Published Feb 7, 2003
I know there was recently a thread posted inquiring about nurse to patient ratios on med-surg floors. What I'm wondering is what is your nurse to patient ratio and also the acuity of your patients? For example, do those of you with a higher ratio have less acute patients or more nursing assistants to help out? Are your nursing assistants allowed to things such as simple dressing changes and blood draws, etc? Just curious...
Zee_RN, BSN, RN
Our med-surg has a ratio of 6 patients to 1 RN. There is one aide for 18 patients. So 3 nurses share one aide. The assignments on med-surg are purely geographical; e.g., one nurse gets the first block of six rooms, and so on. I think the ratio can go up to as much as 12:1 on nights but is usually 9:1 again with one aide to 18 patients.
Aides do not perform any dressing changes or blood draws (but nurses don't do blood draws either--lab phlebotomists do all our blood draws except for patients with central lines). The only "skilled" thing aides are allowed to do at our place is check capillary blood glucose (finger sticks).
plumrn, BSN, RN
Zee, does that mean that the nurses have 6 pts and have to do most of the baths, too? Like elsewhere, I am sure each nurse will get at least one admission each thru the shift. How can you get it all done in a day? I have trouble doing ANY baths with 6 pts!
6:1 med-surg ratio is actually a pretty good ratio, Plum. The baths are split up among the different shifts; they aren't all done on daylight. The aide is still responsible for most of the baths. They may do 4-5 on 7-3, and another 4-5 on 3-11, and then the most confused and disoriented ones on 11-7.
I work on a medical floor in a pediatric hosptial - night shift. The usually patient ratio for days and nights is four patients to one nurse. There are CNAs and they are usually on per section (about 16 rooms). With more than four patients there is usually a CNA assigned to a nurse. Also, depending on the acuity of the patients the nurse may only have three.
It sounds like the nurse to patient ratio is better than average from what I have heard. Then again, hospitalized children have different needs than adults.
I work in a rural hospital on the peds floor. I hear what you are saying about hospitalized children having different needs, Kailua. We are trying to get our DON to hear that because right now, we can have a 7:1 with possible aide for 14 patients. Not safe if you ask me.
I've found my area has done away with acuities and does 'staffing by numbers' which is unfair...the acuities are so much higher now than they used to be on medsurg.
As an agency nurse I find I rely heavily on my CNA's/PCA's who know the patients...and can be a good resource for me. :)
My PCU has total patient care 5:1 which can be extremely difficult. ICU is 1-3:1 and is much easier because of the controlled environment of ICU.
On medsurg, I can usually (depending on acuity) handle 8-10 on nights IF I have a good CNA assisting me. But a few hourly BSG's and too many multitask patients can make this load unbearable. ...also if the CNA is stretched too far they cannot be as helpful, obviously. I don't think a CNA should have more than 15 personally.....and should have less if there are lots of totals. I generally do my own vitals, IO's, and BSG's but ask her to answer lights, do physical care, etc. A PCT I may delegate more to...depending on situation. We do what we have to sometimes to get through the shift
Every facility does things differently...and I've found it is very hard to get administration to commit on paper to set ratios as this sets them up for liability problems.... as they seldom keep them.
I believe we will have to go Cali's way (unionize and legislate) for facilities to comply with safe ratios...and I hear facilities are already finding loopholes in the law out there. GRRR
rachel h, BSN, RN
Thanks for giving me a little insight. The reason I ask is because my hospital just upped the numbers-more pts per nurse- due to being overbudget...
I work straight evenings and our new nurse to patient ratio is 1:5. That doesn't sound like much compared to what some nurses on this board have posted, but it seems that the acuity of our patients is so high that the 1:5 ratio is pretty tough. We have a level one trauma center, so when we get admissions from the ED, the patients can be pretty bad off... also we are a county hospital so a lot of the patients we treat have multiple health problems due to lack of health care related to being homeless, mentally ill or just non compliant.
Last week I had two total care patients, one with a trach, peg, continuous TF, turn q2, incontinent, etc, the other was a new transfer from the MICU who had just been extubated that day, and she was a quad, had a urostomy, pain out of control, wet to dry drsg change for cellulitus that was like shoving kerlix into a crater, also had two post-ops who needed frequent vitals, both had low BPs, pain issues, nausea, and I got a new admit- direct from the clinic and I was given absolutely NO report- with diverticulitis and in a lot of pain. Oh, and I can't forget my nursing home patient who kept yelling at everyone walking by to come in his room and everytime he saw me walk by would scream for the nurse- thankfully I discharged him at 4pm...
Now I am fairly new, which may be part of the reason why this seems so overwhelming, but I have been noticing that a lot of the nurses who have been on that floor for years are also getting out late fairly frequently, so it can't be just me.
Anyway, sorry to ramble on... thanks for giving me your input... keep it coming...
Tweety, BSN, RN
Unfortunately, we go by numbers and not by acuity. If we have X number of patients we get X number of nurses and aides. The challenge is making a fair assignment so one person doesn't have higher acuity, that the acuity is spread out fairly. Sometimes it doesn't come out how difficult an assignment is until the nurse has dealth with high acuity during a shift, and then for the next shift, we'll make a new assignment.
The hospital my mom works at has a 1 to 12 nurse/patient ratio...a disaster waiting to happen if it hasnt already. I would NOT work there.
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