general question: WHAT IS A GOOD cna TO PT RATIO?

walkingon, CNA, LPN · Apr 28, 2007

I just got finished with my training program a couple of days ago. My instructor called to tell me about a job at a certain LTCF and said that their staffing ratios were "better than most" around here at 4 aides to 25 residents, which averages out to a little over 6 residents per aide. No idea about hospitals. Hope that helps a little bit! :chuckle

yousoldtheworld · Apr 28, 2007

At my LTC facility, we usually have between 12 and 16 residents per aide (depending on the hall), which, frankly, is too many to give proper and full care to.

pepperann35 · Apr 28, 2007

Here in Florida, we have 1 CNA to 4-6 residents during the day and eve. and 1 CNA to 10-20 residents at night. Its a LTC facility, pretty well staffed, I think.

chadash · Apr 28, 2007

Thanks for your replies!

jb2u, ASN, RN · Apr 28, 2007

In general, no matter where you are, more than 1cna:8pts. is too much. However, it depends on the acuity of the patients and how much the nurses expect you to do. If you have to do all basic care, v/s, ambulate in halls, oob to chair x 3, etc. then no more than 4 patients per cna would be appropriate. I've been the victim, along with my patients, to ridiculous ratios that did not allow me the proper time to take good care of my patients and had nurses that did not want to touch the patient. I've also had great experiences with some outstanding nurses that understood the amount of work I had and would clean a patient if they walked into the room to do wound care anyway. I've also had nurses call me to the room and stand there watching as I cleaned the patient so that they could do wound care. I've seen nurses looking all over for the cna when THEIR patient asked for a bed pan instead of just taking care of it themselves. So, my point is, it depends on what the nurses expect for the cna's to do and how acute the patients are. There is no such thing as a patient to cna ratio because we are there to assist the NURSES not the patients. By helping the nurses, we help the patient. But, the reason that we are bathing/changing the patient(which is part of every nurses job) is so that the nurse can get his/her job done and do the things that require a license. That is one reason why I hate when cna's talk back to the nurses. The nurse is our boss. We are there to do whatever we can, without going outside our scope of practice, to make their day more manageable. That is why the position of the cna was created. We are very important, but we should not forget our role.

Sincerely,

Jay

aerorunner80, ADN, BSN, MSN, APRN · Apr 28, 2007

This is very helpful. How bout hospitals?
I was asking because I had 22 ortho patients Thurs. I did all the vitals etc. and documenting, with an agency aide to help with baths ( that was all she was allowed to do but she was great). I did only seven baths, pretty much totals, so thank God she was there! Good portion of the pts were q4s with foleys and polar cares. Ortho pts are hard to move, post surgically, in pain, and need assistance with every thing, though I had no feeders. 3 patients were on contact precautions, one droplet. I must document twice, on the door and in the computer. I do blood sugars and all Is and Os and answer call bells.
most weekends and at least one weekday I am the only nursing assistant, with 14-16 patients. We do have incontinent patients and those who need turning every 2. The days I have another aide, I can have as low as 7-10, but that is rare, and that is heavenly!
I love the days I have eight patients, I can give them great care, and they are never without ice in there pitchers and polar cares, they are turned, powdered and shining.
Is this typical?

Sounds about right. I work IMC and ICU and the whole floor is split with just two NT"s (same thing as an aide) so, depending on how full we are in IMC, I will have 11 pts (22beds) and of course on the worst days I'll have 22. It's not as bad as it really sounds though because the pt to RN ratios are so low, the RN's are great at helping us out with bedbaths, vitals, and other things that it really makes it more bearable for everyone. In IMC some of them are mobile which really helps when it comes to showers/baths and even linen changes (linen is changed daily) and some are total assist. I'm not so sure how ICU is because I haven't been oriented to that unit yet but for IMC, that's a normal day.

chadash · Apr 28, 2007

Well, the nurses are wonderful but way to busy to help with anything. So if I can not do it on a heavy day, it is not done.

arpeggiated · Apr 29, 2007

On my med/surg floor, we can have up to 14 patients. Of course, this doesn't take into consideration acuity at all. The charge nurse just draws the line and if you have self-cares, great, if you have total cares, you're in for a long night.

Lately they've been trying to have 3 cna's at night, which brings it to 2 aides having 9 and 1 having 10 pts. This still feels like too much. Last night for some strange reason, we had 4 cna's. I had 7 pts, but I was still running my ass off (3 post-op and 1 incontinent)

I would say that on a med/surg floor, definately no more than 8. Especially if there's ortho pts, or incontinent pts.

And, it all depends on how helpful your nurses are as well. When you have 14 patients going up and down the hall and 3 of your nurses want you to sit outside pt's rooms and watch on top of your post-ops and incontinent pts and all the vitals, hs cares, i/o's, etc, it's just impossible and overwhelming.

chadash · Apr 29, 2007

On my med/surg floor, we can have up to 14 patients. Of course, this doesn't take into consideration acuity at all. The charge nurse just draws the line and if you have self-cares, great, if you have total cares, you're in for a long night.
Lately they've been trying to have 3 cna's at night, which brings it to 2 aides having 9 and 1 having 10 pts. This still feels like too much. Last night for some strange reason, we had 4 cna's. I had 7 pts, but I was still running my ass off (3 post-op and 1 incontinent)
I would say that on a med/surg floor, definately no more than 8. Especially if there's ortho pts, or incontinent pts.
And, it all depends on how helpful your nurses are as well. When you have 14 patients going up and down the hall and 3 of your nurses want you to sit outside pt's rooms and watch on to,p of your post-ops and incontinent pts and all the vitals, hs cares, i/o's, etc, it's just impossible and overwhelming.

This is an ortho department, (with over flow from med surg, most of them on precautions, a number of them incontinent.) This is first shift (0645 to 1515), and I have often been alone with 14-17. The last time was 21 or 22. On this occasion, all that saved me was an agency aide who did some baths, so I was not really alone, but she could not do vital signs, post ops, blood sugars, documentation of even Is and Os. I also did baths.

The nurses are so so overwhelmed themselves.

arpeggiated · Apr 29, 2007

I work at a >60 bed hospital. We have 3 units: DOU, which is supposed to be tele but is just regular med/surg, is 12 beds; unit 100, is usually kept for mostly surgical pts, is 14 beds, and West Wing, my unit is everything thrown together, and is 28 beds. We also have a 10 bed ICU that takes everything.

Daniella83 · Apr 29, 2007

Was wondering what would make a good ratio for NA to patient in certain settings:
LTC
Hospitals: Med surg
telemetry
orthopedics
ICU
Thanks!

I work in LTC, sorta like a dementia unit but they can't call it that because it isn't a locked ward. On 1st and 2nd shift we usually work with either 5 or 6 CNA's (there have been times we've worked with 4 because of call outs) and there are about 60 residents on the floor. Out of those 60 residents, we each have about 8-9 complete cares to take care of and maybe 1 or 2 assists. Everyone has their different ways of how they do "complete care". My idea of complete care is washing from head to toe at bed time, mouth care, transferring into bed-the ones that get out of bed, and then changing every 2 hours (repositioning) when incontinent (which most complete cares are). We have some residents with foleys and some with colostomys also. The people that with call assists basically just need help assisting with care. THey pretty much walk with their walkers, they wash themselves, get themselves dressed we just got to help them. On 3rd shift, we work with 3 cna's and we pretty much take hallways. We do rounds every 2 hours and they wear over night disposable briefs and we change them every 2-3 hours when their wet/soiled-same thing, reposition the ones that need it. In the morning we each get up about 3 people, because breakfast on my floor comes up at 7:10, so everyone needs to get up.