Mandated Nurse-Patient Ratios - page 8

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   liz0105
    I have worked in the ICU at large teaching hospitals both in New York City and California. The difference in patient ratios blew my mind when I arrived in CA nearly two years ago.

    Back in NY, if we had empty beds, we admitted patients regardless of our staffing situation - the ICU attending would just shrug and say, 'The nurses will deal with it'. One day, I found myself with FOUR patients, two of which on vents, the other two fresh mastectomy DIEPs with hourly flap checks and unrelenting nausea. Took one break and ate my lunch standing up in 15 minutes.

    That night, I applied for my RN license in CA.

    In CA, we do not admit into empty beds without appropriate coverage. My first break is 30 min, and our second break is 45min-1hr, depending on how 'hot' your ICU looks that day - and we ALWAYS get breaks. Ratios in the ICU are either 1RN:1 pt or 1RN:2pt, sometimes even 2RN:1pt (ECMO, Rotaprone).

    I cannot STRESS how much more supported and how much happier I am as a nurse in California. I understand that some CA nurses have their issues with their respective institutions, just speaking from my personal experience...
  2. by   Nurse Beth
    Quote from liz0105
    I have worked in the ICU at large teaching hospitals both in New York City and California. The difference in patient ratios blew my mind when I arrived in CA nearly two years ago.

    Back in NY, if we had empty beds, we admitted patients regardless of our staffing situation - the ICU attending would just shrug and say, 'The nurses will deal with it'. One day, I found myself with FOUR patients, two of which on vents, the other two fresh mastectomy DIEPs with hourly flap checks and unrelenting nausea. Took one break and ate my lunch standing up in 15 minutes.

    That night, I applied for my RN license in CA.

    In CA, we do not admit into empty beds without appropriate coverage. My first break is 30 min, and our second break is 45min-1hr, depending on how 'hot' your ICU looks that day - and we ALWAYS get breaks. Ratios in the ICU are either 1RN:1 pt or 1RN:2pt, sometimes even 2RN:1pt (ECMO, Rotaprone).

    I cannot STRESS how much more supported and how much happier I am as a nurse in California. I understand that some CA nurses have their issues with their respective institutions, just speaking from my personal experience...
    Yes!! This.
  3. by   unknownjulie
    Thanks for the repost and let's keep this at the top of the pile. It's a good reminder.
  4. by   Jessy_RN
    Yes it is. Can only keep wishing this would finally happen and not just be a conversation ya nurses keep having.
  5. by   Devnation
    As a new RN, I worked in a level I trauma ED in the inner city. On one particularly hellish shift, We were short-staffed and every other nearby ED was on diversion if not closed. I had a trauma, a code, a hot appy needing urgent OR, and a complicated fracture, among my TEN patients. Yep, I said ten patients. When I asked the charge nurse for help, she moved both of vented patients into the same room. Thanks a lot!

    I look back on this now and think about how absolutely insane that was. I would never want my loved ones to be cared for by a nurse with that sort of assignment, especially a new nurse. At the time, I was just absurdly grateful to have an ED/trauma job, but I cried many a day after work. And I am not a crier.

    A fellow newbie and I both commiserated about how we both wished we had been hit by a bus so we would not have had to come to work. Although, since we would have been trauma patients, they probably would have just rolled us into the facility and put us to work!
    Last edit by Devnation on Jan 26 : Reason: Clarity
  6. by   Sunshine.nurse
    Quote from smartassmommy
    If the "Medicaid doesn't pay enough for resident care but we can afford lobbyists " ltc industry can be beaten.
    I disagree with you on this. LTC and sub acute nurse patient ratios need to be focused on now. Having up to 40 to 1 ratios in Florida is dangerous for the patients. Placing LTC as a lesser priority shows, at least to me, the mindset that our geriatrics populations as less worthy of immediate action. And I just feel that maybe, just maybe, that by working on LTC's nurse patient ratios to a safe level, the return to hospital percentages would come down because LTC nurses would have time to actually do their other nursing duties like HT assessments instead of passing pills for 8 hours.
  7. by   Nursemom367
    I work in a LTC facility, night shift, I myself am responsible for 45-50 residents of varying capacities. Alzheimer's, Dementia with behavioral disturbances, physically challenged with their minds intact, are just a few I take care of. I have 2 aids that is all. We work 12 hour shifts with no time for lunch breaks or 15 minute breaks. It's corporates call on staffing and they are in another state but tell us how many nurses we need on a shift. On a regular night there may be 2 FT nurses and one PT nurse on duty and 4 aids to take care of 100 residents. This is ridiculous! Everyone is so burnt out. We all know that resident care is no where near what it should be. I feel guilty that I cant give the care that I know my residents need and deserve. We go in a rush all night just to get things done. I really hope these Bills pass; for the residents sake and ours.
  8. by   LovegelatoRN
    And hire break relief RNs! We are never assigned more than 5 patients on my unit, but everyone gets 5, and charge always has a full assignment. I always take my lunch break no matter what, but sometimes it's not until 200 PM.

