Safe Pt Ratios for Med Surg

  1. I have tried to find a thread on this, and nothing addressed it quite adequately for Med/Surg pts, ESPECIALLY surgical pts.

    Our new Clinical Manager for our surgical care unit wanted to know what we consider safe ratios with our population: fresh surgeries from PACU, outpatient surgeries, and 1-3 day recoveries, and swing bed patients. Right now we usually have 1 RN and 1 or 2 LPN and 1 or 2 CNAs for 16-35 patients, avg is about 21 pts. I think 4-6 pts to a team of 1 RN and 1 LPN and 2 teams sharing a CNA sounds about right-the fresher the surgeries, the less pts should be in a group though, just for safety, and orthos I think should lower ratios also.....what are your opinions, just for sake of info gathering?
    BTW, our hosp is trying to get Magnet status, but yet our staffing is awful, some shifts, it goes beyond pt safety issues....They have juggled numbers to make it look good on paper. Do these Magnet folks read between the lines? Any thoughts on the staffing question are much appreciated.
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  2. 30 Comments

  3. by   Thunderwolf
    I work on an Ortho-Neuro Med Surg with total census being 24, which it is most of the time. As you guess, our patients don't move very well and require a lot of hands on. Our staff for 24 patients is 3 RNs, 3 LPNs, and 2 Aides. PT gets them up initially if they can on POD #1. This mix is doable. I've worked at another hospital in the past where staffing was much less and it was horrid. Hope this helps.
    Last edit by Thunderwolf on Jan 4, '06
  4. by   HappyJaxRN
    I am so spoiled. The most patients I get is 4. Usually only 3, but last night I had 1. Not a med-surg floor...but transplant....but after a certain number of days out from the surgery, they are considered med-surg patients. We usually have 17 patients on the floor. We range from having 1 patient to as many as 4. The usual number is 3. Most of the time we have 2 PCT's.

    I would be lost working somewhere that I would have more than 5 patients. When I float, I have 5....on CV and on the med-surg floor....I don't know how ya'll do it...
  5. by   liljsmom02
    my assignment ranges from 5-8 pt's. we are fighting hard for more staff and more coverage. i feel like i am running an assembly line. 25 beds. 3-4 nurse. 1 LNA (god bless her)
  6. by   cdmadere
    Ok, you guys. Here is Louisiana at the hospital I work at we range from 5-8 patients per nurse. I am getting burnt out quickly and looking for a career change within nursing. I go home so stressed out and tired...
  7. by   obtech_doula
    I usually work OB but when I float to medsurg their usual staffing for max of 28 pts is 2 RNs 2 LPNs and 1 Tech. They average 20-24 pts, with anything from ortho to surg to swingbed pts. They even have peds pts as our hosp doesnt have a ped unit.
  8. by   ana tomy
    I work on a med-surg unit in Canada..work straight nights.That seems to be when people go sour or things happen. There's no knitting going on(as some people think of N shift) There are 36 pts with 3 RNs,2 LPNs. We also run the Code cart to other units. It can be busy. I go through burn out spells.
  9. by   kristi-lpn2
    I work on med-surg floor we can have up to 26 patients on my floor. The staffing we usually get is 1RN,3LPN,1CNA; sometimes we get 2RN,2LPN,1CNA. Every now and then we get 2 CNA but not very often. I work doubles on the weeken 7a-11p. We get very busy and stay busy we used to be staffed better than this and when we have 36pts according to our pt/staff ratio we are working 2nurses short and 1 aide short the majority of the time.
  10. by   NCLEX_CareBear
    I work on a GI med/surg (mostly surgical) floor. We have 16 patients on the unit. Rarely an empty bed. On days and evenings, we have 4 nurses and 2 PCAs (Personal Care Assistances). On nights, it's 3 nurses and 1 PCA. I feel like we are WAY understaff...Pt wants so much from you...many times, I feel like I'm stretched in all direction. So stressed-out!!!
  11. by   KK92RN
    I work on a 28 bed ortho, neuro, med-surg, trauma unit. We have split the floor so it works like this: staffing for the floor total. 2 charge 6 nurses on the floor and 2 pca. Each side has a charge and 3 nurses and 1 pca for 14 pts. now don't get me wrong people still complain but the majority of our pts are hips and knees so we get alot of postops. maybe 7-8 on one side and 4-5 on the other most of the time. this is in addition to giving blood and new admits and stuff like that. We run most of the time but very rarely does one nurse have more than 5 pts a piece.
  12. by   twinmomoftwins
    I work on an ortho med-surg unit. Lately, staffing is sub-par. The other day, with 22 patients and an RN call-out, they were going to staff us as 2 RN's, 1 LPN (float) and 2 PCA's. When I objected, they replaced the LPN with an RN (pulled from another unit) but then left us with 1 PCA. As charge nurse, I had an 8 pt. assignment to start the shift!! I would dream of a 5 pt. assignment. Hasn't happened in a long time!!! To add insult to injury, the LPN compained to the VP that I refused her! Heck, I was refusing an 8 pt. assignment, I was hoping to keep her plus get another RN, Am I dreaming or what?! Luckily, I have a D/C by 10:30 am. Guess what, they want to send the first post-op of the day at 11:00!! By the end of my very long 12 hour shift, with D/C's and post-ops, I've charted on 11 patients, ugh!!
  13. by   applesRN
    I work as a resource team nurse. My job is to float to any med- surg or rehab unit that needs me, between 2 hospitals. I would say the average is 6 patients on day shift, with a low of 3 on telemetry ( on a good day) to a high of 11 on a 30 day rehad unit. The tough part is when you have 7 patients on day shift on a fresh surgical floor- complete with TPN, PCAs, chest tubes, etc, and the manager says # 8 is on the way. If there were more CNAs, or maybe make the ones who just sit around actually do their work (some); maybe that would relieve some stress. But when i can't do assessments or give meds because I'm constantly being paged for drinks or bathroom lights- that really makes me mad. Our hospitals just got Magnet status- and then our DON left within 2 months, we started a new computer system which drove us mad for several months and lost nurses on the way, and I would quit if I could. It just keeps getting worse. I would say that staffing is unique to each unit; but patients are coming to the floor when the should be in the unit, and we are having to rush people out the door for insurance, and the ER is holding people because there are no beds, we are poorly staffed on most units, the managers are yelling "save money, move them out quicker, work more efficiently! Just do it". Yet our motto is "Excellent Care.... Every time." Every time? I can't remember the last shift I was able to have a meal. No breaks either. If we barely get a chance to see our patients, how are they getting excellent care? The hospital jsut announced it is cutting 60 FTE. Not nurses, but if you cut out custodians- who's gonna clean the rooms? oh, let the nurse do that. etc. Thanks for letting me vent a little.
  14. by   ttiebooRN
    At the med/surg unit I worked on each RN had 5-7 pts. LVNs had their own pts. Each PCT had about 10 pts. It was extremely chaotic. We had people working 3-11 and 7-7. it seemed like shifts were changing constantly. You were either picking up pts from someone leaving, getting a post op or sending someone home... unfortunately, I let it push me over the edge one day and I quit... Having trouble getting a job now. Oh well. Just glad I'm not there anymore. I wasn't doing anyone any good by being stressed out.

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