nurse to patient ratio orthopaedic floor? - page 3

by nurseortho

20,370 Views | 37 Comments

Hey there! I work for a Texas post total knee and joint surgical unit. 6years ago the nurse to patient ratio was 1:4 on nights(no cna, no secretary). 1:4 on days with a nurse aid. However, one year ago a new CNO came on... Read More


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    I work in an orthopedic,neuro unit. We have a lot of surgeries. We have had 10 patients per nurse on days with 1 aide for 20 patients and a charge nurse.I am talking 7am to 7pm. Most of the time we have a ratio of 7 or 8 patients each. RN's and LPN's have same # of patients. We have so many pts coming from surgery and others discharged that we might end up charting(by hand) on over 10 patients a day. night shift 7pm to 7am has it bad also. If we do have a couple of aides scheduled, they will float one elsewhere cause they are short staffed worse than we are. I work for a "for profit" hospital in Fl. I have been a nurse a long time and this is the worst I have ever seen it.
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    I work on an ortho/neuro unit with other medical patients thrown in the mix like detoxers, GI bleeds, PNA, COPD and change in mental status. We get 1-5 on evenings with a secretary until 21:30 and 3 aides if the unit is at capacity of 32 patients. I have it great compared to a lot of the other posters but one confused patient or detoxer can suck all of your time up. The thing that makes the number of patients we have worse is that you still have to chart on all of them. The charting is what makes our jobs hard.
    suziq842 likes this.
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    37 bed med-surg/ortho unit in PA. Days and Eves 1:5, Nights 1:6. Usually 3 aides (sometimes 4) day and eve. 2 aides at night. 1-2 secretaries days. 1 floating at night. Clinical mgr out on the floor 80% of the time to help.
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    Our unit has 32 beds...40 planned surgeries average weekly....RNs 1:6 techs 1:10.
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    Where I work we have 5-6 RNs with 6 patients each, 4 techs (on a good day), yesterday we had 2 for 27 people..., and 1 unit secretary.

    It's the same for nights except they have no unit secretary. They say we're the best staffed floor in the hospital...we're also the busiest so most days it feels like we need more staff...or less patients. Hahaha
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    About 5:1 ratio, a night secretary and we have 1 NA for every 10 patients =) We are 48 beds and 10 nurses. Mostly Ortho with a sprinkling of stable Med/Surg patients.
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    Is it crazy? 1:6(7) here (Baptist health system in San antonio). We feel too tired and it is not safe for our patients. Can we form a union to protest it?
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    I have been working on the same Orthopedic floor for roughly 4 years now. When I first started the ratio was better but at this point it has changed. Our dayshift is about 1:5 with 3 CNA'S-our floor holds 24 beds. There is a scale for how many CNA's we get though, as 3 is if we have a full house and are lucky. Evening ratio is 1:5-6, and Nights is 1:6-8. Even though orthopedics is not critical care, it demands ALOT of time since mobility is a great issue-it can take 5 minutes or more to walk someone to the bathroom. Being understaffed makes us more concerned about patient falls, i.e., someone has to go to the bathroom and decides they have been on the light for too long without response so they walk there on their own. Many falls happen that way. I understand the hospitals are suffering financially but as the difference in ratio increases the patient satisfaction scores become worse and patient safety becomes an issue.
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    I work on a 30 bed orthopedic/plastic surgery unit in non-profit hospital in WA. On days (7A-7P),we have a 4-5:1 ratio for RN, 7-8:1 ratio for CNA, 1 secretery, charge nurse takes no patients. On nights (7P-7A), 5-6 ratio for RN, 1-2 ratio for charge RN, 8-10 ratio for CNA, secretery until 11:30P if 18+ patients on unit. The acuity of these patients is getting higher and higher and more is expected from the RN and CNA, which leads to poor charting/poor pt care/poor pt satisfaction/increased risk of errors! Unfortunately, our staffing is considered pretty good compared to nationwide on similar units.
    Most of the staff love what they do and it shows in the teamwork we have on the unit.... We have resource team of RNs and CNA's that fill in holes in the core staffing. They have told us frequently how no one wants to float to our floor as it is one of 2 of the hardest units to work on (the general surgical/neurosurgical unit is the other one and has similar staffing matrix) due to staffing ratios. We frequently will discharge between 1-4 patients and be expected to take over the postops/ED admits that refill those beds, which can mean electronic charting on up to 9 patients during the day!
    Very frustrating to say the least, especially if you are detail oriented! At present we do have a "flex nurse" M-Th from 10:30A-7P that helps settle the postops and helps with tasks for the nurses. Several of the nurses, including myself, are requesting that the flex nurse position be absorbed into the matrix so more RNs can have max of 4 patients, esp. in the higher acuity groups.
    Good luck people! I think it will just be getting worse and these days will be considered "the good ol' days", so try to keep a positive attitude and do the best you can, and continue looking for ways to save time (volunteers are great at restocking, answering call lights/phones, walking with the confused patients....just hard to find a good one that's reliable and enough bodies to help out every day of the week day and night!)
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    Hi everyone! Although i've been reading allnurses for a long time, this is my first comment here. I'm a portuguese RN and reality here is very different.

    I've started working in ortho a week ago. We have two wards in our floor (32 beds each) with 12 Intermediate Care beds. We have both pre and post-surg patients, most of them above 60 years old, except for polytraumatized patients which are usually younger.

    Our nurse/patient ratio is awful. Day time - 1:12/14 (regular patients) and 1:6 (intermediate care patients); nights - 1:16. Charge nurses take no patients and there are 3 aids during days and 1 at night.

    I think it is important to clarify something: in Portugal, there are only two types of nurses (RNs - with a 4-year Bachelor's Degree and Nurse Specialists - who are RNs that get a Master's Degree in one of these areas - paediatric and child's health nursing, women's health and obstetrics nursing, psychiatric and mental health nursing, community health nursing, rehab nursing and medical-surgical nursing). About our aides, their responsabilities are to help nurses and doctors with routine tasks, and cannot be responsible for any type of care.
    Last edit by Portuguese Nurse on Aug 11, '12


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