CNA to patient ratio

jb2u, ASN, RN · Oct 30, 2006

I have never heard of a cna to pt ratio. The fact is we are there for the NURSE and not the PATIENT. So, a cna to pt ratio does not really come into account. Everything a cna does is actually the Nurse's job. We are there to assit them with the basics so that they can focus on the technical stuff. This is why they can delegate responsibility, but NOT accountability. Now, you do have some nurses that will "never touch a bottom because that is the cna's job," but that is the wrong attitude to have because it IS the nurses job to ensure that the bottom gets cleaned. If the cna is busy then the nurse has an obligation by the Nurse Practice Act to clean that pt's bottom. There are many great nurses out there and there are some lazy cna's, but the fact remains that the Nurse has full accountability to the pt and the cna is there to help out that nurse as much as possible without going beyond their scope by "practicing nursing without a license!"

That being said, Nurses can not even get together enough to have mandatory ratios across the U.S.; so, I dought we will EVER see a cna to pt ratio. A cna to pt ratio of 14:1 is quite common and usually would not be a problem IF you have Nurses that do some of the basic care with you (ie: take some baths, change some briefs, etc). If, however, you are expected to do all care that does not require a license then it is nearly, if not completely, Impossible!

vampiregirl, BSN, RN · Oct 30, 2006

It sounds like you are a CNA in a hospital, I've been a CNA in long term care, so I'm sure things are a little different. I've had more patients than that on occasion (up to 22, uuugggghhh). It's not easy. For me, prioritizing (safety first) and being proactive were my best strategies. I also was continued to provide quality care to all of my residents, I ignored the suggestions of others to "cut corners" to get done faster. These strategies also seemed to get me more assistance from the nurses. They saw that I was providing the best care that I could, so often they were more willing to help. Communicating with the nurses (not complaining) was another thing that I found helpful... letting them know what I had gotten done and what I could use a hand with. For example, if a had a resident who was on their call light every few minutes and I suspected it was because they were lonely, the nurse and I could ensure that one of at least popped in the room every so often (then the call light would usually come on less frequently). Hang in there, usually it get better!

Plagueis · Oct 30, 2006

I don't think we'll ever see CNA to patient ratios. If there aren't national nursing ratios, then I don't think CNAs will have any. I have had as many as 15 residents to care for, and I have gone crazy with that load. I couldn't imagine having 22! Is there a "right" number of patients/residents that a CNA should have in order to properly care for them? I remember reading an article in an issue of Ladies' Home Journal earlier this year, (I can't remember the name of the article, but I think it was the June issue), and it was about nursing homes, and one person quoted stated that CNAs are overworked because they have too many residents to care for. In addition, the person said that a CNA shouldn't have over five residents, so that the CNA won't feel rushed when caring for them. I would love to have only five residents, but I know that many nursing homes would fight this small ratio.

hptogram · Oct 31, 2006

I tried looking that up today. I work at an ALF with a Memory Support Unit. Over the last couple of weeks, the two new girls that were hired for nights have taken turns calling off. It usually ends up with me working the ALF side (appox. 35 residents, most do not call, but a few call often, one in particular calls every 20 minutes! And of course, whenever I'm working alone, that's when someone has a seizure or falls or something. MS has 22 residents) alone. Last Saturday night it was just me and my partner. My partner will not work in the MS Unit. I've never been trained for that unit, but I go in there and talk with the night owls. I ended up working in there. I asked the LPN who was leaving for the night if the DON or the Program Director for MS had been called. She said they both said there was nothing they could do and they weren't coming in. So that made me look into ratios of residents vs cna's. I found nothing. Very frustrating.

maelstrom143 · Dec 14, 2006

as an rn that does not have an issue with helping my cnas i can say this: even with our help, the residents are not getting the proper care r/t improper staffing ratios. a realistic number of cnas to resident ratios would be 1:10 (heaven would be 1:6, but that will never happen, due to corporate greed). i would not have a problem dealing with my 24 bed unit, even if full, if we had sufficient people to care for and give our residents the personal touch they require for a holistic approach to their treatment. my unit has high acuity. having one cna for 20+ residents when we have a no show or when they schedule inappropriately is unrealistic. having call lights answered within 1 minute with what i consider a skeleton crew is not only unrealistic, but insane.

why can we not get organized enough to work for legislative measures to ensure patient safety? we do not think we can make a difference. not enough of us are willing to stand up and make the extra effort it takes to organize. i have heard many people say how they no longer belong to any organization. i know for a fact almost no one at my facility is part of any professional group, save those in management and a few of the nurses.

there are not enough of us active vs the organizations and affiliations working for the large corporations making profits at the expense of our patients. every time we turn away from what we perceive to be inappropriate or unsafe, we are facilitating these corporations' practices. every time we choose to make do with what we have and drive on, we are facilitating them. every time we become discouraged and inactive, we are facilitating them. in the long run, we will all pay for our inability to stand up and say, "this is wrong." we are all getting older. i, for one, would prefer that something be done before i am in need of our services. otherwise, it is going to be quite ugly.

