nurse-patient ratio - page 9

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   norinradd
    Forget policy. Every time we complain about ratios we are told "they are merely guidelines, you take what you are given".

    I work med/onc. The most I have had with a CNA is 16, 13 without. 25% are onc with either chemo, blood or frequent PRNs not to mention the overflow we get from PCU/ICU.

    Even then it wouldn't be so bad if they excepted best effort, but they keep adding demands on our time and set up systems that makes only the nurse at fault if something is missed.

    Does anyone know of a resource to argue better staffing?
  2. by   BeeStrong
    There are resources available thru the ANA website if you are researching staffing ratios and patient safety; they have done a lot of research on this subject; there recently was a newspaper article about the latest research that pt outcomes are better when nurseatient ratios are lower; surprise, surprise; but at least they actually have research now to back up something that nurses have known all along. The acuity systems I have seen do not keep up with the rate of admissions so I feel it is better to have the Charge make the decision on staffing; not many systems will staff acc to admission rates; at my hospital we "[pend" 3 " patients just to account for admissions; we are a 300 bed hospital; 22 bed onc/med/surg unit; 5 RNs days, 2-3 cnas, 5 RNs eves, 1-2 cna, 4 RNs eves 1-2 cnas, usually 1:5 pts days/eves; 1:6 or 7 on noc shift.
  3. by   Shellsie
    i work at a small hospital (45 tele/ms beds, 8 imc beds, 9 surgical, 6 icu beds) and on regular med/surg there are still alot of LPNs so they do team nursing sometimes. when its team nursing generally there are 8-10 patients with an RN, med nurse, and CNAs roughly get around 12 each. When they do primary care its 5-6 per nurse and same ratio for CNAs. the surgical unit and imc unit each have 2 nurses for their 8-9 patients and the ICU gets 3 nurses for their 6 patients
  4. by   Clarisse
    I work in a small hospital, med/surg unit. Our usual ratio 1RN8-13 patients not including covering for the LVN's patients,if we get lucky we could have 3 CNAS and 2 units secretaries in each med/surg units. But they already experimented with 1 unit secretary to cover both units, not including continues admissions and our charge nurse not even lifting a finger to help us no the floor. We get all kinds of med/surg patients from ortho,psych to onco. Just imagine all of these during 7A-7P shifts.
  5. by   Clarisse
  6. by   ruca30
    Days/afternoons is 1:6 here, midnights 1:8. That's the theory, anyway. There has rarely been a day where I've worked a midnight shift with less than 10 patients, or a day where I've had less than 7.
  7. by   debRNo1
    Originally posted by Clarisse
    Im in NY, mostly med med-surg busy busy unit day shift. On friday I had 10 NOT SAFE at all with discharges and admits. My unit is 28 beds and on a good day we have 4 rn's/ cna's and hopefully a ward clerk. 6-7 depending on acuity is sometimes managable. Usually Im not done with assessments and meds till lunchtime then do the accuchecks and my 1400's before I get a break somewhere around 3 pm when there tends to be a lull in the chaos.

    Friend of mine works at a cardiac hospital on a med surg floor and has 10-12 on day shift, dont know how she manages that, they just sent a flyer for an open house I filed it right in the garbage can :chuckle
  8. by   RN-PA
    I am not being purposely naive, but I wonder who arrived at the magic number of SIX patients being manageable by one nurse on med-surg. I have had shifts with 6 patients who were all partial- to self-cares, mostly "walkie-talkies" and yes, that was busy but manageable. But throw into the mix coverage for an LPN who has 6-7 patients, some of whom may be a new admission (RN's muct do admissions and initiate care-plans), needing to hang blood, do IV pushes, call the Dr. for any of their problems along with your own load, and there's nothing very manageable about that. And of course, you can have shifts where you have only 3 or 4 patients, and depending on their acuity and problems that crop up, you can be running all night.

