Office personnel counted in RN to pt ratios

  1. Where I work, when they are figuring out the schedule based on tech and nurse to pt ratios, they count one of our office workers as a tech (even though she goes nowhere near the pts but she is a CNA, and they count our supervisor and D.O.N. as two extra RN's (they also have no pts).
    now they count this based on how many minutes each pt receives with an RN or a CNA, or some such formula i thought was set forth by law?
    so it that legal to count those two in, when they have no pt contact? It's not a secret that they do this either.
    This makes it APPEAR as though each nurse only has so many pt's. when in fact we & our techs have more.
  2. Visit BrendaH84 profile page

    About BrendaH84, BSN

    Joined: Oct '12; Posts: 116; Likes: 133


  3. by   amoLucia
    When doing the staff-to-pt ratios, there are rules that mandate which positions count. Nurse supervisors are determined to be clinical positions, so they do count in the formula, but I believe the DON position does NOT count, even though it is a license. The Inservice/Staff Devel position counts as clinical. Not sure about MDS or any auditing/data entry positions.

    Staffing patterns are reviewed by State DOHs, esp at survey time, so to 'plump up' or' pad' the numbers is fraudulent. Now if there is a true mistake being made about who truly counts is one thing. But if it's being done deliberately...

    I worked one place that REQUIRED some non-nsg staff to be certified CNAs, altho they did not have direct clinical care positions. The logic was that in a state-of-emergency (snow/weather, excessive staff illnesses, labor/union job actions, etc) they COULD be moved to provide DIRECT clinical hands-on pt care. They could THEN be counted into the staffing formula, but only for the actual time/hours that were spent doing that direct care. They were like emergency backup substitute clinical staff. But they only counted when they DID do direct care. Sooooo, unless that tech person is doing direct clinical care... Be aware that the definition of 'clinical' can vary and she may be involved in something that might qualify.
  4. by   jadelpn
    And by something that might qualify, it can be healthcare level CPR certification. Or helping out with call bells for minor "change my TV channel" type issues....
  5. by   BrendaH84
    ok thanks. hey what does mdr stand for?
  6. by   amoLucia
    Quote from BrendaH84
    ok thanks. hey what does mdr stand for?
    MDS is about that reimbursement person's position (usually a nurse and we have a specialty room for MDS here on AN)which reviews a pt's status for the level of care that they need and what we and Therapy are providing towards meeting that need. It gets submitted to the feds and then drives financial payment. And it is much more complicated and detailed than as I've described.

    ***** To any MDS nurses out there - do you or do you NOT count into the staffing numbers? It's been a while since I did 'the numbers'. What about infomatics?

    The main difficulty that staff have with understanding staffing formulas is that it is just NOT A HEAD COUNT of staff caring for pts. Pt acuity is what drives the need for a specific amount of time to provide BASIC care. And acuities have very specific definitions, not just some employee thinking 'heavy' or 'complete' care means more nsg staff is needed for the unit. Wounds, IVs, cast care, trachs and some others usually count as extra needed time in the formula, whereas a pt with C-diff pooping 10 times a shift doesn't count into the acuity formula.

    Management is usually very careful about meeting 'the formula's numbers'. That's what's REQUIRED by the State for minimum staffing, so to be below the requirement could result in a deficiency. But they usually don't go over very much. However there ARE some facilities that do staff better and are above the minimum requirement - I've worked for both over & minimum coverage places.