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Lev <3, BSN, RN 51,899 Views

Joined Jun 3, '11. Lev <3 is a ED Registered Nurse. She has '5' year(s) of experience and specializes in 'Emergency - CEN'. Posts: 2,884 (53% Liked) Likes: 5,344

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  • Jan 4

    Staffing ratios are a must., but it must include other areas such as long term care. I would like to hear what everyone's opinion is for appropriate ratios for long term care, assisted living, and rehabilitation,

  • Jan 4

    I have worked in California in the past and can tell you even with ratios it is too much. It has become worse over the years because of gov. regulations, hospital p/p, and the push for pt. satisfaction, and higher pt acuity. I can not even imagine having 7 med-surg patients, this is crazy and unsafe.

  • Jan 4

    We have been consistently under staffed on evening shift since October ... management says "the call volume doesn't indicate higher staffing ratios" than 1.5 nurses for this shift - but calls come in clusters, and many are very involved and/or behavioral health patients ... am I (present - not the number crunchers) missing something?

    Dreading my shift tonight (as per usual lately) ...

    Feeling stressed, irritable and burned out to the Nth degree ...

  • Jan 4

    With all the expenses lost in replacing burnt out nurses, fines for hospital acquired pressure ulcers, medication errors, and everything else listed above, etc., how come hospitals haven't realized reducing nurse to patient ratios will actually *save* the hospital money?

    Is it more expensive really just to hire a few extra nurses? All the hospital scores and safety numbers would rise, including HCAHPS.

    It would be a win-win for everyone. What am I missing?

  • Jan 4

    Ashley sank into a chair in the breakroom on her MedSurg unit in a large hospital in Florida. It was 0330, 8 ½ hours into her shift. She had not yet taken a break of any sort, including a bathroom or hydration break. In staff meetings, it was repeatedly emphasized never to miss a lunch break or stay overtime, but in the moment, it was hard to manage. Right now her stress was so high that as soon as she sat down, she struggled to keep back the tears.

    Of her 7 patients, she had had two rapid responses (RRTs) and one patient was sent to ICU with sepsis. She was pretty sure she had missed the early signs of sepsis in her post-op patient, with an increased heart rate and infected wound. It's just that there was too much information and she was cognitively overloaded.

    Her phone buzzed in her scrub pocket. Wearily she picked up the call. It was Laura, the charge nurse, sounding stressed out. "Ashley, I need you to take an ED admit in Room 4123. Is the room clean? Can you take report now, please?"

    Across the country in California, Lindsay works on a similar MedSurg unit. Because she works in California, she can never be assigned more than 5 patients. Her day was busy and at times crazy. She knew that adding on 2 more patients would make it unmanageable. Thank goodness it was 5 patients, and not 7. During lunch breaks her patients were covered by break nurses and she did not take her phone into the breakroom.

    Why is there such disparity? How is it that a patient with exacerbated CHF on Tele in Alabama has a nurse with five other patients and a patient with exacerbated CHF on Tele in California has a nurse with only 3 other patients?

    The reason is that California has mandated nurse-patient ratios in every hospital unit. ICU is 1:2, SDU 1:3, Tele 1:4, Med Surg 1:5.

    Patient Perspective

    If you were a patient and could choose, would you choose a nurse who has 4 patients or 7 patients? If your baby was in NICU, would you want your child to have a nurse with 1 other infant, or 2 other infants?

    There is abundant evidence to show that patients suffer when nurses have too many patients. The following is a quote from Ruth Neese's Talking Points for Safe Staffing.

    1. Cost to replace a single nurse burned out by overwork from understaffing was in excess of $80,000/nurse in 2012 (Twibell & St. Pierre, 2012).
    2. The difference between 4:1 and 8:1 patient-to-nurse staffing ratios is approximately 1,000 patient deaths (Aiken, Clarke, Sloan et al., 2002).
    3. Patients on understaffed nursing units have a 6% higher mortality rate (Needleman et al., 2011). This risk is higher within the first 5 days of admission (Needleman et al).
    4. An increase of one RN FTE per 1000 patient days has been associated with a statistically significant 4.3% reduction in patient mortality (Harless & Mark, 2010).
    5. Adding one patient to a nurse's workload increases the odds for readmission for heart attack by 9%, for heart failure by 7%, and for pneumonia by 6% (McHugh, 2013).
    6. Lower patient-to-nurse staffing ratios have been significantly associated with lower rates of:
      1. Hospital mortality;
      2. Failure to rescue;
      3. Cardiac arrest;
      4. Hospital-acquired pneumonia
      5. Respiratory failure;
      6. Patient falls (with and without injury); and
      7. Pressure ulcers (Aiken, Sloane, et al., 2011; Cho et al., 2015; Kane et al., 2007; Needleman, Buerhaus, Stewart, Zelevinsky & Mattke, 2006; Rafferty et al., 2007: Stalpers et al., 2015)

    7. Higher numbers of patients per nurse was strongly associated with administration of the wrong medication or dose, pressure ulcers, and patient falls with injury (Cho, Chin, Kim, & Hong, 2016).
    8. Rising patient volumes, higher patient acuity, and reduced resources lead to nurse burnout and fatigue, resulting in first year nurse turnover rates of approximately 30% and second year rates up to 57% (Twibell & St. Pierre, 2012)."


