Nurse-pt ratios - page 2

I work on an ortho unit in a large hospital, a lot of hips, knees and backs. Our current ratios are 4-1 on days, 5-1 on evenings, 7/8-1 on nights, with CNAs having about 10pts each. Our supervisor... Read More

  1. by   geekgolightly
    Our ratio is 5:1, sometimes 6:1 (rare) on days. 6-7:1 on nights. 12 hour shifts, no LPN's, PCT's assigned to 8-10 patients for bed changes, and vitals.

    I work a Neuro floor with telemetry. Many of our patients are total care.

    They promise us, if we move to accepting drips, we will reduce the load to 4:1. One can only hope.
  2. by   Sailingshoes
    So after reading all the replies, and finding out that it could be even worse I have decided to look for something outside of hospital nursing. It is just too crazy already and if my pt load goes even higher I feel I will be compromisng my health even more. I refuse to turn into a high blood pressure, overweight nurse....that seems to be the result of so many good nurses that do perservere, bless their souls as I don't mean that to be an insult. I only hope and pray that I can find my niche and still make a living. How do you guys do it???? I guess I am just a wimp.
  3. by   RN123
    Quote from Fire Wolf
    AMEN to the call off issue.

    I should have clarified, but when I wrote "nurse" I meant RN and LPN for our facility. Each one, including the "charge" nurse is expected to take a full load of 7 to 8 patients.

    The nusing assistants are assigned to the floor to help us with vital signs and baths, but each nurse is totally responsible for her/his assigned patients and every aspect of their care.

    That is 1 RN/LPN for 7-8 patients and the one nursing aide will be shared between two to three of the nurses. Without the nursing assistants the nurses honestly could not function and the aides have my utmost respect.

    The worst downside on the staffing is that if you are busy with one patient that is unstable and heading to transfer to ICU, or assisting to put in a chest tube, triple lumen cath, etc, that task can take you off the floor to your other assigned patients and put you literally one on one with a single patient.

    No one is there to fill the gap and if you are in the middle of passing medications, or giving blood, or God Forbid, have two patients going sour, then your license literally walks a tightrope.

    It drives me crazy and scares me to death sometimes.
    Fire Wolf, I agree with you. Med/surg/Tele unit with 80% geriatric pts, We have 1RN: 7-8 patients all the time. PCAs do vs, labs, and bath etc.. but not all of the PCAs helpful, some of them even don't bring pts water..If not lucky, work with a lazy PCA, RN has to do some PCA's work...
  4. by   Cheyenne RN,BSHS
    pcas do vs, labs, and bath etc.. but not all of the pcas helpful, some of them even don't bring pts water..if not lucky, work with a lazy pca, rn has to do some pca's work...

    [font="comic sans ms"]i understand about pca's that aren't helpful, but if you have a good one, they are worth their weight in gold. seems that no matter how many patients there are, if you have a good pca that you can trust and count on, it makes the entire shift 100% better.

    as with any job, there are always some individuals that won't pull their load and are not worth diddly-squat. they can make or break a nurse.

    the pca is usually the first part of care in care-giving and the one that the patient sees the most of. they are the one's who will first pick up on changes in vital signs, output, skin integrity, or even levels of orientation or shortness of breath in a patient to report to the nurse. it takes all levels of care and care-givers to do nursing now with the acuity levels so high and the staffing ratio's so insane.

    i keep plugging along trying to balance medications and treatments and patient care, but i feel like it is only a matter of time until something is missed and a patient goes sour because i was not there to assess-reassess and note a change in their condition:uhoh21: .
  5. by   beckyboo1
    In Missouri, we ARE allowed to give IVPB, just not pushes. And I can't believe there are hospitals who still only utilize LPNs for med nurses??? In my hospital, we do our own assessments and chart them. It would be an insult to me for an RN to have to be the one to do it. We have an RN charge nurse and occasionally an RN on the floor, but my unit is generally staffed with mostly LPNs and we do a good job

