Nurse to Patient Ratio - page 4

:mad:RATIO 11 TO 1 AND ONE CNA...NOT SAFE....HOW DO YOU STOP IT AND WHAT CAN YOU DO!!! UNSAFE AND POOR PATIENT CARE....PLEASE HELP!... Read More

  1. Visit  Chico David RN profile page
    2
    Wow! For some reason I had not looked at this thread before and am pretty blown away at what some nurses - and patients! - are enduring in many parts of the country.
    We know we are lucky in California to have legal ratios, but I had not fully grasped how much worse some places can be.
    I think it's worth throwing out a few things to think about:
    1. Our ratio law and its implementation did not just happen - it took a long fight by a strong union that engaged thousands of nurses and pushed legislators to do that right thing. And it was not an easy push, by any means.
    2. The ANA - the organization that many still (erroneously) think of as the voice for nursing has consistently fought against real ratio laws, working with the hospital industry to derail them everywhere.
    3. Ratios don't just make our lives better, they save our patients lives - solid studies show that too many patients per nurse produces significantly more patient mortality.
    4. Management will push us as far as we will put up with. When enough nurses stand together and say no, these staffing practices will change - and not until then.
    5. Ratio laws have been introduced in legislatures in a number of states: Ohio, Illinois, Massachusetts, Texas, Florida, and probably more I don't know about. But we won't see those laws pass until enough nurses come together and take action to support them.
    dmarsala and lindarn like this.
  2. Visit  TXNurse77 profile page
    1
    I work nights at a SNF. Presently my ratio is 1:65 with 2 CNA's.
    lindarn likes this.
  3. Visit  Aeterna profile page
    2
    Quote from Chico David RN
    Wow! For some reason I had not looked at this thread before and am pretty blown away at what some nurses - and patients! - are enduring in many parts of the country.
    We know we are lucky in California to have legal ratios, but I had not fully grasped how much worse some places can be.
    I think it's worth throwing out a few things to think about:
    1. Our ratio law and its implementation did not just happen - it took a long fight by a strong union that engaged thousands of nurses and pushed legislators to do that right thing. And it was not an easy push, by any means.
    2. The ANA - the organization that many still (erroneously) think of as the voice for nursing has consistently fought against real ratio laws, working with the hospital industry to derail them everywhere.
    3. Ratios don't just make our lives better, they save our patients lives - solid studies show that too many patients per nurse produces significantly more patient mortality.
    4. Management will push us as far as we will put up with. When enough nurses stand together and say no, these staffing practices will change - and not until then.
    5. Ratio laws have been introduced in legislatures in a number of states: Ohio, Illinois, Massachusetts, Texas, Florida, and probably more I don't know about. But we won't see those laws pass until enough nurses come together and take action to support them.
    I'm just curious: what is the legal nurse-patient ratio in Cali? I'm in Canada so I'm ill-informed about this.
    lindarn and Chico David RN like this.
  4. Visit  Chico David RN profile page
    1
    Quote from Aeterna
    I'm just curious: what is the legal nurse-patient ratio in Cali? I'm in Canada so I'm ill-informed about this.
    I don't know them all off the top of my head - it varies by unit, but here are some samples:
    ICU - 1:2
    stepdown unit - 1:3
    specialty unit (peds, tele, oncology) 1:4
    Med/surg 1:5
    Emergency 1:4 (unless a patient is heading for an ICU - then the ICU ratio applies)

    A couple of other items that can be just as important as the numerical ratios: These ratios are in effect "at all times" which means days and nights and includes break and meal periods - in other words, to be legal there should be designated people to relieve you during meals and breaks - not just another nurse "watching" your patients.
    And these ratios are supposed to be floors, not ceilings - hospitals legally should staff up from that for high acuity patients.
    Both of those issues are not complied with as often as the basic numbers - a lot of hospitals try to fudge it in various ways and enforcement is uneven - it's always a work in progress.
    lindarn likes this.
  5. Visit  carolmaccas66 profile page
    1
    Try being one RN for a 100 patients and supervising about 10 staff! That happened to me one night. I had no break, running round like an idiot, had the other RN came on ignoring me and giving me cheek (I complained), had lots of other problems that night too.
    I will not work aged care now; those staffing levels are disgusting. I wish the families were more aware of these problems, problems is they don't want to care for their 'loved' one or can't and they just ignore what's going on.
    Nobody cares about the elderly and demented now.
    lumbarpain likes this.
  6. Visit  TygRNoef profile page
    1
    Quote from Chico David RN
    I don't know them all off the top of my head - it varies by unit, but here are some samples:
    ICU - 1:2
    stepdown unit - 1:3
    specialty unit (peds, tele, oncology) 1:4
    Med/surg 1:5
    Emergency 1:4 (unless a patient is heading for an ICU - then the ICU ratio applies)

    A couple of other items that can be just as important as the numerical ratios: These ratios are in effect "at all times" which means days and nights and includes break and meal periods - in other words, to be legal there should be designated people to relieve you during meals and breaks - not just another nurse "watching" your patients.
    And these ratios are supposed to be floors, not ceilings - hospitals legally should staff up from that for high acuity patients.
    Both of those issues are not complied with as often as the basic numbers - a lot of hospitals try to fudge it in various ways and enforcement is uneven - it's always a work in progress.
    I'd be happy with anything even close to those ratios. I work on a stepdown cardiac unit, and the normal staffing ratio is 5:1, often we go up to 6:1, and on that rare day when you're down to 4:1 you just spend the day dreading the admissions you might get. The worst part is, on the rare occasion that we're staffed well enough that everyone will get 4:1, more often than not, our nurses are pulled to regular Med/Surg floors so that they can have 5:1 ratios.

