nurse-to-patient ratio

  1. What do you think about the proposed for nurse-to-patient-staffing ratio?
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  2. 21 Comments

  3. by   pickledpepperRN
    I know about the proposal in Arizona for 2 or fewer patients per registered nurse in ICU, CCU, and other critical care units.
    For California I have kept up on quite well, even attended a hearing.

    What are the others?
    Almost any law or regulation will improve the staffing at some facilities. Long term care needs ratios! All areas are of concern.

    Hospitals where I work do not always follow the requirements unless they are reported. Nurses have to be the police too.
  4. by   mayberry
    Frankly, safe nurse to patient ratio are a long time coming. Any thoughts on how to get this concept out to the public?
  5. by   rck213
    I am in Central NY State and we need some guidelines to start with. Now our administrators feel we all should be able to care for 6-8 patients with no overtime, no allowances for acuity levels or age, I am on general peds and have many adult patients also, no PICU in area so we have insulin drips and babies on CA monitors, some should be 1:1 or 1:2 at the most.
    Many times our ancillary staff is absent or pulled to another unit and the RN has to absorb their work too.
    A MIMIMUM staffing ratio of RNs PER PATIENT, not unlicensed personnel, with the allowance for MORE STAFF as acuity dictates would be a place to start .
  6. by   Gotzfaith
    I work on a rehab unit that offers, PT. OT, Activity and Speech therapy. It is common to have six to eight patients per nurse (LPN's and RN's). On rare occasions we have had to handle up to nine patients. It is difficult at times to do more than pass meds and get assessments done on a shift. It gets very frustrating to give the care that my patients deserve in this enviroment.
  7. by   pickledpepperRN
    OMG
    I am an adult nurse. What the babies and you have to deal with is SO unsafe!
    Look uo the New York State Nurses Association on the "Politics "threads.
    This is what we are doing in California. We've had 1:2 in critical care, including PICU & NICU for 30 years.

    http://www.calnurse.org/gr/aanestad.html
    PS: I enjoy Peanuts and my nickname at one hospital is "Aunt Bea".
  8. by   sehbear
    Well in Victoria, Australia, we have nurse patients ratios and they are all very technical but they work great.
    Each hospital is allocated a catergory A, B, or C dependant on a number of factors... bed numbers, acuity, emergency room within hospital, and from that the ratios are born.
    Specialty areas like icu, nicu, burthing and labour areas etc. all have different ratios. The process is relelatively new and is still evolvong.
    Interesting!
    Worth fighting for guys it really is, we fought long and hard - even had stop work bans (something I cringe about) but it was worth it!!!!
  9. by   HARN
    nurse patient ratios are a VERY important issue. It's one thing when all of your patients are oriented & do it your-selfers.....but when you start having cofussed, high matience patients that's were things get unsafe. I work on a telemetry unit with a very high patinet turn over. If the unit is used as it was ment to be used then 8 patients to one RN is cool. However that is not the case. We get a lot of medical over flow, that need a lot of attention (meds or care). So three RN's for a 24 bed unit, one nursing assitant, one RN has to watch the monitors at all times....many admissions at one time of the night, high acuities(rating of each patients care), Many new grads on the floor needing guidance ....things are starting to get stressful & unsafe...I am 2 yrs into nursing these are my concerns
  10. by   Rocknurse
    I work in ICU in the UK and our patient ratio is 1:1. We are so busy that I struggle to keep up sometimes so I could not imagine having more than one patient, but then we don't have such a thing as RTs and we usually only have one healthcare assistant per shift. We do absolutely everything on our own with no help. Everyone hates rotating to HDU where the ratio is 1:2 because nobody can cope. It's hell.
  11. by   Soulcatcher
    i work in a va hospital's icu, in a rather rural part of the us. our rn-patient ratio is 2:1, although at times it has been 3:1; we've had to reduce the number of patients we admit because of staffing shortages.

    on our med/surg/telemtry and pulmonary floors the ratio has typically been 1:15. when i first stated working here > 5 years ago it was 1:30. an rn would work with one na and an lpn. it felt terribly unsafe and administration wasn't very helpful. "just do the best you can," was the usual response. i don't think to this day they realize it wasn't an issue of convenience, but instead a safety concern. how can i assess the 15 patients on my team, pass medications twice, help feed a meal, help turn q2h, answer the phone, talk to families, admit new patients, deal with the thousand-and-four problems that every nurse has to face in a typical shift, take off the huge pile of orders the day shift didn't get to, and go home feeling like i did anything more than stick my finger in the hole in the dam and wonder what i missed..

