Cardiac Floor RN, LPN, technician ratio

Fiona59 · Jul 30, 2009

Well, our on our unit each RN and LPN is responsible for their own workload and assist each other as required. Each nurse is responsible for their own admissions, discharges, blood sugars, dressing changes, assisting with the am care of their own patients.

We have an extra RN on day shift who does all wound vacs, PICC dsg changes, iv lines changes, does charge relief and is generally useful when the sh*t hits the fan workload wise.

We have one NA who showers, assists with making bed and some ins/outs.

Our hospitals policy is if there are three or more isolation rooms on a unit, they are assigned an extra RN or LPN from the float pool to cover the rooms.

cjcsoon2bnp, MSN, RN, NP · Jul 31, 2009

Can anyone give advice on scheduling base on patient acuity? I work on a busy cardiac/nephrology floor. My nurse manager is having a hard time trying to please the RN's and LPN's based on assignments.
Here are the areas we are having the most problems with:
1) Totals
2) Contact Isolation
3) PICCS
4) Diagnostic procedures
5) Surgical procedures
6) New Admissions
7) Discharges
8) AMS
9) Falls
10) Accu checks
Each a.m. nurse starts out with 4 patients. There are days where she/he may have 5 patients. The nurses are burned out due to the heavy load. We do own accuchecks, in addition to taking our own patients' food trays to our patients'. We must have 3 RN's on day shift. We have 2 technicians bathing, etc.. 32/33 patients..
Can any nurse who is happy with their module working on a busy floor give me some advice to share with my floor?
Any advice would be greatly appreciated.. My manager is open to suggestions

I work on a busy Med/Surg. floor that has a lot of telemetry patients and patients with vascular issues, we usually have around 26 - 30 patients on our floor and although our floors sound similar I can tell you that the staffing is not even close.

First of all we don't have any LPNs work on our floor, most of our patients require IV meds. and many need blood hung as well as IV Push meds. and its way too much of a hassle to split up the patients who don't need those things just so that an LPN can take care of them so we only use RNs. I have no bias against LPNs in anyway I just think that using an LPN in a Med/Surg. floor like mine isn't practical. But I will say that on one of the Med/Surg. floors in my building that specializes in Orthopedics they do use some LPNs but their assignments are often smaller and must be signed off by an RN. So what's the point really?
We use CNAs or NSA as techs. who assist the RNs. The CNA/NSA does accuchecks, venipuncture, EKGs, vital signs and assisting patients with the ADLs as necessary. By having this additional staff we are able to decrease the incidence of falls and provide better care to our patients because the RNs now have more time to do what need to do within their shift.
Each RN handles their own admissions, discharges and everything else associated with their patients because they are not caught up doing jobs that CNA/SNAs or a Unit Assistant can do.
In the first shift (7 AM - 3:30 PM) each RN has 5 patients (usually 1 or 2 are isolation), each CNA/NSA has between 6 - 9 patients and 1 Unit Assistant to pass out and collect trays, get fresh linens, go on supply runs for anything the RNs need and transport patients to and from the floor.
In the second shift (3 PM - 11:30 PM) each RN has 5 patients (usually 1 or 2 are isolation), each CNA/NSA has between 6 - 9 patients and 1 Unit Assistant to pass out and collect trays, get fresh linens, go on supply runs for anything the RNs need and transport patients to and from the floor.
In the third shift (11 PM - 7:30 AM) each RN has 6 patients (usually 2 are isolation), there are 2 CNA/NSAs who each have between 13 - 16 patients and a Unit Assistant is on call if the RNs need them but unlike the 1st and 2nd shift Unit Assistants the 3rd Shift Unit Assistant covers multiple floors.

It seems to me that the biggest difference in staffing between our floors is the number and function of auxiliary staff (CNA/NSA and Unit Assistants) while adding more of these staff and expanding their skill set would cost more money I believe it would also improve the level of care provided by the RNs and make your lives a lot easier. Basically, for our staffing we are looking at 5 or 6 RNs, 4 CNAs and 1 Unit Assistant plus 2 secretaries for the first and second shift and 4 or 5 RNs (depending on the census), 2 CNAs and 1 secretary along with 1 shared Unit Assistant on call for the third shift. I believe that in the last 6 months we have had 1 documented fall, our hand washing compliance has gone way up and the patients pain management and satisfaction scores have improved as well.

!Chris :specs:

jeholland · Jul 31, 2009

Thanks so much!! You Rock!!

I forgot to put in the list above the RN's have to push drugs, blood , etc.. for the LPN's and do RN assessments for the LPN's..

I forgot to put in the list above the technicians can't always do the VS's on new patients', nor get the new patient their supplies, etc..

cjcsoon2bnp, MSN, RN, NP · Aug 1, 2009

Thanks so much!! You Rock!!
I forgot to put in the list above the RN's have to push drugs, blood , etc.. for the LPN's and do RN assessments for the LPN's..
I forgot to put in the list above the technicians can't always do the VS's on new patients', nor get the new patient their supplies, etc..

See and that's the point. I love LPNs I know a few that are absolutely amazing and are great nurses but if you need to have an RN to push drugs, hang blood and do assessments for them then what's the point of having them in that sort of setting?

If you need to make a case to your manager for having more CNAs/Techs. then you should let them know this is what each CNA/Tech does on my floor. Here is a basic schedule of my day:

Arrive at 3 PM and I write down my assignment from the board usually somewhere between 6 - 9 patients.
I go and take a set of vital signs from each of my patients, making sure to report anything abnormal to the nurse immediately and starting anyone on 2L of O2 via Nasal Cannula for anyone with a Sp O2 of under 90.
After vitals are done I pass out fresh ice for patients who can have it and I go and find the nurses for my patients so I can get report from them. During report they let me know the diet, toileting and ambulation needs of each patient as well as if they need blood sugars done or any kind of testing/blood work that needs to be done later in the shift as well as if they need to leave the floor for any surgery or diagnostic scans.
By that time, I do the blood sugar checks for anyone who needs one before dinner. After the Unit Assistant passes out trays I (as the CNA) make sure that my patients are all set up and are eating dinner.
When patients are finish I record what they ate and I help get anyone cleaned up who wants to be cleaned up. Usually by this point at least one patient (probably more) has been discharged and a new patient has been admitted, so I make sure I take vital signs on the new admit and have a whole setup done for them (hygiene products, incentive spirometer and telemetry setup if needed.)
After dinner and getting patients cleaned up then I do any of the blood draws or EKGs that are scheduled and ambulating any patients that need to be ambulated before they go to bed.
Before my shift ends I add up the I&Os for my patients and make sure that the rooms are somewhat clean so the night staff isn't tripping over the stuff patients leave all over the place.

So that's pretty much what I do for my shift, I can't imagine only having 2 techs. on for 30 patients. That's crazy. I really hope that what I said helps when your talking to your manager.

!Chris :specs:

pageygirl · Aug 2, 2009

We usually have 4 mostly 5 patients on a tele floor for 21 patients we get 5 nurses and 2 techs one unit secretary our floor max is 32. Actually our numbers are not that good today I had 6 patients on days which kept me very busy.