    If hospitals hired break relief nurses (these nurses would need to be there by 900 am and not leave until 5 p, and same for night shift), nurses and CNAs could actually get a morning and afternoon snack or light dinner during their 12 hours. Regular staff could rotate through being able to do that and be a resource (not new grads though)...because everyone wants to work 900 to 5....which keeps it fair.
    I never thought I would go into nursing leadership, but when my children are older, I probably will because I want to fight for these kinds of conditions...and you can't argue with money. That's way cheaper than hiring agency nurse upon agency nurse and paying PRN rates for all of the burnt out full timers who "go PRN".

    The main part is...hiring the right break relief nurses that actually change patients, pass meds for others, greet the new admit and ensure they are stable, print discharge paperwork, etc...if it's somebody who just sits at the desk, that's not helpful.

    It seems crazy to me that I am thankful I don't have 7 patients....as that should never happen in an acute hospital. I have ICU transfers, heparin drips, total cares, new strokes, etc...5 is plenty...and really, 4 should be the max on telemetry as she mentioned.
  9. by   scout mom
    When I first started nursing, I worked med-surg & we were so short staffed that I would sometimes have 4-5 patients on nights while was I still on orientation as a brand new nurse. Our average load was 8-9 patients on night shifts with some nights having as many as 10 or 11. Our PCT's would usually have up to 15 patients. If they had the same load as the RN, it was a good night.

    I transferred to ICU after a couple of years, which I liked a lot better, but staffing was still an issue. I worked in a smallish hospital with an 8 bed ICU and usually 3 primary shift RN's. A RN was on medical leave while I was on orientation and I was working as the 3rd RN on weekends. When I went on nights, we were short staffed a RN and for quite a few Saturday nights, there was only 1 other RN and myself for the whole unit. I remember one particular night, we had 8 patients, 4 of which were vents. No clerk, no tech. RT was wonderful and would help us turn patients, etc...

    They did increase staffing to 4 RN's a shift, but they also added another bed. Still no tech and no clerk for evenings or nights.
  10. by   Tiffilynn1
    1. Review, discussion and action regarding a decision to support, oppose or remain neutralregarding Senate Bill 361, making various changes relating to health care facilities that employnurses: The Board reviewed Senate Bill 361 regarding staffing in facilities that employ nurses.This bill provides numeric nurse/CNA to patient ratios. The Board discussed the pros and consof requiring specific staffing ratios. In addition, the Board clarified that no research hasestablished that numeric staffing ratios actually improve patient safety. It was moved andseconded the Board remain neutral should D. Scott be asked for testimony regarding SenateBill 361. MOTION CARRIED.




    Copied from Nevada State Board of Nursing (available online).
  11. by   Tiffilynn1
    Our nv state board made this decLaration to remain "neutral" regarding mandated ratios. I was surprised to read the portion that states evidence doesn't show staffing ratios increase safety. What??? See copy/paste portion below. WOW!

    Review, discussion and action regarding a decision to support, oppose or remain neutral regarding Senate Bill 361, making various changes relating to health care facilities that employ nurses: The Board reviewed Senate Bill 361 regarding staffing in facilities that employ nurses. This bill provides numeric nurse/CNA to patient ratios. The Board discussed the pros and cons of requiring specific staffing ratios. In addition, the Board clarified that no research has established that numeric staffing ratios actually improve patient safety. It was moved and seconded the Board remain neutral should D. Scott be asked for testimony regarding Senate Bill 361. MOTION CARRIED.
  12. by   Nicole.Amina
    I recently transferred off the med/surg unt in my hospital because it was just getting ridiculous. They were giving nurses assignments of 10-11 patients because we're so short staffed. They've been working with 2 CNAs on the unit for months. Since last April, about 20 nurses have left that unit. I wish I was exaggerating with that number. The new nurses aren't staying long enough to make it off of probation. But how do you expect a new grad in their first nursing job to provide safe nursing care to 10 patients? To say the least, we're burnt out.
  13. by   Nurse Beth
    Quote from ROSE BSN
    Staffing ratios are a must., but it must include other areas such as long term care. I would like to hear what everyone's opinion is for appropriate ratios for long term care, assisted living, and rehabilitation,
    S 1063 and Hr 2392 include a 1:5 ratio for skilled nursing

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