nurse-patient ratio - page 3

Within the last year, we restructured our Med-Surg nurse patient ratio to be 1:6 for days/eves, and 1:8 for nights. I am interested in hearing what other ratios in Med-Surg are. I work in a 400 bed... Read More

  1. by   JillR
    At our facility we usually have 1:4 on days and 1:5-7 on PM's and Nocs.
    Usually have CNA for days and Nocs but no CNA for PM's, although sometimes we get lucky and get one, maybe once a month. I work PM's.
  2. by   brenda-boo
    We have Rn and LPN and CNA with a maximum of 10 pt on days, RN and CNA team on eves with a max of 7 pts, and a max on nights of 9 to 11 with RN-LPN-CNA. We have an acuity system and we use it when we are requesting more staff to care for increased acuity or increased admissions. The Charge nurse is one of the abovementioned RNs who have a module of patients. Most people here are happy enough with our numbers but we do have a few openings right now and would love to fill them. The CNAs routinely use each other as a reosurce for helping with turns, baths, ambulations and anything else that takes two people. We also have beepers so the desk people don't have to wander around looking for the "right nurse" to contact. If staffing is borderline, we keep nurses on-call so we have that buffer to call when census changes. Anyone want to come out to the coast of Washington. We are only 30 minutes from the beach and not too far from the big cities either!

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  3. by   vicki
    In response to your question regarding staffing,I work in an inner-city hospital that is State funded. We receive all of the indigent patients, ie: all the ETOH and long term polysubstance abuse patients. Most of these patients are in chronic liver, renal and pancreatic failure. Mix this in with surgery, ortho and oncology. This adds up to a very high acuity level with almost every patient. We routinely have 9-11 patients on day shift. We are supposed to have a PCT to work with us, but they only staff the entire hospital with maybe 2-3 PCTs, and they are responsible for all phlebotomy and EKGs. They are never available, so we not only do our own patient care, but we also end up doing lots of our labs and EKGs. Even if we do have a LPN to work with, the hospital does not allow them to work within the legal scope of their practice and they are more CNAs that can pass meds. This creates a lot of tension between the nursing staff. Also there are no patient transport positions in the hospital, so the nursing staff is responsible for geting patients to their scheduled tests. Many times we work without unit secretaries. Our unit secretary left for maternity leave and was never replaced. After about 10 weeks, they realized she was not coming back and finally have decided to try and find a replacement. Why hurry, the nursing staff will continue to follow-up on the unit clerk's responsibilities just to cover their own butts. There are many things I enjoy about working where I do because the patients need people so bad who really care and do not judge them harshly, but I really do not know how much longer I can keep going at the pace we do.

  4. by   MISSYMELB123
    WE ARE A 100-150 BED SMALL HOSPITAL AND I AM SORRY TO SAY THAT AS A CHARGE NURSE OF MED-SURG I AM RESPONSIBLE FOR SEEING AND CHARTING ON UP TO 30 PATIENTS ON 3-11 EVERY EVENING IF WE HAVE MORE THAN 19 PATIENTS I GET 2 NURSES TO PASS MEDICATIONS BUT NEVER MORE 2 WE DO TEAM NURSING AND IT IS VERY STRESSFUL AND DIFFICULT. THE OTHER NURSES ARE USUALLY LVN'S AND THEY PASS ALL MEDICATIONS. IT MIGHT SOUND IDEAL BUT IT IS VERY DIFFICULT.
  5. by   NurseJenn
    I work on a 42 bed medical/tele unit in a small town hospital. We average 1:7 days and 1:9 nights with the possiblity of more if we get a lot of admits. The charge nurse does not normally take patients, but usually will if we get busy. We average 2 aides on the floor on days, and usuallly none at night. Acuity is not looked at when assigning case loads. I would like to see the days go 1:5, but I don't see it happening soon.
  6. by   Bed Side Manners
    I work in a small rural hospital that has an ER, 26 bed Med-Surg unit, and a surgical department. We get EVERY kind of case you can think of ranging from peds to cardiac, and everything in between. Our staffing ratio is 1:3-4 days, 1:3-6 eve, and 1:4-7 on nights. Days has 2 aids, eve has one or two if we are lucky (I work 3-11), and nights has one. The charge nurse takes a full team, and shares taking her turn accepting admits. We staff according to acuity, and when our accuity is up, we are able to get the staff we need from nursing staffing agencies. We have a radiology, lab, and respitory depts. in hostpital 24/7. From reading the other posts, I feel VERY lucky to be where I am. I will think next time before I complain about my working environment. Good luck to all of you who are working in those "Hosptial Sweat Shops", my heart goes out to you and your patients.
  7. by   SueBe40
    I work on a 35 bed med-surg unit that is more surg than med. Each of the rooms are private. It seems ideal but it is hard to take the 5+ new surgical patient assignments when the patients are so far apart. We generally have 1:5 on days (12 hour shifts) and 1:6 on nights. Lately there has been such a shortage that we have been taking 7 patients each on the day shift. Our charge nurse does not normally take a patient load but recentlly they have.