    i think it's improving, but slowly and with reluctance. the focus is truly on primary care these days and acute inpatient care seems to be forgotten, or is at least far, far down the list of priorities.

    i've seen two rns on the wards in the past year, usually with the support of at least one lpn and na, else two nas. so, at least there are 2 people to care for each 'team' of 15 patients, with an rn to oversee both. but still, they face the same problems. when do you have time to assess anyone? it turns into reactive nursing. because ward nurses do not have time to assess fully, they often only catch complications or changes when they become obvious instead of catching them in the early stages.

    every day i'm grateful i came to icu. i know what my patient ate, how much he voided, what his lungs sound like, what his rhythm is, what his labs are, how he's responding to his gtts or meds, his level of orientation, his functional capacity... all the things i need to know, i have the time to find out. the ward nurses are valiantly treading water.

    so, what do i think about mandatory staffing levels? our patients need them! the safety of the patient and the caregiver should be of paramount concern.
  12. by   rck213
    Originally posted by spacenurse
    OMG
    I am an adult nurse. What the babies and you have to deal with is SO unsafe!
    Look uo the New York State Nurses Association on the "Politics "threads.
    This is what we are doing in California. We've had 1:2 in critical care, including PICU & NICU for 30 years.

    http://www.calnurse.org/gr/aanestad.html
    PS: I enjoy Peanuts and my nickname at one hospital is "Aunt Bea".
    Although we are a Children's Miracle Network Facility our administration refuses to acknowledge that there are special staffing needs for the pediatric patient. We have no pediatric resource person, no peds clinician, our NM is an OB nurse who manages OB, LD, Nursery , Special Care Nursery and peds.
    Believe me our peds staff has looked into every possible state regulation and come up empty. There are no set ratios for peds.
    Since we are not labeled a PICU, even though we have patients that would be in that unit in another facility, administration does not apply PICU ratios to our unit. We are told that we can handle 8 BECAUSE some of our patients are adults, never mind that they are post angio patients or adults with pca's or epidurals.
    I have written to the DOH of NY State, to NYSNA and the ANA, everyone sympathetic but not very helpful. We desperately need legislation to at least force the hospitals to look at this as a real issue requiring action. As for their pat answer, "we can't hire because there is a shortage" That is bull, there have been positions obliterated and no one hired even though they have applied . It is all about money. By the way, we have a union but they seem to be in bed with management. With the amount of ADO's filed they should have a good case that the nursing administrators are not holding up their end of the Nurse Practice act as they are NOT providing adequate, competent, qualified staff for the type of patients we have. If I had money and never had to work again as a nurse I would run with this but unfortunately I need to work.
  13. by   Chaya
    I feel that staffing ratios are an unachievable goal in the current healthcare environment. However, I also feel that it is necessary to define these goals as a first step to ensuring patient safety. At some point, it does become impossible to care safely for x number of patients above the ideal, and I think patients and family members should be aware. If nursing truly WERE a customer service industry each unit would post a disclaimer something to the effect of
    "Sorry, due to high patient- nurse ratios this shift we are temporarily unable to guarantee any of the following: that medications will be passed on time, that each patient will be assessed in a timely matter, or patient safety in general can be assured. We cannot be held liable for adverse events that may occur from an excess patient-nurse ratio during this time. Thank you for your patience".

    Therein lies the difference. The first part IS true, but here we are talking about potential loss of life, not a cold hamburger. And although we are taught the we are responsible for patient safety in ALL situations, there need to be guidelines. Should a nurse lose his/her license for not being able to care for 60 patients? If not, what number iat what level of acuity? Makes ya think! (And cringe!)
  14. by   TreceRN
    After reading some of these ratios, I'm starting to think maybe we don't have it so bad after all! Our cardiology and med/surg units are staffed as a "care pair" model with one nurse/CNA per 6 patients on days and evenings. On nights we do "modified primary" with nurses taking up to 7 with some CNA support. For example, if the unit has 24 patients, we would staff with 4 RN and two CNAs on nights. We changed to this model 1 1/2 years ago and we haven't had too many complaints. Our biggest challenge is the acuity/activity, especially admits and discharges. We are also receiving a lot of pressure right now from administration, who are now comparing our staffing guidelines to other areas and realizing that our HPPD (hours per patient day) is on the high side compared to other hospitals of similar size and service line. I'm fearful the conclusion will be to go back to our old model, which was overwhelming for everyone.:

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