pt to nurse ratio - page 3

What is the patient to nurse ratio where you work? What shift do you work and what area of nursing are you employed in? :) :) :) :) :) Michelle... Read More

  1. by   Uptoherern
    we used to have to do acuity levels on our patients, and have them done by 2300 so the charge could call the numbers in to staffing. The stupid thing was, they never staffed by acuity anyway, so it was just more work to do. patients were given numbers for how much you had to do. an acuity of 70 points would equal an 80 yr old confused post-op TKR with foley, iv, O2, get the picture. It would be nice if we could be staffed by acuity. On the med-surg floor where I used to work, days and evenings had 5 max on your own, or up to 8 max on a "team"...which is yourself plus your own cna. OK if you have a good cna...really crappy if you get a cna that can not be found. (I have found them in empty rooms with the door closed, watching tv and talking on the phone, while lying in the bed!

    I don't know why administration likes to staff nights so awful. they would get 9 - 10 patients apiece and if lucky, would get a cna. Our hospital has recently been sold (again). and new ceo is cutting every penny he can find. charge on tele floor has had to be secretary, monitor tech AND take patients!!! rns are quitting, and i don't blame them in the least. I quit floor nursing 2 yrs ago and now work in er.
  2. by   melodebbz
    Our nurse/patient ratio is 1-8 on day shift, 1-10 on pm shift and 1-10 on midnight shift!! This is a telemetry unit! We have 30 beds and 22 cardiac monitors.
  3. by   ohlpn
    There seems to be a huge lack of concern for staff/patient ratio in the ltc setting. People are dying needlessly out of neglect.

    I work 11p to 7a in LTC and we routinely work with 2 LPN's & an
    RN in this 150 bed facility. There are usually 6 to 12 STNA's on this shift; more often the lower number!
    Anyone who has not worked LTC may not be aware how busy it gets in a nursing home on this shift. We have our wanderers, our screamers, our sundowners & those little 98 year old dears who have forgotten they can't walk anymore, & get up to go to the toilet unassisted.
    I'm not so sure we have many residents who needlessly die because of staff to patient ratio's, but I know all of us on all shifts work our fannies off to make sure they don't needlessly die. All the recent financial cutbacks assure us that things will probably not improve anytime soon. Nance
  4. by   nurs4kids
    My co-workers and I just kick ourselves when we read this thread. We fuss about poor pay (which is average for this area)and we fuss about things the hospital does/doesn't do...BUT

    post surgical peds..

    20 bed unit (we stay full most of the time)

    Days 5-6 RN's, plus charge nurse who takes no patients
    1 CA

    (days has a huge patient turn-over, so not as wonderful as it sounds...but still not bad)

    Nights 4-5 RN's, charge takes patients
    1 CA until MN

    so, max ratio is 5:1 and that's rare. I HAVE done 7:1..was a few years back and was just one of those "whaddahell nights" when several call in.
  5. by   3651bht
    Go to dialysis ... Three patients in the morning and three in the afternoon. No nights, no Sundays, no major holidays.. ie T-Day and Christmas ,,,,,,

    bobbi ( I'm everywhere)

    May the sun shine brightly on you, in peace, and may the wind be always at your back or something like that......
  6. by   mjamesRN
    On the average I have 9-10 patients with at least 5 directs. I feel sorry for my LPNs. They work their butts off, but if I'm not watching I can see some slacking going on. I don't blame them though, yet I realize that their bad habits just make more work for me in having to reassess areas that are skimmmed over due to the workload and the panic. Staffing is ridiculous. My hospital doesn't staff on acuity at all but on mere numbers, and our orthopedic unit is a "dumping ground" for admissions so even if we've got empty beds, we're definitely going to fill up with ER admits, and our staffing doesn't change unless we all start melting down. The holidays were horrific because there was no supplemental staff to jump in. It's very discouraging.
    I only graduated in May and that seems like 100 years ago. When I have real issues going on, the "support" I get always has a tag with it that my license is on the line. I don't like having my license dogged like that when the problem isn't my fault. Like a warrior however, I go back in even though I want to call out and of course, I quiver thinking about what I could have left undone that may cause problems for the next-shift nurses and more importantly, my patients.
    I'm also sick of the rest of the so-called colloborative team leaving simple duties up to me like phoning in radiology orders and drawing blood, or even changing med times on preop antibiotics. These problems are actually and ironically giving me the confidence to reconsider my vocation and do something else.
    The "Art" of Nursing is doomed in the shadow of bureaucratic healthcare.
  7. by   Jenny P
    I work ICU and we have either 1:1 or 1:2, never more than that, but we may have 2:1 if the patient is very sick. Our assignments are strickly according to acuity here where I work.
    I really think that hospitals (and LTC's) need to staff according to acuity levels instead of nurse-patient ratios. If the patients are walking, talking, and independant; that's one thing (and who sees those pts. anymore? They aren't in any hospital or facility I know of!); but if the patients are bedridden and dependant; you will have your hands full with even 4 patients.
    I am amazed that so many of you work in such unsafe conditions! Having more than 10 patients is so scarey! I would be afraid of losing my license every shift I work with ratios like that.
    Those of you in LTC have just convinced me that I probably will not be moving on to LTC when I can no longer do ICU. I guess it is a fantasy that I can find a place like the nursing home I started out in; where every patient was thought of almost as family and treated as respected and loved community elders. Dang! It was such a neat place to work back then.
  8. by   RN-PA
    At our hospital, the nurse to patient ratio is often 1:11 on nights. There are usually a number of LPN's, too, so the RN is sometimes responsible for 22 patients! (We are a 65 bed med-surg unit with everything from ortho to peds to renal to resp to chemo to post-op, etc. etc. and it's divided into 3 teams.)