    One note to this unit is that our facility does not have a step-down unit, so to speak. So we generally get vascular surgical patients as well as others that in othe institutions would be in step down units. We use satellite telemetry and can sometimes designate the patient as a 1:3 or 1:4 in order to adjust do to the higher acuity.

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    SueB
  8. by   gibby
    I manage 5 units- one 8 bed ortho, one 15 bed oncology, two 24 med/surg and one 25 bed med/surg. The ratio's are 8:1 on 7-3 and 3-11, 10:1 on 11-7, except the large units - if above 20 we had the 3rd nurse. Same ratio's for nurse assistants, 11-7 we always maintain 2 nurse aids. We have no charge nurses, use a clinical resource nurse to float between the units to assist with all needs, also float a nurse tech on 7-3 and 3-11 to do glucoscans, peipheral IV removal, dsg. changes, decub. care, ostomy care, g-tube fdgs. All units have a unit sec. The staff seem to be overwhelmed most of the time. We have very rapid turnover in patients. Many seemed to be overwhelmed by the pace. Delegation, prioritization and organization seems to be a problem amoung some of the nurses. They previously depended upon a charge nurse and appears they have not had the opportunity to develop these skills. Any suggestions for improve would be appreciated.
  9. by   sonnie
    Originally posted by Bed Side Manners:
    I work in a small rural hospital that has an ER, 26 bed Med-Surg unit, and a surgical department. We get EVERY kind of case you can think of ranging from peds to cardiac, and everything in between. Our staffing ratio is 1:3-4 days, 1:3-6 eve, and 1:4-7 on nights. Days has 2 aids, eve has one or two if we are lucky (I work 3-11), and nights has one. The charge nurse takes a full team, and shares taking her turn accepting admits. We staff according to acuity, and when our accuity is up, we are able to get the staff we need from nursing staffing agencies. We have a radiology, lab, and respitory depts. in hostpital 24/7. From reading the other posts, I feel VERY lucky to be where I am. I will think next time before I complain about my working environment. Good luck to all of you who are working in those "Hosptial Sweat Shops", my heart goes out to you and your patients.
    Bed side manners:
    We are soul sisters!! I too work in a small rural hospital!! We are licenced for 40 beds we cover ER, OB, and med/surg. We try to staff by acuity but it is hard when your census can fluctuate in the blink of an eye. We have 1 RN to cover the ER on all three shifts, on 3-11 we also staff a tech who is an EMT on first or second call for our ambulance. On the floor we have 3 RNs and 3 CNAs on days for an average of 3-6 pts/RN depending on the mix. However one of the RNs must be available for OB We have a great DON who will help when she can and our social service/discharge planner is a RN who also helps. PMs has generally 3 RNs and a LPN + 2 CNAs again one RN must cover ER and someone responsible for OB if we have a patient. On nights we have 3 RNs and 1 CNA again one must cover ER. On evenings and nights we each have an Assist. DON who when is not helping with patient care or putting out fires takes care of staffing and other stuff. We welcome anyone who wants to come to beautiful Oregon and work with us we are a fun group and pretty much all love our hospital and patients!!!
    N. Mitchell aka sonnie
  10. by   sanshin99
    I currently work on a 47 bed med/surg floor in the military. We get a mix of everything but have a increasing trend of hem/onc patients post chemo with all the accompaning issues (ie, neutropenic,mult blood prod)Our ratio always runs 1:10 regardless of accuity. We do have enlisted personnel who can draw blood,start iv's etc. It seems that the nursing shortage is hitting the military harder. I mean who wants to serve their country when there are better paying jobs with less stress?
  11. by   JOY, RN
    I WORK ON A SURGICAL UNIT AND AVERAGE ON AM'S 1:4-5, PM'S 1:6-8 AND NOC'S 1:6-9. OUR UNIT AS YOU MAY IMAGINE IS FAST PACED AND MOST OTHER NURSES IN THE HOSPITAL DO NOT WANT TO "FLOAT" TO OUR UNIT. IT SEEMS AS THOUGH MANAGEMENT IS IGNORING OUR PLEA FOR SMALLER, SAFER RATIOS. HEALTH CARE IS NEGATIVELY AFFECTED BY THESE STAFFING CUTS EVERY DAY YET WE ARE EXPECTED TO PROVIDE OUTSTANDING CARE WITH THE MINIMUM RESOURCES WE ARE GIVEN. IF I KNEW THEN WHAT I KNOW NOW, I'M NOT SURE NURSING WOULD HAVE BEEN MY CAREER CHOICE. WE FEEL OUR VOICE WILL NEVER BE HEARD. I LIKE WHAT I DO BUT I WISH THINGS WERE DIFFERENT.
  12. by   plumrn
    Gibby- Your nurses are OVERWORKED and UNDERSTAFFED!.8 -1 on days! REALLY!Don't give us that managers tripe about poor organizational or delegation skills.WHO are they going to delegate to.EVERYONE is too busy.It's amazing how many nurses are acused of this.A real wonder they can even find their way to work everyday.Try lowering the nurse to pt ratio and see quality of care and job satisfaction improve.Who can get organized in that mess.They're too busy putting out fires all day and drowning at the same time.GO MILLION NURSE MARCH! Pts and their nurses deserve more than this.PQUOTE]Originally posted by gibby:
    I manage 5 units- one 8 bed ortho, one 15 bed oncology, two 24 med/surg and one 25 bed med/surg. The ratio's are 8:1 on 7-3 and 3-11, 10:1 on 11-7, except the large units - if above 20 we had the 3rd nurse. Same ratio's for nurse assistants, 11-7 we always maintain 2 nurse aids. We have no charge nurses, use a clinical resource nurse to float between the units to assist with all needs, also float a nurse tech on 7-3 and 3-11 to do glucoscans, peipheral IV removal, dsg. changes, decub. care, ostomy care, g-tube fdgs. All units have a unit sec. The staff seem to be overwhelmed most of the time. We have very rapid turnover in patients. Many seemed to be overwhelmed by the pace. Delegation, prioritization and organization seems to be a problem amoung some of the nurses. They previously depended upon a charge nurse and appears they have not had the opportunity to develop these skills. Any suggestions for improve would be appreciated. [/QUOTE]