    On one occasion, I was pulled off of my floor, leaving them with a ratio of 6:1 to go to a Med/Surg Oncology floor where I was assigned 5 patients, and the rest of the floor got a 3:1 ratio. I would have complained, but I felt like I was on vacation with only 5 Med/Surg patients.
    lindarn likes this.
  7. Visit  ninja-nurse profile page
    2
    ...and this is why I desperately want OUT of med-surg. Except, reading this, apparently it's EVERY type of unit. Is there no where sane left?
    lumbarpain and lindarn like this.
  8. Visit  albinahaide profile page
    1
    negligence will probably be rampant there....i feel more sorry to myself and my patients because we have a 25:1 ratio here....tons of work...i can say that you are still luckier than me hehehhe....
    lindarn likes this.
  9. Visit  jrwest profile page
    2
    Quote from ninja-nurse
    ...and this is why I desperately want OUT of med-surg. Except, reading this, apparently it's EVERY type of unit. Is there no where sane left?
    if there is, i would love to know where it is.
    as far as I see it it all sucks. A walking liability.Not a matter when , but how bad.(although go ahead and sue me- cant get blood out of a stone.....
    lumbarpain and lindarn like this.
  10. Visit  lumbarpain profile page
    1
    I was a half and half RN once..... floornurse one day, then the next day supervisor.....in a 100 bed facility. Although I am quite capable of handling 35 patients....I couldnt do this. going back and forth from trying to get into a routine only for it to be devastated the next day was horrendous. Needless to say it didnt last.....I found out a nurse that had worked there before was coming back for her job. I was a patsy, and this was during The State visit!!!!!! Never ever again will I do such a stupid thing. They dont care about you, just as long as they have a body there so it looks good. If you develope a good routine with competant aides who are mostly full timers!!! thats a miracle within itself. But, most times its not that way.
    lindarn likes this.
  11. Visit  Awesomepossum profile page
    0
    I have the same problem, I'm on a med/surg ward with a lot of complex cases, like people who just had all of their guts taken out and are getting chemo. I routinely have 6-8 pts on a "good" day (we're only supposed to have 5 but hey, why keep nurses employed, we're so easy to replace right?!) and 8-12 on nights. Note many of these people end up on the unit because they're so unstable.

    I can't quit because if I quit from the big company I can't get another job in the area and I don't have enough exp to transfer or get hired at the good hospital. I'm just screwed.
  12. Visit  lumbarpain profile page
    1
    Considering most Moms that have children have a tough time organizing/keeping house, working a job and just keeping sane with a family to care for...NURSES have an extended family so to speak on their jobs!!!! Taking care of elderly, the very demanding patients, critical patients as well as documenting all that you do, giving meds, dealing with distraught family members/ writing up reports, calling docs and auxiallary staff/organizing your CNAS/ Keeping yourself from getting sick/ and just Keeping your own life intact is just as stressful as it gets. 30 patients is FAR TOO MANY IN A SNF....and with critical patients...2 is more than enough!!!!!! SNF should have only 10 patients per nurse. Thats enough.
    lindarn likes this.
  13. Visit  Asystole RN profile page
    1
    Quote from lumbarpain
    Considering most Moms that have children have a tough time organizing/keeping house, working a job and just keeping sane with a family to care for...NURSES have an extended family so to speak on their jobs!!!! Taking care of elderly, the very demanding patients, critical patients as well as documenting all that you do, giving meds, dealing with distraught family members/ writing up reports, calling docs and auxiallary staff/organizing your CNAS/ Keeping yourself from getting sick/ and just Keeping your own life intact is just as stressful as it gets. 30 patients is FAR TOO MANY IN A SNF....and with critical patients...2 is more than enough!!!!!! SNF should have only 10 patients per nurse. Thats enough.
    It is impossible to determine workload from a single aspect just as it is impossible to determine a full health assessment from viewing a single body system. Patient acuity, assistive technology, assistive personal, facility design, shift, work responsibilities, and unique patient characteristics are all very important factors that go into determining a "safe" patient load.

    Having 10 confused, combative, total care, post CABG, vented patients with no assitive personnel that are more than 30 yards from each other would be not safe.

    Workload should be the determinant of what is a safe nurse to patient ratio, not a number.
    interceptinglight likes this.


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