Medical Floor Patient Ratio...

  1. This is for all those that work on Medical Departments. What is your RN/patient ratio for dayshifts and nightshifts? What is the total number of beds in your unit?
    At my place of employment, we have 40 beds on the Med floor. The assignment is 10 patients to 1 RN and 1 RPN care team during dayshifts. Nights are 10 patients to 1 RN. We have been trying to add another med cart to the floor to decrease the load to 8 patients per RN. Occasioanlly there is a float RN, but with the volume of sick calls, the float resource nurse ends up on a cart. We feel unsafe - things are just too nuts and staff is quitting like crazy. Something has to be done, however it seems to be falling on deaf ears.
    Thanks for your input.
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  2. 14 Comments

  3. by   Tweety
    Depends on the # of CNAs. Sometimes on day shift it's 7:1 (with a nurse, either RN or LPN, and one CNA all to his/herself), or 4 to 5 total care without any CNA help. (Most of us would rather take the 7 and have a good CNA with us, than be alone with 5). Nights is a grab bag of anywhere from 6 to 9, depending on the CNA. Rarely it's 10:1, during staffing crunches.

    It's a vicious cycle, nurses having to go 10:1 getting frustrated, calling in sick and quitting, then leaving then compounding the problem. Wouldn't it be nice if management could see that it only harms them and the patients and the nurses in the long run to do that.

    Neuro and PCU have lower staff ratios than medical, which isn't really right. The medical patients are just as acutely ill and deserve better staffing ratios.
  4. by   nurse626
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    Last edit by nurse626 on May 8, '03
  5. by   rachel h
    How can you guys have so many patients!? We have about 54 beds on our medical floor and on days our ratio is 4:1, eves is 5:1 and nocs is 6-8:1. We have four stations and a nursing assistant assigned to each nursing station plus a 'fly' nursing assistant. We also have an LPN who flies the floor and does most of our admission paperwork for new admits, starts IVs, helps with discharges and meds when we get really busy.

    I don't know how you can do it with 10 patients! I am busy enough as it is with 4-5 on eves! I don't know if it makes a difference, but at my hospital we don't have an IV team and all stat lab draws have to be done by the nurse ( I don't know if this is pretty standard everywhere?), so that takes up some time, too.
  6. by   Repat
    Boy oh boy. I work telemetry. We (RNs) typically have 6 pts, the CNA's 10-12. We have no IV team, so we insert all IVs, draw all bloods. Lately we have had no monitor tech or secretary on w/e's, so we have to take all our orders off, etc, etc. Burn out is high, to say the least, and I, for one, have considered leaving seriously many times recently. Just don't know if it is any better anywhere else (although Minnesota sure sounds good!).
  7. by   RockiNbarbi
    This is the way it is...and we do NOT have an IV team, we do our own. We have 6 Telemetry patients most of the time. On a good day we have about 2 peritoneal dialysis pts. in. Not to mention the ones that have just stabilized and come from ICU, and the ones that are in distress and on their way there. At this point in my research, there is NOT a more horrible floor to work than this one.
  8. by   Angelica
    I'm a student working part-time as an extern on a medical floor. We have teams on day shift that consist of 2 nurses and one CNA. Each team cares for 10 pts. Nights have one nurse and one CNA per 10 pts.
  9. by   mattsmom81
    I haven't done medsurg in 20 years....but needed the $$$ so accepted an agency shift on a medsurg/ rehab unit last Thursday.. I was pleasantly surprised but perhaps I lucked out as most of my patients were post hips, knees and backs, nothing unstable. It was a 24 bed unit with 3 nurses and 2 PCA's...quite pleasant. The hardest part was figuring out the tedious Pyxis machine for the first time...LOL!

    I've done mostly ICU and some PCU and I agree...PCU has always been more difficult than ICU in my local facilities. Give me my 2 ICU super sickies and I'm fine....but PCU can be full of close- to- crashing patients without ICU resources or staff...and with a 5:1 ratio and only one CNA for 38 patients, it makes for some crazy scary shifts IMO.

    PCU also seems to get the super difficult patients medsurg doesn't want, plus the dumps from ICU who 'no longer meet criteria for the unit' but are unstable. Too many times this second group ends up right back in ICU unit the next day.....often they're moved out prematurely only to pacify a screaming surgeon who demands his patient go to ICU overnight recovery.
  10. by   Going80INA55
    Ditto...to mattsmom. I also think the unit is a piece of cake compared to step down. It definately shows that you have truly worked both floors. Those who havent cant understand.

    It is not uncommon on step down to have one or two near crashing...if and once they do crash they get tubed go to the unit and they are hit with MS and ativan and now they are VERY managable patients.
  11. by   mattsmom81
    Thanks, Going 80....but we should probably add that these sentiments are coming from ICU nurse standpoint...we know what we are doing in ICU so thus it is NOT so difficult for US there....but it does take a lot of learning and skill to get comfortable in the units.

    I agree it's a perspective thing....Medsurg nurses may look at ICU and PCU from the patient ratio standpoint (some want to go there to have 'only' 2-5 patients) and don't really understand what can happen ICU/PCU, when patients go bad and there is NOWHERE else for the patient to go. That patient is critical, yours to manage, often without a doc around....and the docs DO expect critical care nurses to know how to handle critical patients without them, don't they?? How many times have we had to intervene to save a life...waiting for the doc to call back for 'orders' already initiated in lifesaving situations? To do less could be construed as negligence IF we know what to do......sad but true.

    Critical care is easier when we're critical care nurses...but when I go to medsurg, it's harder because I have to mentally downsize my patient data...can't know every detail with 10 patients.

    Critical care and medsurg nurses are BOTH good at what they do....and a strong medsurg nurse can make a great ICU nurse in time with a good internship.
  12. by   kewlnurse
    LAt time i worked med surg was ortho than onto the renal.tx floor 3-11 on ortho had 8-10 pateints, nocs had 12-16. renal floor 7pm to 8 am 10-16 patinets, never ever will i work on the floor, it's teh icu or nothing for me know.
  13. by   cindyln
    I work a postpartum/GYN surg floor and the last 2 days we had 12 patients with just 2 RN's. There is no aides. Everything is done by the RN. My legs killed me at the end of the shift. These weren't easy vaginal delivery patients. These were c-sections, hysts, PTL on bedrest patients. I would have killed for a simple vag delivery pt
  14. by   mattsmom81
    Cindy, I agree...I'd also rather have 10 patients with a CNA to help than 6 all alone...that can be a killer when they are needy and need total assist to get OOB, beaucoup meds, dressing care, and treatments, etc.

    Plus women are so whiney...I'd much rather take care of men for the most part. Probably sounds like a sexist generalization, LOL... but this is what I've discovered through the years. (Of course there's always the exception...like the psycho druggie guys who take apart their beds and barricade themselves in the room...hadda few of those <sigh> )

    I agree Kewl, ICU is my fave too..but sometimes we gotta do what we gotta do.

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