    [This message has been edited by plumrn (edited November 22, 2000).]
  13. by   pickledpepperRN
    Gibby:
    Will you let your nurses have 1/2 hour for report? 1 hour. 5 minutes to check each chart? 40 minutes. 5 minutes for assessments? 40 minutes. 5 minutes to pass meds? Another 40 minutes (twice). Dressings, IV or NG pulled out? 40 minutes. Please let them have 10 minutes to chart on each patient! 80 minutes.
    How about mobilization. Assessing balance or turning, helping into a chair? 5 minutes OK (they have help I know but we don't want contractures and decubiti) 40 minutes.
    Lunch?=1/2 hour.may a nurse use the bathroom twice for 5 minutes? 10 minutes.
    There is rapid turnover. Give 1/2 hour for one discharge, one admission, one transfer. Please! Thank you!
    Your nurses need at least 5 minutes a patient to track down results call the MD, follow through.
    Well, they have worked more than 9 hours in an 8 hour shift. No codes, upset families, lost belongings, missing meds or equipment. Pretty good nurses! Why are they so overwhelmed? Can't they do 9 hours work in 8 hours, go home wondering (or knowing) what they missed, be sorry for not being able to be in more than one place at a time, and have energy left for their family?
    How long will it take before they go back to school to learn computers?
    PS: You are overworked too! that is too many patients! YOU have been made responsible for the quality of nursing care without being provided control over the resources needed for that care.
    Please don't let your so called superiors tell you the nurses need better delegation skills. NURSES should do nursing! NOT delegate it to others. That is the reason for nursing school!


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