Nurse to Patient Ratio

Nurses Safety

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I live in NC and work in a small community hospital. To say that we're short staffed is an understatement. Our nurse:pt ratio can be as high as 1:8-9. I have worked some nights where I am the charge nurse, the unit clerk, have 6 pts, another RN with 8 pts, one NA, and no nursing supervisor. Is anyone else having this problem? I know the morale of our nurses is dwindling to nothing & we all feel as if we are putting our license on the line everytime we work under those conditions. It seems that talking to administration has done nothing because we have been experiencing this type of problem for over a year and night shift is usually the shift that suffers most. Any suggestions on how to get the higher ups to realize how big of a problem this is? All input would be appreciated!

Define "small." I personally know of one small rural hospital where they only staff 1 RN, 1 LPN, and 1 NA with no nursing supervisor. The RN and LPN act as ER, Med-Surg, OB, swing bed nurses, whatever. However, their average inpatient census is 3-4 and maybe 3 people need ER services a day. And there is a huge, sophisticated hospital 2 hours away so anyone really sick would be sent straight there.

I am guessing your staffing is probably based off of old patient data that wouldn't justify more staffing. I would start keeping my own personal record of how many patients you care for/admit/discharge daily and what kind of care they needed (IV/PO meds, blood administration, dressing change-if you already have an acuity system in place I would use that) plus how much time you spent on paperwork/on the phone as charge nurse/unit secretary. I would keep track for about a month, then schedule a meeting with the administration to present the data. It shows you care about your job and that you're not just griping when you have cold hard data to back it up. Hopefully even if nothing changes right away it will open their eyes since they aren't there to see the day-to-day struggles.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I live in NC and work in a small community hospital. To say that we're short staffed is an understatement. Our nurse:pt ratio can be as high as 1:8-9. I have worked some nights where I am the charge nurse, the unit clerk, have 6 pts, another RN with 8 pts, one NA, and no nursing supervisor. Is anyone else having this problem? I know the morale of our nurses is dwindling to nothing & we all feel as if we are putting our license on the line everytime we work under those conditions. It seems that talking to administration has done nothing because we have been experiencing this type of problem for over a year and night shift is usually the shift that suffers most. Any suggestions on how to get the higher ups to realize how big of a problem this is? All input would be appreciated!

*** The number of patients per nurses isn't really relevant. 8 or 9 may be perfectly appropriate depending on acuity. Staffing levels must be determined by patient acuity. There are many standardized way of calculating patient acuity. Your hospital needs to adopt such a measure and staff by it. If not they will learn to do so the same way everyone else did, the expensive way, when they lose a big lawsuit.

Every time you believe that you are seriously understaffed, and that can be every time you work, you must write a note of protest or refuse your assignment BEFORE you take report. YOU CANNOT BE CHARGED WITH ABANDONMENT IF YOU REFUSE TO ACCEPT AN ASSIGNMENT BEFORE YOU TAKE REPORT. Of course, you can be fired.... This is such a damned hard place to be in, I do not envy you.

Find a good standardized method to determine acuity ( as already mentioned ) and whenever you are short-staffed then make several copies. Keep the original, send copies to your immediate supe and each individual on the 'up' line, as well as the hospital's legal team, the health dept, state officials and JCAHO. Your supe should be given a copy each time; the others maybe every few days or shifts.

Oh, the BON gets copies, too. Make certain that your own nursing insurance is up-to-date.

And DO NOT SHARE this info with anyone who does not need to know. Do not make this fodder for gossip.

Best wishes.

Specializes in ER.

Unfortunately that does not hold true for us ER nurses...at the beginning of the shift there may be one or two patients in the ED - which is fine since we have 2 RNs staffed at that time. But when patients begin coming in (our administration does not believe in anyone being in the waiting room - pull them all in to the ED) or the other hospital goes on diversion (which they have done a lot), then we are in a dire situation. What do we do...I may be dealing with a critical patient and when I am finally able to leave the room and look around the ER - I have 4 more patients that no one has even told me about or given me repot on. I find this frightening. I have been an ED nurse for 8 months and can say I love my job for the most part but having no back up until noon is just too much. Any ideas how to constructively address this issue???

We are considered a critical access hospital. There is a fully functioning ER, OB, OR, and 20 bed med-surg/tele floor (which is where I work). According to the staffing models we have in place, night shift is always short staffed while day shift is very well covered. Our nursing manager & DON are fully aware of the staffing issues and there have been several "near miss" instances due to inadequate staff. We are affiliated with a larger hospital that has a float pool, but for whatever reason, they don't float to our hospital.

What we have decided to do is file a grievance. I don't know if this is going to help, but we all feel as if we worked too hard to obtain our licenses to lose them due to inadequate staffing.

The only staffing model in place is based on nurse:pt ratio, not acuity. Most of the pts that are admitted are total care. We care for everything from the cradle to the grave. With 8 or 9 pts, you cannot pay close enough attention to all of them. I always fear that we will have one pt go down and while we're busy with that one, another will go down and no one would even be aware. I agree with you about the lawsuit, it's not a matter of if, it's a matter of when, I just hope I'm not there when it happens.

It must be a for profit hospital.

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