Mandated Nurse-Patient Ratios - page 6

Ashley sank into a chair in the breakroom on her MedSurg unit in a large hospital in Florida. It was 0330, 8 ½ hours into her shift. She had not yet taken a break of any sort, including a bathroom or... Read More

  1. by   sweet sunshine
    Quote from PurpleMyst
    Hi everyone, I have not posted in a while but since I received my BSN I've been working on a very busy medical/surgical/oncology floor(Magnet hospital). It took quite a few months to get used to taking care of as many as 6 patients and sometimes more because of discharges and admissions. I'm stubborn and outspoken and I complain a lot about being overloaded at work and so do many others, but nothing much changes and newly hired nurses just keep leaving. We lost a large number of nurses after my first year on that floor because of the overload and management issues on my particular floor.
    Lately it seems that they just keep adding more stuff for us to do, like redundant additional documentation that is not for the patient record. I questioned the extra documentation and made a suggestion that we use our resources to make it easier but no one cared. I do love taking care of my patients but I feel like I can't give quality care, only just enough to keep them safe, and even that is debatable.
    Since all these facilities are so obsessed with patient surveys on the quality of their care, why not make it mandatory for each facility to publicly, and in a visible area of each unit, post a daily nurse to patient ratio sheet?
    These healthcare facilities are constantly emphasizing patient safety and education so why not educate the patient and/or family on how many patients each nurse has to take care of for that shift?
    Many patients do ask me how many patients I have and I just tell them, but management doesn't even want us to tell them that we were busy with another patient and it's why we were delayed in answering their call.
    Right!!! Imagine if that was one of the questions on the survey? Were you aware of how many patients your nurse had? Lol
  2. by   LadysSolo
    No, you are never supposed to be busy with another patient, you are supposed to make your patients think you have all the time in the world for just them. Some of my nursing homes that I go to DO post the number of nurses and STNAs on per shift. I think that's a good idea.
  3. by   DF-LPN
    The 1:4 or 1:5 really doesn't matter because they find ways around it. I worked for a facility that literally broke it down to seconds. It was nothing to go into work and there would only be 2 nurses and 3 cena's for about 115 residents, I had 4 hallways. I would have to count up our hrs, 8 for nurse, 7.5 for cena, take that sum and check the chart for how many hrs need to be covered for a particular number of res. Subtract to see how many hrs needed to be covered. But don't forget the 4 floor nurses that start at 06:30, that's another 2 hrs. Well lookie there I'm only short a 1/2 hr, so I would/could only mandate a cena to stay 30 my least busiest time of the shift! Bottom care is a business, and like any business, it's there to make money.
  4. by   DC Collins
    If nurses support this kind of legislation, it MUST include the ED.

    People ask how this can be done if an emergency comes in, especially when the worst emergencies sometimes involve more than one nurse:

    1) Enough float nurses to cover the emergencies (and breaks, to include the 15 minute breaks, while we are at it - no more "buddy breaks", which would then violate any such ratios).

    2) Eliminate "Pull Till Full" protocols where every room is filled regardless of staff availability. When an ED RN is tied up in an emergency, no more of that nurse's rooms are filled with non-emergent patients until that emergency is cleared.

    2A) What if another emergency presents itself in the waiting room and that nurse's room is the only open room? See #1

    3) Have a Triage RN at All Times. If there are no patients in the waiting room, the triage RN can help with tasks (clean rooms, medicate existing nurses' patients, etc.) until another pt shows up.

    4) Have an "Ambulance Triage Nurse" (Whether that be the Charge Nurse, one of the floats, etc.) Just because a patient comes in by ambulance does not mean they cannot wait in the Waiting Room right along with all the other pts. Many times pts come to the ED via ambulance just to avoid the waiting room, and there are patients in the waiting room who are sicker than the ambulance patient.

