Advice please!!!

[Orthopct]

I need some advice on a couple things. So the ortho unit I work on isn't doing too well right now. For RN's- what is the best start time for a shift? Most of our post ops come up between 10am and we usually get our last around 8 or 9pm sometimes. Shift change is horrible, nurses are trying to get report, post ops coming up, lights all over the place, and the aides are running like chicken with their heads cut off. Now our nurses start at 7a, 11a, 7p, and 11p. The 7a and 7p times are the worst. The aides start a half hour earlier than the nurses, to try to answer lights, get vitals, etc. what would be an ideal start time to work more efficiently and make sure patients aren't waiting for things that they need?

number 2-charge nurses. Now in my opinion , the charge nurse is very important. Some people are trying to eliminate charge all together, and just have floor nurses. Is this a good idea?

our patient ratios are 1:5/6 for Rn on daylight, 1:6/7 for nights, one charge, huc during the day, 1:15 or more for aides

please send me your comments so we can get our unit to be the great ortho unit we once were. Thank you!!!

[mmc51264, BSN, MSN, RN]

we all start at 7. Shifts are 7a to 7p. M-Th are the biggest OR days. Fri are ankle days. We have post-ops come up whenever they can. Usually not before noon, but if we have a room, they come. They keep coming until PACU is empty. Sometimes that means 2100. They love to send them at 705 errrrr.

You really need a good charge nurse that can assign rooms and admissions so that no one is too swamped at one time.

The first thing I notice is that your ratios are off. We are 4-5 pts during the day and 5, with the odd 6th on nights. Aides are 1:10 during the day and 1:15 at night. One HUC each shift.

We just got a new manager and it has been a rough transition. We have had some things could have gone wrong because we are not staffed well. One night there was 1 aide, a confused person, one that required security 3x and then an RRT. It was a mess. Most of our staff are relatively new staff so it is hard when people don't always know what to look for.

We are getting ready to transition to having step-down beds, which will help with staffing numbers, but doesn't help with the lack of experience.

You def need a charge nurse and need to lower patient ratios.