Frustrated need direction..please :o)

[4everstark]

SO I have spent the better part of two days poring over Nurse Practicing Acts, State Board of Health Laws and Regulations and JCAHO's web site trying to find where we as nurses are protected when it comes to patient-staff ratios. Of course as you all can probably tell me, there is little information to be found. Terms like adequate staffing, and reasonable staffing are everywhere, but ill defined. I have only been a nurse for a year now, but with all of the focus on patient safety shouldn't there be a clearly defined line when it comes to this? Not only to protect the patient but to protect us as well. Is there some where else I can look for this information?

[Maremma]

Not yet. There are nurse's that are fighting for safe and well defined ratios but you know how long it takes to move bureaucrats.

[amoLucia]

This is an issue that's been batted around for eons without any real resolution. And you're right about it being ill-defined. There's no real way to measure adequate staffing based on numbers only. It all depends on various factors.

Think about it ... say, some pretend rule said, '1 nurse to 5 patients'. The 5 pts could all be walkie-talkies, stable, uncomplicated, ready-to-be-discharged pts. Or the 5 pts could all be train-wrecks with lines and tubes going in or coming out of every orifice, natural or otherwise. Think about all the combinations possible based on unit - 5 ICU pts or 5 LTC pts or 5 babies or 5 hospice or 5 psych, etc. How do you measure 1 heavy care, 2 moderate cares, and 2 light cares? Acuities are difficult to define - 1 arrythmic pt with a drip who's stable to start but is now crashing?? Add in the wanderers, climbers and the fallers and the callbellers. The pretend rule was 1/X. Would it work?

It's just so variable. I doubt you'll ever find what you seek. As I said, this is an age-old issue around since the dinosaurs roamed.

[Aeterna, BSN, RN]

This is an issue that's been batted around for eons without any real resolution. And you're right about it being ill-defined. There's no real way to measure adequate staffing based on numbers only. It all depends on various factors.

Think about it ... say, some pretend rule said, '1 nurse to 5 patients'. The 5 pts could all be walkie-talkies, stable, uncomplicated, ready-to-be-discharged pts. Or the 5 pts could all be train-wrecks with lines and tubes going in or coming out of every orifice, natural or otherwise. Think about all the combinations possible based on unit - 5 ICU pts or 5 LTC pts or 5 babies or 5 hospice or 5 psych, etc. How do you measure 1 heavy care, 2 moderate cares, and 2 light cares? Acuities are difficult to define - 1 arrythmic pt with a drip who's stable to start but is now crashing?? Add in the wanderers, climbers and the fallers and the callbellers. The pretend rule was 1/X. Would it work?

It's just so variable. I doubt you'll ever find what you seek. As I said, this is an age-old issue around since the dinosaurs roamed.

Agreed. It depends on so many variables. Even trying to predict a patient's acuity can be difficult, because things can improve or go sour very quickly. For example, our usual patient load is 1:4, with a couple of nurses having 5, but we were working short an RN, so a few of us had to pick up a fifth patient. I had 5 patients today and it was very, very busy (our floor has been incredibly busy lately in general; as in, busier than usual!) but I was managing to get by, even if only just. But, things went incredibly bad in the afternoon and I completely drowned.

Or another example. Our usual night shift ratio is 1:6, with two nurses having 7. I was scheduled to work 3 nights in a row, and on the first night, I had 7 patients. However, they were all stable patients and most of them were walkie-talkies, which made things a lot easier for me. The second night, the charge nurse had a difficult time deciding who to give 7 patients to (we try to share the love, LOL) so I volunteered to keep my 7 patients, as long as they were the same ones. Even though I had an extra patient, I still managed to do very well and even helped out the other nurses with only 6 patients.

Then, there was the time I had only 3 patients (as a Christmas gift, our manager gave us an extra nurse over the Christmas holidays), but I ran my butt off the whole entire shift for 3 days straight (one man was getting blood products and high-sensitivity chemotherapy all day, every day; another woman was having seizures and then started acting very bizarrely with fluctuating LOC; and my third patient, by the third day, was having chest pains). I was grateful I didn't have a 4th patient because I'm pretty sure I wouldn't have been able to handle it!

So, it depends on so many factors. As amoLucia said, there's no real hard and fast rule.

[jadelpn, LPN, EMT-B]

If you are in a union, go to your rep and ask for an "unsafe staffing" document that you can fill out. Otherwise whatever safety issue documentation you have. This of course would be specific to when you feel that you did not have enough staff to adequately care for the patient load. Not that management will respond to it (and there's always hope that they will) however, documentation to inadequate staffing. I believe JAHCO has rules as well, but specific to them and their accredidation. (so I have "heard" but again, I would look and see if they actually Do have ratio suggestions). It not only stinks when one is overwhelmed, it is unsafe. And to bring it up to management as "patient safety" may (or may not) enlist a change. Unfortunetely, it will probably take a patient complaint to be heard more clearly. And that is beyond unfortunate.

[wooh, BSN, RN]

Management won't care about patient safety. If you want to complain about ratios, your best bet is to mention how bad it is for customer service. But still, management won't care. Bottom line is staffing costs money, and you'll just be told to manage your time better.