Staffing Hours and how you cope?

[RNPATL, DNP, RN]

As I read the posts on this board, I often see nurses complain about staffing and the nurse to patient ratio. A question I have for nurse managers is .... what are your budgeted hours and do these hours include the nurse manager, education and/or clerical support for the manager?

In my last position, I ran 2 med-surg units, one with a productive standard of 6.48 and another with a productive standard of 6.68. In addition, I ran a step down unit with a productive standard of 7.45.

For the med-surg units, this generally gave the nurses a 5:1 nurse to patient ratio on days and a 7:1 nurse to patient ratio on nights. In the step down unit, we ran a 4:1 nurse to patient ratio. Of course, this was if there were no call offs. On a busy surgical day, by the end of the day shift, the nurses may have 6 patients, but I always tried to keep them at 5. From 7PM - 11PM I tried to run a CNA to assist with care, feeding and cover call lights when the nurses were busy with admissions, meds, etc. Also, I ran a unit secretary until 11PM most days, including weekends.

Of course, with these standards, it left very little left over for me as the manager, so I ran all three units, did a great deal of the education (unit based) and was able to have a 20 hour per week clercial aide to help me keep up on the files and such.

How do you manage your hours and what type of support do you have to help you run your unit(s)?