madated 5:1 acute care nurse ratios. I also would love to see the nurses in this country to stand up and take a stand for our post acute nurses. There really should be no more than 10:1 ratio for sub-acute units and 15:1 on long-term care units, even that maybe too high depending on patient acuity and behaviors.
  13. by   mardel9113
    I was one of those burned South Florida Nurses. Ortho-Neuro floor , day shift and 13 patients in one of the HCA hospitals. And my floor manager and co- workers complained that not only I didn't take my lunch brake. Also I was happily working and , staying after my dhift( without asking to get pay for that) trying to get connected with my patients of the day , because I nearly had done a passing meds all day. I quit after my first year in that place. Not only med errors were done there, it was patient abused situation to me.

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