    And....I'd LOVE to have a day with only 4 patients!
    Becky
  6. by   vandeenurse
    Gosh..some of your ratios are off the chart in a bad way..at my facility on typical med-surg floor we have 4 patients on days and 5 on nights with cp's for all most of the time and a CN with no patients assisting you on the floor..If there is a staffing shortage that day beds are closed until the ratios are workable...
  7. by   sasha1224
    I work(currently, changing jobs!) in neonatal stepdown and our ratios are 3 to an RN, 4 to RN/PCA team and 5 or 6 with RN/LPN team. Our LPNs cannot do anything with IVs. Just recently they have been allowed to write assessments, though as the RN I have to go behind them, re assess and write an agreement. IF we are short staffed it goes to 5 with RN/PCA team. Our charge nurse has 0-2 depending on staffing. We take mostly chronic BPD, trach vents and feeder growers with apnea of prematurity. So most of our kids aren't super sick. Sometimes we get these RN feed only pts and they run in lots. So if you have that five and all five are RN only, it can get hectic. When we have an LPN team, they take three of the five(or six) and do the cares.
  8. by   worldtraveler
    Wow, after reading some of these posts I would have loved to have been in the work situation where I had 7-8 patients, 4 pts.-never would have happened! At my last hospital type employment, I worked on a Nursing Home Floor at our VA Medical Center in Miami, Florida.I worked 2nd shift mostly and on each floor were two wings with a capacity for 26 beds and they were full 99% of the time. Staffing for the 2nd shift consisted of a Rn, Lpn and 4 NAs. I had, on a Regular basis, 23-25 Patients(you read that correctly) with 2 nursing assts.Two Very Lazy NAs. They, the NAs, can make or break your day, as one astute Nurse posted. They broke mine 99% of the Nights. As an LPN, I had to prepare and administer meds for 20-25 patients(that included Oral, injections, Aersol Treatments-Respiratory didn't come to our floor on pms-only for an emergency blood Gas draw or trach change or a Code). We had to perform our own BLood Glucose checks(usually a minimum of 6 on my floor--those old Vets, bless their hearts, I'm one myself, took lousy care of their health in their younger days and now are paying the price) and prepare and dispense the insulin. We had all the IVPBs(usually 2-3 bags at 5 pm and 9pm) We had tube feedings-usually 3-5 patients on feeding pumps at all times. The NAs would not Do the Blood Glucose checks or Catherizations, management did not mandate them to do it. We had to do our Charting, a narrative on each PT(every shift).,we had to call the Doc on any elevated temps or Blood Sugars for his NOW orders. Not to mention the calls to the Pharmacy for meds not in the Cart(seemed like this was a nightly ordeal and we could never get this situation rectified. If, we had any spare time, we were expected to help with the feedings at supper time.Right, if we had any spare time...Not mentioned was in case a Pt went Bad, we had to transfer him to the Cart/gurney for readying him for Transportation, who wheeled him over to the Hospital Wing of our Bldg. Sometimes we wheeled them over ourselves as transpotation were not the fastest actors. I know this sounds like one big BS Story and if I did not experience it myself, I would call the person a Liar. No one could be expected to do what I just wrote but I did. Maybe because I am a VietNam Era Vet I feel a Bond and Special Empathy for these old Vets(had some young gulf war vets but not many-I left before the Iraq Vets started to arrive) I lasted 1 yr at this pace, with 6 weeks out for sick leave as my system broke down. I remember a few nights as I left at midnight and walked to my car, put the seat back and thought, got to catch 10 minutes of a Nap and next thing I woke up with the Sun rising at 6 pm.That was how hard it was! If you ever find yourself in a like situation, bail out before you break down(healthwise) or make an error that costs you your license. I can never return to this type of work, I now work home health at a much slower pace(diabetic visits) and surprsingly, make much more money. I guess I was so concerned for our Veterans that I toughed it out but in the end it Out-toughed me! Take Care of Yourself First because your management for sure never will! A lot to be said for Unions fighting for safe staffing ratios!! Complain to management in the Federal Government system?? This is where Slackers get the rewards-been there, saw that! Its so True!
  9. by   CV_LVN
    I'm an LVN on a cardiovascular intermediate floor (CCU stepdown). LVN's take our own patient loads here, do our own IVP (including most cardiac drugs), we monitor our pt's on cardiac drips, heparin drips, etc, can't hang blood that's it. Remind me not to go to some of your places of employment, it sounds like LVN's are treated like dirt and some of the attitudes are pretty low towards them too. FYI guys your license doesn't always make the nurse....so no need for attitudes, we all have our own unique skills.

    Oh yeah, max ratio is 5:1 RN or LVN, either can take any kind of pt. on the floor. If we have vents on the floor it's a 3:1 ratio.
  10. by   vandeenurse
    World traveler that sounds just terrible...thank god your are outta there..Ratios like that are ridiculous and one should never ever have to go along with that!!
  11. by   jodyangel
    Becky I work on a tele floor and I'm an LPN. I have 6 patients. I have an RN assigned to cover me, but in reality they have their own 6 patients. So I only go to them if I have an IV push. Do you have NA's to help with pt. care? We only have a few left..so sometimes we're on our own.

    Quote from beckyboo1
    I'm an LPN on a telemetry unit. We do not share assignments and we do our own IVs, except for IVP's and blood. We generally have pt care techs but our ration is 6 pts to one nurse, on all 3 shifts. IF we're lucky, and this doesn't seem to happen often anymore, we'll have a nurse designated for admissions, discharges and transfers.

    Becky
  12. by   jodyangel
    Lol, right on.
    I hang all my own IV antibiotics. I do my own head to toe assessment. I call the doctors..but am not allowed to take the orders. I talk to the docs on the floor. I'm telling ya, I'm on my own!! I do 90% of the work of an RN, but get paid LPNs wages.
    Thus, I'm back in school to get better compensated!

    Quote from Haunted
    It is lovely! screech....BAM! I just crashed and burned. It all depends on your patient acuity. I bet there have been days when you had those 8-10 patients, a CNA and possible an LVN to assist you and things went smoother than doody from a goose. Question, your LPN's give IVPB???
  13. by   CV_LVN
    I'm lucky to work where I'm at I guess. I take telephone orders everything except hang blood. Push cardiac drugs, everything. I do not have an RN assigned to watch over me. We have an RN charge nurse. Each nurse has 4-5 patients, we have 2 nurse tech's for the unit (max 30 patients total capacity) they draw all our blood. We are 99% functionally independant. We just cannot do the initial assessment of new admissions and hang blood. All routine meds PO IV Drips can be done by LVN's. Plus we are mostly all ACLS certified as well. I had a 6 week critical care orientation as well as IV therapy classes, EKG classes, etc when I was hired. I have also worked ICU and taken full load of ICU pt's, vented, drips, etc. I guess Texas has looser rules for LVN's than other states.

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