everyone complains that ratios will never improve. yet, those are the same people who are unwilling to get up and do something about it. if we have a problem with something, we need to get up and fix it or at least attempt to do so. complaining never solved anything, unless it was used to fuel change.:pumpiron:

jyoung1950 · Dec 14, 2006

i have been working as a cna for about two months now. i finally feel comfortable with most of my assignments.
the nas that have been at the hospital for a while are starting to complain and call in sick alot. the problem is, management has decided to split the number of patients between two cna. so far i have had as many as 14 patients on the day shift in med/surg. it's really hard keeping up with all the demands. you can get behind very quickly.
does anyone know if there is a cna:patient? i heard 14 and some of the cnas flat out refuse any new admits after that (i wish i could do that), but i need to be sure first.
i live in california, and i've checked the state website, but could find nothing regarding regulations for cnas.
i could be getting the dirty end of the stick. :smackingf

at the hospital, i work at na's could have 16-20 patients on day shift yet! how do they expect patients to get fed and all the vitals taken and patients getting on and off stretchers to go to labs. and this seems to all take place between 7 a and 8 a!

we can't keep na's here. most either transfer to another position or quit.

veronica341972 · Dec 18, 2006

HELLO,

I have been working at an area hospital for the past 5 months and though I was promised when first employed there would be a maximum of patients under my care (I work at an oncology unit), it has never been the case. At times I have had to work with 25 patients (and a minimum of 18 or so). Though I say 18 it doesn't mean the work is easier. Working in Oncology patients are needed to be looked after even more.......I used to work with some wonderful nurses who would never mind answering a call light on occassion however most of the nurses have moved on to other places and the new nurses I work for will never answer a light if they aren't busy.......How can I provide the best care I can? Frankly, it seems, no matter how hard I try I never feel I can........someone will always have to wait. It is hard to leave a room when you have a patient who wants nothing more than to have a word or two after going through some form of cancer or illness. If the nurses understood that the CNAs and RNS/LPNS are a team maybe better care would be given.

There have been times when there could of been an extra CNA on hand to come in and help with the patients but it seems that this hospital I work for ONLY CARES ABOUT SAVING MONEY! What a shame for its patients!

veronica341972 · Dec 18, 2006

As for the ratio it really depends on what YOUR FACILITY cares to provide its patients. The hospital I work for refuses to hire additional help for our unit which seems unfair. I do know of some CNAs who have literallY WALKED OUT because they had as many as 25-30 patients (which is totally unfair) and literally told "You have enough help". Well some nurses won't.......I am getting to the point where I feel it is justified to ask for more help especially when the nurses aren't helping.........

bethin · Dec 18, 2006

as an rn that does not have an issue with helping my cnas i can say this: even with our help, the residents are not getting the proper care r/t improper staffing ratios. a realistic number of cnas to resident ratios would be 1:10 (heaven would be 1:6, but that will never happen, due to corporate greed).

i agree. as an aide i've had as many as 26 pts (i was by myself). this is on med/surg. there is a prn nursing supervisor who won't call people off (hence we love the guy) because staffing is great when he's supervising. when he's there nurse:pt ratio is 1:4 and aide:pt ratio is 1:6. that works the best. it's amazing - both nurses and aides can give wonderful care when ratios are low. but, when other supervisors work ratio for nurses is 1:6-7 and aides 1:14 or more. there is no way i can give quality care to that many pts. the whole time i'm taking care of a pt i'm thinking of the twenty other things other pts need and the lights going off. i feel like i run into a room, solve the problem and run out. i don't get a chance to talk with them.

days like that i feel like i've done nothing. i don't think we'll ever see legislation regarding aides ratios because we are there to help the nurse. we are like their personal secretaries - at least where i work.

Scrubz · Dec 19, 2006

I usually work a Med/Surg (Geri) wing and float Peds. The Med/Surg wing holds 24 beds and the Peds holds 9, so that's 33 total and although you rarely see all beds full they'd still only have 2 aides working, so that would be around 16:1. Luckily I usually work nights so it makes it a little easier on me; I'd hate to work days with 33 people. But like I said, that rarely happens. Busy for us is around 20-25 total in those two wings.

As far as patient to CNA ratios are concerned, I don't think any facility follows a strict ratio policy, or at least I've never heard of one. CNAs usually do grunt work, although still important work, so I don't see any reason why a CNA couldn't handle a larger load than a nurse.

Sometimes you just have to prioritize, bite the bullet, and get to it.

maelstrom143 · Dec 21, 2006

as far as patient to cna ratios are concerned, i don't think any facility follows a strict ratio policy, or at least i've never heard of one. cnas usually do grunt work, although still important work, so i don't see any reason why a cna couldn't handle a larger load than a nurse.
sometimes you just have to prioritize, bite the bullet, and get to it.

unfortunately, not all cnas want to just “bite the bullet and get to it,” as you so glibly put it. many of the cnas i work with actually care about their residents as human beings who deserve and need human contact on more than just a drive-by shooting basis. some people actually need to have someone show they care enough to ask how they are and whether or not they need anything. some residents actually refuse to eat, saying that they want someone to show them that they matter, that they are somebody.

my section is a high acuity section. my residents come to us not only with acute, emergent care problems, but also with chronic illnesses (both mental and physical) that compound whatever it is they went to the hospital to get resolved. my unit has 24 beds. it is hard, if not impossible, to keep residents safe when you have several residents who need one on one care and only two people (1 nurse and 1 cna) available to take care of all their needs.

desensitizing ourselves to the situation in order to make ourselves feel less guilty is not enough. these people, their families, and/or their insurances are paying through the nose for their care. a snf stay can average anywhere from 50k to 70k yearly. these facilities are operating in the black. why can they not hire more help? falls and injuries happen when there are not enough staff on the floor. a realistic ratio has to be established. losing cnas due to improper staffing not only costs money spent training them, but also institutional memory of how and why things should be done a certain way. yes, we can always replace someone to do the “grunt” work, but we cannot always replace the caring and compassion that go with good help. one day it may be us in that bed, wishing someone gave a darn.