    The night shift nurses are bailing left and right to other floors and units. They hire Agency nurses from time to time to help staff and have been offering $2000 bonuses to get RN's to rotate to nights for a month at a time. But the regular night shift staff are all burnt out and angry at the amount of patients they have to take. The latest burden our new manager has added is that all night shift nurses need to be chemo. AND peds. certified. That is also in the job descriptions for all the open positions on nights.

    As a 3-11 nurse, I try to do as much as possible for the nurses before I leave because I feel so sorry for them... Our manager treats the situation as if she's got a horde of nurses waiting in the wings, ready to take the night shift nurses' places when they get fed up enough to finally leave.

    Day shift ratios are 1:4-5, and evening shift is 1:5-6. Day shift may have 5-6 PCT's and we usually only have 3 PCT's, one to a team and I'm always pushing for more nurse's aides. I'd be willing to take 7 patients on evenings if there were 2 PCT's to help the team. The evenings we've had even a 4th to float the floor has been some help.

    I think we generally have it better than many hospitals, however, from what I've been reading on various threads here. We have 1-2 unit clerks on evenings, there's an IV team and Respiratory therapists to do treatments, and phlebotomists. At a hospital where I worked 4 years ago, evening shift on med-surg meant 5-7 patients, start IV's, some resp. treatments, and NO nurse's aids. I rarely did P.M. care-- just tried to keep my head above water.
  9. by   amyBSN
    I work on an orthopedic floor 7a-7p shift and we usually start with a team of 5-6 patients, and with that team of patients we are paired with a CNA who does baths, bedmaking, passes meal trays, blood draws, vital signs, etc.
  10. by   mjamesRN
    So much of this is ludicrous. Despite how much of a turn over my hospital does, staffing in concordance with a shortage or non-shortage is unlikely to change when it's all about money. In other words, there could be 25 extra nurses waiting in the wings, but when we're at the established "staffing number", extra nurses are pulled to other units, float the house, or are on mandatory call off.

    We're staffed on numbers, not acuity. For a 30 bed unit, optimum staffing is 4 RNs, 2 LPNs and 2 Techs. This is a rare event mind you. 7:1 isn't bad, but when you're hustling with preops, post ops and discharges (especially postops), there is seldom enough hands to go around for transfers, etc.

    Another factor that is never considered is geri-psyche. Sundowners and post op morphine coo-coos cannot be constantly watched. Those oldies are tireless in climbing out of bed, pulling out lines, etc., and often restraints don't hold down the houdinis among them.

    If your Techs are lazy, you're really screwed.

    It's a no-win situation.
  11. by   babs_rn
    I'm an agency nurse in the ICU/CCU of a facility where I was employed a long time ago and swore I would never be an employee of again...

    ICU/CCU : One nurse - 1,2,or 3 patients. If working short, might have 4 if we get an admit. Keep in mind though, we do also get overflows and we more often than not have to quickly move patients out to the floor and get a stat clean on the room in order to get new patients in so you might be admitting 2-3 (per nurse) in a night, meaning you're actually caring for 5-6 patients in the unit (though not all at one time) by the time all is said and done. Not really that uncommon to do that.

    On the floor in the same facility: the heaviest, sickest 35-bed floor right outside the ICU doors - days, 1:8 with 3 techs on the floor. Nights, 1:10 with 2 techs on the floor. Charge nurse doesn't take patients on days but does on nights. I used to work this 13 years ago and quit - they had a policy that if any nurse on the floor got written up for any reason, the charge nurse (me) got written up with her. Hey, I had 10 patients of my own too! One night we had call-ins and so it was just me and a float nurse from ICU and we had 34 patients, admitted one through the night which filled up the floor. Sheesh!!

    On the med-surg/peds floor, they usually have 2 nurses for up to 18 patients with a tech on days but none on nights.

    I work post partum/nursery. When I'm on the floor, I can expect 3-4 mother/baby "couplets". (Translates to 6-8 patients). When I'm in the nursery, I can expect that myself and another RN will be in charge of 20-45 newborns (depending on census). At the higher end, we sometimes get a third person.

  13. by   Bermuda
    Tele floor the 7a-7p shift is usually 4-5 for initial assignment but could end up with 7 by the end of your shift...transfers from the unit and new admits.... never know...but charge nurse is very good and watches out for her staff.....CVICU 1:1 for fresh CABG and if >24hrs/stable then 1:2.. a 12 bed PCA all RN's. Of course we all have bad days and good days....that is nursing...isn't it?:kiss