    I saw one of my managers on Friday (right before the Halloween-evening-shift-from-hell), and she mentioned, in regard to nurse to patient ratios that she still believes 1:6 should be "manageable". The hospital where she used to work had 1:8-9, so she thinks we have it pretty good. Of course I mentioned that 1:6 is not taking acuity into consideration and she grudgingly agreed. One of our upper management nurses mentioned in a local newspaper article about nursing shortages that ran within the last year that she thought that 1 nurse for 6-7 patients was "adequate" staffing. (How about asking a patient? How about asking the nurse in the trenches? )

    But again, what's the deal with this "one-size-fits-all" staffing for med-surg units? I can see a number of years ago, maybe when patient acuity wasn't so high, that 6-7 patients would be doable, but nowadays.....
    Last edit by RN-PA on Nov 2, '03
  9. by   MinnRN
    I work in a large midwestern teaching hospital, 745 beds. The unit I work is a medical floor that specializes in endocrine, diabetes, and kidney problems, although we see a little bit of everything. Our staffing ratio on days and evenings 1:4, nights 1:8. Our charge nurse often takes a full patient assignment or "flies" and will process admissions. Acuity of the patient no longer seems to matter when staffing our unit, you may find yourself with 4 level 2 (low acuity) or 4 level 4-5 (high acuity) patients. Charge does try to gather staff input before assigning patients. For those of you who feel this is is a cushy assignment, I would like to add, that often we do not staff PCA's on our unit, and the Rn is responsible for all patient care along with stocking supplies, etc.:imbar
  10. by   mcg02
    I work in a hospital in Atlanta (Decatur) Ga and our ratios vary for days anywhere from 5-7 patients with average of six and same for evenings and on nite anywhere from 6-8 with an average of 7. We have techs eacy shift 6-7 on days and evenings and 3-5 on nites depending on how many patients on floor..



    RN,BSN
  11. by   nursenatalie
    Our floor has ratio of 1-5,6 on days and 1-7,8 on evenings. The big difference comes in with the CNA's...day shift is allowed 2-3 and we (night shift) dont get a CNA until we have 15 patients on the floor...it is very hard to deal with 7 post-op patients with no CNA and never a unit secretary!!!
  12. by   NurseStyles
    I work on a med/surg/tele/peds mixed unit. Usually for days, we have 1:6-7 RN or LVN with a CNA for each team of 6-7 patients.

    PMs is about 1:4-7 RN or LVN with the CNA ratio being 1:6-12

    Nights is about 1:6-9 RN with the CNA ratio being 1:11-16

    Days has a charge nurse who covers the LVN
    PMs has a charge nurse usually with no patients, who covers LVNs sometimes no charge nurse
    Nights--no charge nurse, no unit clerck

    WE have auxillary staff to perform all RT functions, all labs, ECGs etc on all shifts.
    Our average census is about 20
  13. by   NurseStyles
    Originally posted by RN-PA
    I am not being purposely naive, but I wonder who arrived at the magic number of SIX patients being manageable by one nurse on med-surg. I have had shifts with 6 patients who were all partial- to self-cares, mostly "walkie-talkies" and yes, that was busy but manageable. But throw into the mix coverage for an LPN who has 6-7 patients, some of whom may be a new admission (RN's muct do admissions and initiate care-plans), needing to hang blood, do IV pushes, call the Dr. for any of their problems along with your own load, and there's nothing very manageable about that. And of course, you can have shifts where you have only 3 or 4 patients, and depending on their acuity and problems that crop up, you can be running all night.

    I saw one of my managers on Friday (right before the Halloween-evening-shift-from-hell), and she mentioned, in regard to nurse to patient ratios that she still believes 1:6 should be "manageable". The hospital where she used to work had 1:8-9, so she thinks we have it pretty good. Of course I mentioned that 1:6 is not taking acuity into consideration and she grudgingly agreed. One of our upper management nurses mentioned in a local newspaper article about nursing shortages that ran within the last year that she thought that 1 nurse for 6-7 patients was "adequate" staffing. (How about asking a patient? How about asking the nurse in the trenches? )

    But again, what's the deal with this "one-size-fits-all" staffing for med-surg units? I can see a number of years ago, maybe when patient acuity wasn't so high, that 6-7 patients would be doable, but nowadays.....

    Our LVNs do admissions, hang blood, call doctors, they do everything except IV pushes and piggybacks, and central line care. I wonder if this is legal, I guess I should check with the LVN scope of practice. The charge nurse just cosigns the charting.

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