All in the name of "productivity"

[Marie_LPN, RN, LPN, RN]

Our med-surg floor summary for 1/03/04:

We have a total of 35 beds.

We have 35 pts. Our floor is set up in the Pod design.

17 of these pts. are beyond "confused" and like to get up out of bed, take 2 steps and fall on the floor.

3 of these pts. are there for diarrhea (confusion+diarrhea=dangerous mess on the floor).

1 pt. brought in from a nursing home because he tried to choke a nurse, with h/o of psych problems that include biting, spitting, and throwing objects. Also in renal failure. Mental health refused to take him. And the dialysis unit had 8 empty beds and a nurse pt ratio of 1:3.

All of the 17 confused pts. were restraint free. In addition to the 17 (which were ALL incontinent all around, because after all, when it rains, it pours), there were an additional 4 that were bedridden and incontinent of urine and BM.

I am a float aide for night shift for 35 pts. In a nursing home, to have to look after 21 people is illegal. 35 pts. is not too bad when they're not climbing over berails and walking around or peeing in the nightstand.

I should have had help. I always have great help, because i work with a bunch of great nurses who insist on helping, but it's hard when they have pts. who like to get out of bed and eat skin barrier. Who would watch the OTHER ones? Who's going to watch the 2 or 3 confused pts. that a nurse has, when i'm in the bathroom with a post-op, and the nurse has to give the meds out?

35 pts, with 6 nurses. Each nurse had 6 or 7 pts. Even though we have this many confused people, and this was known ahead of time, the coodinator refused to give the charge nurse (who also has a group of pts.) another nurse, or even an orderly to help me. (Did i mention that i'm also the night clerk and night phleb?).

Because our "productivity" was low last month, the nurse-pt. ratio will be 1:6 at the lowest, 1:8 at the highest.

And until "productivity" is up, the only way i'll get an orderly to help me is if someone is threatening physical harm. And even then, they will be assigned to that room only.

This was NIGHT SHIFT. I'd hate to be on day shift right now.

Too bad the definition of "productivity" isn't "the best interest of the pts".

:angryfire

[oramar]

It said that non professional staff have some interesting things to say about what is going on in healthcare.

[gwenith, BSN, RN]

This is where plain numbers mean nothing and you have to resort to assessing patient acuity. This is our system - far from perfect but it at least assesses acuity and takes it up a step from straight number ratios

http://www.trendcare.com.au/

[Hellllllo Nurse, BSN, RN]

Originally posted by LPN2Be2004

In a nursing home, to have to look after 21 people is illegal.

Unless your state has its' own specific staffing ratio law, this is not illegal.

There is no federal standard. I've worked in nursing homes in Az and TX. There is no limit whatsoever on how many pts an aide or nurse can care for in these states.

[Marie_LPN, RN, LPN, RN]

Virginia doesn't have its own specific ratio. Local nursing homes that i've worked at in this area have their own rule of 1:10 of CNAs, for nurses i'm not sure.

It used to be that the day shift aide ratio at this hospital was 1:10. It sits at 1:15 or 1:14 now. Day shift nursing at 1:4, now at 1:5.

[mattsmom81]

a CNA can only be responsible for so much. Unfortunately, this common sense flies out the window regarding the nurses' responsibility. Management has a way of blaming nurses if the CNA couldn't be in 6 places at once.

We have had to resort to doctors orders for 1:1 for very confused patients where restraints may not be an option. If we don't, we know it will be falls, incidents, lawsuit city. Trouble is, then these patients get 1:1 observation (taking the 1 CNA away from 10 others that also need her help)...

Tough when we only have 1 CNA for 35 patients on our PCU unit.

[Tweety, BSN, RN]

I know what you mean about the productivity. My hospital staffs like that. Sometimes I can get more help when the acuity is high like that. Other times in the name of productivity we aren't allowed the extra help.

35 patients is way too much for one CNA to handle. Hats off to you.