    These are just a few changes which can and should be made. I am sure others who have more.
  5. by   LibraNurse27
    Keep up the fight! Even here in CA facilities have been resistant to change. As mentioned above my hospital went to the total care model so CNAs are only used as 1:1 sitters and although Med/Surg nurses have "only" 5 patients each we often have no charge, no break nurse and patients that belong in ICU as they have made the criteria for transfer more strict. We have to continue fighting on a national level as well as a local level and within our individual facilities. I personally could NOT handle the stress and the ratios of long term care and I have a huge respect for those that work in this specialty.
  6. by   Here.I.Stand
    Quote from Nurse Beth
    The nurse-patient ratios in LTC are abominable. Where is the soul? I believe mandating acute care ratios is a start, and LTC will follow.
    Why not push for both concurrently? Am I missing something?
  7. by   JBMmom
    On our med-surg unit I have 7-8 on nights. They're talking about going to 3 PCTs for our unit (30 beds), but giving us one more nurse. So we'll have 5-6 patients, but only a partial PCT- currently we're assigned one nurse and PCT to our assignment. I don't think that will help much, as I am not very efficient at the PCT related activities and it will probably end up taking me longer- ugh. There are nights were 8 seems really unsafe to me. Our days and evenings cap at six, which I think is still too much.
  8. by   Elaine M
    While I have thought about taking an ED or med-surg job so I can understand more about my elderly mother's care when hospitalized, I look at these posts and realize I can't and won't do it. I'm looking for a NICU job again, where the patient-nurse ratios are reasonable and doable. Even the busiest days in a level 2 or 3 NICU don't seem as bad as med-surg.
  9. by   ICUman
    Quote from Elaine M
    I'm looking for a NICU job again, where the patient-nurse ratios are reasonable and doable. Even the busiest days in a level 2 or 3 NICU don't seem as bad as med-surg.
    Definitely so. NICU nurses have it good.
  10. by   RainMom
    My faciliity recently started working with a consultant. Ever since the first of the year in OR, our managers have been pushing us to send people home early every day. In PACU, the managers waltz thru repeatedly to see if we're busy. Sure, we may have 3 nurses sitting here, but there are multiple surgeries in process & we can't send people home to leave nurses taking multiple pts simultaneously. It doesn't work that way in our dept with 1:1 occasionally 1:2. OR staff has said it is the same for them with the charge told to send people home ASAP during the day.

    The ratio changed for our pre-op dept & the manager is included in the numbers. How the heck does that help? Only on an absolute day from hell does she come in & help out with clerical things. It was hinted at that they are looking at moving towards pre-op nurses prepping 2 pts at a time. While that may not sound crazy if you don't work this dept, taking a pt off the street & getting them completely prepared in 90 minutes (or less) can be a race against time, especially if a nerve block will be done, nevermind difficult IVs, missing paperwork, drawing labs, EKGs, pre-op breathing tx, & educating the pt/family regarding the surgical process & post-op expectations.

    We also have been informed that we will be crosstraining to another dept to do procedural sedation (& take call). Volunteers first; otherwise, we will be assigned.

    I've also heard rumors that the floors have been changed to a 1:6 ratio for days.

    I forsee a mass exodus soon.
  11. by   mjhamm917
    I always see many ratio ideas/ recommendations, but I never see anything about HH or hospice Nurse: patient ratios. These need to be added too
  12. by   kaylee.
    The CA ratio law clearly defines tele and Stepdown: tele is stable cardiac pts (1:4). SDU is those in between icu and med/surg. They are unstable often and stable to unstable - requiring 3:1 ratio.

    I work in CA on a very busy "telemetry" floor. This hospital has no "step-down" officially: just icu, tele, and med/surg units.

    Does that mean we have no "step-down" patients? DEFINITELY NOT! Where are they housed? Telemetry.

    My floor retains the title "Tele" so its abiding by a 1:4 ratio but with very heavy "stepdown" pts with tele pts sprinkled in.

    So here its a fixed ratio where the acuity definitions are vague so the hospital is skirting around the legal expectations.

    Everyone feels the stress and burnout is palpable right now.
    Last edit by kaylee. on Jan 15
  13. by   SobreRN
    We had an ally as governor with Gray Davis. The hospitals (and republicans) delayed implementation by years and years.