nurse-patient ratio

  1. I have read with great interest the varied ratios on med-surg units. Being the manager of a 50 bed ortho-neuro unit, and continually working with budgetary constraints vs. heavy, heavy patients (accuity, equipment, plus weight!), I am feeling caught between reasonably and safely staffing, staff retention, and satisfaction scores. Can anyone working a similar unit tell me what your patient satisfaction scores are if your staffing ratios are more than, say, 4-5 on days, etc? Also, do you retain staff if your ratios are heavy, and if so, what is your secret?!!!!
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  2. 11 Comments

  3. by   bunky
    Hi Joy! Hey, we just got a new staffing grid on the surgical floor I work on. It's supposed to be a surgical floor but we see more medical than surgical patients these days and the accuity is really high right now. Guess what? Our grid is so bad that they won't let us see it! I am not kidding they actually told us that we can't see it as they don't want to be held to it if we refuse to take and admit because the grid says we're entitled to another nurse! One night on nights they had 9 and 10 pt's each with NO CNA's! We'd kill to have 4-5 pt's each on any shift! I've seen the day staff with 8 each and 2 CNA's for 30 patients. You sound like a very good nurse manager for at least looking for an opinion before you make a move. And as for staff retention? I work with a few nurses who have been here for almost 30 years on the same unit. Interestingly enough those ones are hurting and saying that they think it has hit rock bottom and it's now time to think about retiring. It's a shame because they have such a wealth of experience to impart and I feel that the hospital is going to be the loser on this latest move. It has left the senior staff feeling totally fed up.
  4. by   normarae
    I realize you wrote this in June - I am also trying to understand why I would be held in contempt for refusing to accept an assignment for primary care for 30 severe acuity tele/med pts with 1 LPN and 1CNA

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  5. by   normarae
    I realize you wrote this in June - I am also trying to understand why I would be held in contempt for refusing to accept an assignment for primary care for 30 severe acuity tele/med pts with 1 LPN and 1CNA

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  6. by   GJBOUSHLEY
    HI JOY, I WORK ON AN ORTHO/NEURO UNIT AS TEAM FACILITATOR (CHARGE NURSE) THAT HAS 29 BEDS. OUR STAFFING RATIO IS 1:3 IF ACUITY IS VERY LOW THEN 1:4. WE DO NOT HAVE AN ACTUAL ACUITY SYSTEM, WE USE OUR KNOWLEDGE AND EXPERIENCE TO DETERMINE A PATINET'S ACUITY. WE UTILIZE CNA'S TO ASSIST THE NURSES WITH THE PATIENT CARES. OUR HOSPITAL WAS NAMED A TOP 100 HOSPITAL FOR ORTHOPEDIC, CARDIAC AND HSOPITAL OVERALL. I FEEL THAT OUR STAFFING RATIO CONTRIBUTED TO THE QUALITY CARE OUR STAFF WAS ALLOWED TO GIVE OUR PATIENTS. WE ARE A NON-PROFIT HOSPITAL IN A CITY THAT HAS TWO OTHER NON-PROFIT HOSPITALS WITH A FOURTH CURRENTLY BEING BUILT THAT WILL BE FOR PROFIT. WE HOPE OUR PATIENT RATIOS WILL HELP US IN RETAINING OUR STAFF.
  7. by   oramar
    Originally posted by GJBOUSHLEY:
    HI JOY, I WORK ON AN ORTHO/NEURO UNIT AS TEAM FACILITATOR (CHARGE NURSE) THAT HAS 29 BEDS. OUR STAFFING RATIO IS 1:3 IF ACUITY IS VERY LOW THEN 1:4. WE DO NOT HAVE AN ACTUAL ACUITY SYSTEM, WE USE OUR KNOWLEDGE AND EXPERIENCE TO DETERMINE A PATINET'S ACUITY. WE UTILIZE CNA'S TO ASSIST THE NURSES WITH THE PATIENT CARES. OUR HOSPITAL WAS NAMED A TOP 100 HOSPITAL FOR ORTHOPEDIC, CARDIAC AND HSOPITAL OVERALL. I FEEL THAT OUR STAFFING RATIO CONTRIBUTED TO THE QUALITY CARE OUR STAFF WAS ALLOWED TO GIVE OUR PATIENTS. WE ARE A NON-PROFIT HOSPITAL IN A CITY THAT HAS TWO OTHER NON-PROFIT HOSPITALS WITH A FOURTH CURRENTLY BEING BUILT THAT WILL BE FOR PROFIT. WE HOPE OUR PATIENT RATIOS WILL HELP US IN RETAINING OUR STAFF.
    Sounds like a great place!!!!

  8. by   BROWN_KK
    It is teriffic that you have taken an interest in what I think is one of the biggest reasons nurses do not stay. The place I work at gives 8-10 med-surg patients to each nurse and you have to admit. There are no more than 2 cna's per 25-30 patients. They have a terrible retention issue for obvious reasons so they over-hire areas like the ICU where people try to hide from those terrible numbers (not telling you that you will have to float) and then use that staff to make up the numbers in med-surg. Dirty Pool!!!!!!!
  9. by   LLDPaRN
    Hello!
    In my facility, I work on medical telemetry and administration is changing the nurse/patient ratios (of course to the detriment of RN's trying to give safe,competent care :-() In addition, we can now be pulled to med/surg floors, where previously we were only pulled to one of the other 2 tele floors or the ICU's (regular ICU isn't so bad, CT ICU is another story, especially since not everyone was oriented there!). Of course, when we're pulled to CT, we're told "You'll be given a patient you can handle." Anyway, on nights, I will now be responsible for 7 patients, ranging from MI rule-outs, CVA's,CHFers, those with arrhythmias, and drips ranging from nitro to amiodarone (maintenance--amio drips have to be started in ICU I believe). On top of this we will no longer have a charge nurse (who had no patient assignment--they watched monitors, helped take off orders, etc). Now we will have a monitor tech and (if they can find someone to take the job) a unit clerk on nites (I'm not holding my breath on that one!). Evening shift will have 6 patients and days will probably have 5 (except for post-PTCA's). Of course, there's no contingency plan in respect to the post-angio's with A-lines; I'm sure there's also no contingency plans in place for when everyone leaves, because everyone is unhappy about these changes (Gee, what a surprise!). Wish I could go to Green Bay,WI but since I'm enrolled in grad school here (a very good one, BTW), I'm kind of stuck .

    Laurie, RN
  10. by   GJBOUSHLEY
    HI TIARA,

    I DO NOT UNDERSTAND WHY ONE WOULD BE CONCERNED TO WORK ON AN ORTHO UNIT AS A WOMAN. PROPER BODY MECHANICS AND TEAM WORK IS ALL ONE NEEDS TO WORK ON AN ORTHO UNIT. THERE ARE "HEAVY" PATIENTS OR DIFFICULT PATIENTS TO MOVE ON ANY NURSING UNIT. YOU WOULD BE AMAZED AT WHAT WE CAN DO WWHEN PROPERLY TRAINED TO MOVE PATIENTS.
  11. by   Tiara
    Joy: What access to orderlies or male nursing attendants do you have? A lot of women are questioning the advisability of working a heavy-duty ortho floor unless they are assured there are a reasonable number of orderlies assigned to help with work that has previously been done by women. There have been times when large numbers of nurses were out on disability for long periods with back problems. A bit of prevention could nip this in the bud!
  12. by   Tiara
    Provided you have enough staff you can move mountains!
  13. by   Tiara
    Sorry; should have clarified. It sounded like I mean orthopedic and only ortho. Of course I did not.

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