patient/nurse ratio

  1. 0 Hello to everyone,

    I am interested in patient/nurse ratio, e.g. at a medical/surgical unit.
    Are you supported by RPNs and unlicensed care personnel?
    Is primary care provided regularly? (In Germany very rare, because cost-intensive)
    When is nursing considered to be unsafe, regarding patient/nurse ratio?
    Has nursing shortage already an impact on patient safety?


    Thank you for your answers!
  2. Visit  Mona77 profile page

    About Mona77

    Mona77 has '7' year(s) of experience and specializes in 'Emergency, medical-surgical,'. From 'BC'; Joined Jun '10; Posts: 99; Likes: 54.

    14 Comments so far...

  3. Visit  RescueNinja profile page
    0
    There are a several teams of 8 pts. RNs are 4:1 with a RPN who is also 4:1 so you have those 4 to do if they require something that is a RN skill, but they are the RPN's responsibility.
  4. Visit  Mona77 profile page
    0
    Oh that`s a good patient/nurse ratio, we have to care for 12 to 16 patients ( in some hospitals even more), without RPNs support ( the nursing programs were abolished in 2004 in our federal state), nursing students assist during their clinicals. Optimal organization and time management are crucial!
  5. Visit  Fiona59 profile page
    0
    Mona: are you moving to Ontario? Ontario is the only province that uses the term RPN, the other provinces use LPN. To add confusion to the picture caused by Ontario, the term "RPN" mean Registered Psychiatric Nurse in most of the rest of Canada.

    My hospital divides Medicine and Surgery into two separate services, so the ratios are different as is the staffing. Surgical Services has 3-4 patients on day shift, five after 1900 and after 2300 it increases to between six - eight depending on the staffing situation. RNs work with their patients, LPNs work with theirs and if you are lucky there is a nursing assistant on the floor to help with the total cares, otherwise, you make sure you work well with others. In my province the PN-RN scope of practice is very similar and experienced LPNs often have more complex patients than RNs with less than three years experience. Unless TPN or blood products are involved there a very fine line between the skills.
  6. Visit  loriangel14 profile page
    0
    RPNs don't act as a support for the RNs, they are responsible for their own patient load and answer to the charge nurse the same as the RNs.As Fiona said, there is a fine line between the two roles. The med-surg unit where I work has the same ratios as Fiona outlined.
  7. Visit  RescueNinja profile page
    0
    Sort of off-topic - do you guys out West have a broader scope of practice than the RPNs do here in Ontario?
  8. Visit  Fiona59 profile page
    0
    Quote from RescueNinja
    Sort of off-topic - do you guys out West have a broader scope of practice than the RPNs do here in Ontario?

    YUP.

    We are also clearly recognized as independent professional nurses. We practice under our own practice permit and are responsible for our assigned patients.

    Our scope of practice is restricted by the facilities we work in. But with the health care $$$ being in short supply, Alberta Health Services has realized we should be permitted to work to full scope.

    LPNs are found in ERs, ICUs, the ORs, Dialysis, School Health and community based care and the ever popular LTC/Continuing Care. I haven't heard of anyone working in NICU, PICU, or CCU. Rumour has it there are few working L&D in smaller communities.
  9. Visit  Mona77 profile page
    0
    Our LPNs scope of practice is far below yours in Canada, they can act independently, regarding ADLs, but all responsibility has the RN.

    But as I mentioned you won`t find them in the hospital setting anymore.
    I will move to BC, but the different terms are confusing, in CRNE prep guide
    also UCWs are mentioned, which I think doesn`t have any nursing education!

    Normally our medical/surgical units are divided, but I work at an interdisciplinary and subdivided ward with all speciality areas, responsible for 12 patients! Subdivided means that one day you work at the inderdisciplinary ward, the next day emergency, and the day after day hospital care!

    I can`t really imagine how it is to work as a RN in BC it seems completely different, although we provide patient centered care, seeing the patient in his entirety, with a focus on evidence-based nursing, communication skills, health promotion and prevention, discharge management regarding the patient`s resources at home and we are used to provide cultural sensitive care.
    In september I will be in Vancouver, perhaps it is possible to find a hospital which can offer me an orientation day to make my own "little" experience!

    One more question:
    I read about 7.5h, 8h, 11h and 12h shifts, but I can`t make out which is the most likely to work in.
    I work 7.25h day and afternoon shift, night shift is longer, 9,5h but you care for 20-26 patients, alone.


    Thanks for your explanations!
    Last edit by Mona77 on Jul 11, '10
  10. Visit  loriangel14 profile page
    0
    Quote from Fiona59
    YUP.

    We are also clearly recognized as independent professional nurses. We practice under our own practice permit and are responsible for our assigned patients.

    Our scope of practice is restricted by the facilities we work in. But with the health care $$$ being in short supply, Alberta Health Services has realized we should be permitted to work to full scope.

    LPNs are found in ERs, ICUs, the ORs, Dialysis, School Health and community based care and the ever popular LTC/Continuing Care. I haven't heard of anyone working in NICU, PICU, or CCU. Rumour has it there are few working L&D in smaller communities.

    That's pretty much the same as in Ontario.
  11. Visit  loriangel14 profile page
    0
    UCWs are Unregulated Care Workers. They don't have any nursing education but have received training to assist with personal care and unregulated tasks on the unit.
  12. Visit  Fiona59 profile page
    0
    Mona: Shifts.

    Oh here is a world of fun explanation. My hospital in AB has 4, 6, 8, and 12 hour shifts. Here's where it becomes complicated (depends on your union) the 6, 8, and 12 hour shifts are that long but you don't get paid for the total number of hours due to unpaid meal breaks. If you are booked for an 8 hour shift you get paid 7.75 hours, the 6 usually gets paid 5.5 hours and the 12 gets anywhere from 11.08 to a bit more.

    In BC, I can't remember how the contract works.

    Then you have to factor in shift premiums. In AB, anything after 1500 hour is considered an evening, after 23hr it becomes a night until 07hr. Then after 1500hr Friday until 07hr Monday is considered a weekend and another premium is paid on top of the evening/night rate.

    Our ratios might sound good but not every shift is fully staffed, so if you are short you have extra patients and file reports with your union. On our surgical units there are patients who in other countries would still be in an ICU environment (it was shock to some of the IENs we had a couple of years back, who thought it would be easy) drains coming out of every orifice, multiple dressing changes, continous narcotics.

    We work for our hard for our money and are careful to guard what we have when it comes to notifying the unions about safety and staffing issues.
  13. Visit  RescueNinja profile page
    0
    Quote from loriangel14
    That's pretty much the same as in Ontario.
    That's what I was going to say...
  14. Visit  Mona77 profile page
    0
    That sounds really challenging, and I feel deep respect to the care you have to provide.
    I can imagine that some IENs were shocked as such surgical patients need constant monitoring, special knowledge and technical skills.
    Hope that my emergency experience will help me to cope with such "extremely" normal patient situations.

    Every IEN thinking that working in a foreign country will be easy (because of the nurses`professionality in their home countries) isn`t realistic.

    On some days I feel scared and unsure if I will be able to meet all expectations, not only my employer`s but in particular the patients expectations on best practice and high quality care.
    I can`t judge if patient/nurse ratio sound good, not knowing exactly all your responsibilities.

    Is it your duty to file reports with your union?


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