Assignment of breaks and lunches

[D.R.A.]

Hello ladies and gentlemen:

I am a day shift charge on a med-surg unit. We have only 21 beds. Our pt census averages 12-14. There are times when we have 6 or fewer, and times when we have 17-21. It varies greatly.

We typically staff three nurse aides when we have 10 or more patients. One of them leaves at 1400. I would call this staffing arrangement a walk in the park. We staff 2 nurses and for 12 or more we staff three nurses. We have an additional nurse who acts as an admission/discharge expediter, as well as doing skin assessments, and care planning.

My dilemma is that the aides have routinely been allowed to break and lunch together. So no aides are on the floor during lunch or breaks. I don't feel comfortable with this. The nursing staff has been allowed to do the same.

The aides do not take patient assignments. They are all responsible for all the patients. This makes it easy for no one to take responsibility in my opinion.

I'd like some advice here. What are you doing. What works best in your experience?

Thanks in Advance.

[peabozzle]

It sounds to me like your first problem is outlined in your most recent post. I would first get rid of the staff members that don't show up, are lazy, don't do their work, take an entire shift to do AM care, don't toilet or turn patients, don't answer call lights, take excessive breaks, and are insubordinate. Once you have cleaned house, your problem of having no staff on the floor to care for the patients may solve itself. Even if it doesn't, one of the solutions proposed above would be a cake walk to implement with all new staff with no preconceived notions :)

[exp626]

From a budgetary standpoint, a few employees are costing your institution more than face value. You have to overstaff just to meet your matrix, and then you pay sick time to habitual callers-in, that's insane! A 4:1 ratio with each PCT having only 6 patients should run like a well-oiled machine. Those employees should be prostrate before the staffing gods!