    Mandated nurse-patient ratios are a matter of public safety. There are regulated practice safeguards in place for airline pilots and truck drivers and other industries. Why not nursing?

    Historically nurses are a silent workforce who have allowed employers to determine clinical practice. But that is changing. The time for change is now. On April 25th and 26th 2018, nurses around the country will gather in Washington D.C. for the 3rd annual rally to urge lawmakers to enact safe staffing ratios. In numbers, we have strength and will be acknowledged.

    Come join allnurses in Washington DC! Meet up with the allnurses team who will be filming and interviewing, and myself, Nurse Beth! Dr. Laura Gasparis, whose conferences many of us ICU nurses have attended, is the lead speaker.

    By standing together, we can bring about needed reform. Will you be a part and bring about change as the nurses did in California?

    Be sure and read Male Nurse Disgusted by Female Nurses for a unique point of view on working conditions and ratios.

    What else can you do? So many things!

    Easily find out who your legislators are and make a call.

    Write a letter to support H.R. 2392 and S. 1063 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017 legislative bills. Legislators respond to topics based on the number of phone calls and mail from their constituents.

    While you are in Washington, make an appointment to see your legislator.

    Share this article on social media. Use hashtags #NursesTakeDC and #allnursesSTRONG

    Please watch the following video for more information on NursesTakeDC 2018. Like this article if it spoke to you, and comment below. Thanks much.

    Neese, R (2016). Talking points for Safe Staffing. Retrieved January 12018. Nurse Patient Ratios | Talking Points for Safe Nurse Staffing

  • Dec 21 '17

    That the general populace doesn't consider a nurse as a real person with feelings (and perhaps neither does administration). I've had more clear headed, cognizant patient's sneeze or cough in my face and not bat an eye, nor apologize. I've had family members also not consider me to me a sentient being either.

    Also, the general populace feels any unkindness dealt is off set by the fact we make a ton of money - which is so not the case.

  • Dec 21 '17

    The Joint Commission has the magical ability to bring administrators out on the floor to help. When the JC leaves, the magic recedes, taking with it the extra support.

  • Dec 21 '17

    The patient is the one with the disease. You can't fix them, you can only educate them and provide the tools (and maybe the motivation) for them to manage their disease wisely.

    You can't fix stupid. But, if they're the one in the bed, you CAN medicate it. If they're the one in the chair next to the bed, you can't fix nor can you medicate stupid.

    Every disaster makes a really great story once sufficient time has passed.

    The most essential characteristic of a nurse isn't compassion -- it's a lively sense of humor.

  • Dec 3 '17

    I found it useful to be told that the resident had a tape recorder hidden in her nightstand drawer that she activated when she turned the call light on.

  • Nov 28 '17

    I think the ER is a shock to anyone, ranging from experienced ICU nurses to med-surg nurses to brand to grads. It's very fast paced and you have to be on your toes, and also the learning curve is immense. But with all of that being said, I'm sure you can do it! Like shaunrn mentioned too, ER doctors are typically much more pleasant to work with than surgeons. Give it a shot, and if you don't like it, you can always go back to the OR or try a new specialty!

  • Nov 14 '17

    Quote from Richard Wolfe
    No one survives a code and goes home with "no deficits".
    That's not true. I've participated in rescucitations where the patient had ROSC and ended up being discharged home without any deficits after therapeutic hypothermia.

  • Sep 28 '17

    Apply for unemployment anyway. I have almost always had a positive reaction from them. Argue that you were not aware that your clearance had been revoked and that it would impact your present job. Tell the interviewer that security clearances are not a standard requirement for practicing nursing, this requirement is employer/employment setting related and no one informed you during the hiring process, etc., etc. Since you went so long being gainfully employed at this assignment, I think the employer would have a hard time selling to the unemployment people that you should have been eliminated. The employer did not do their due diligence in vetting you upon hire, so why do you have to pay the price for their negligence? Lay it on thick. Play it out to the end. You might be surprised.

  • Sep 5 '17

    OP you mentioned you were suffering from depression as well as all the family gunk. I'm thinking that working on your depression for a while and getting that under control would be beneficial to you before starting up in school again. Personally I have depression, am in school, and don't like to take a break from school because the break screws me up. But this could be a good thing for you. Keep with the therapist and figure you out first.

  • Sep 5 '17

    CNA is a 6 unit course. Where I am at, you can do the entire thing in a summer semester (12 weeks). forget the dollar store job and go straight into a CNA class and then work that year as a CNA instead. If you can do 1 science class a semester till you are ready to go to school full time it will really benefit you

  • Aug 31 '17

    You're in the South? Then you know all it takes is a " well, bless your heart" and that should take care of it!