Hello From The Bluegrass - What Is A Safe Ratio For Nurses In The Hemodialysis Unit?

Hello and Welcome! :)

I hope you find the information that you seek. I'm moving this thread to a forum which might better answer your questions.

Good luck! :)

Ted

We have a ratio of 1 nurse to 5 patients in chronic dialysis and 1 nurse to 2 patients in acute dialysis.

We don't have techs though like in the US, so there's just the nurse.

I have 6 years as an LVn in dialysis

my answer is

during changeover

4-1 for techs

3-1 for lvns due to the added responsiblites of caths and meds for the techs.

8-1 during cruisetime for staff breaks

RN charge no more than 15 alone

30 with a non charge RN backup

thats about right and everyone has time to double check the work so no one crashes...one lawsuit r/t crash will eat up the profits of exceeding these numbers..imho

also the RN needs an ICU background...things can get very hairy when you shift electrolytes and take 5 kilos at the same time...but still its amazing how many problems arefixed by a 500cc slow bolus of 0.9NS and putting the pt in Tberg

and

icu acutes 1-1

inpatient

3-1 with 2 nurses present at all times

or 2-1 but that situation always scared me

there are no rules about double crashing while in the hospital

it can and does happen...

5-1

o my god

yall never quit moving at top speed do you.

idoes that include a changeover

5-1 am and takeoff and 5 more on

wow....

I have 6 years as an LVn in dialysis

my answer is

during changeover

4-1 for techs

3-1 for lvns due to the added responsiblites of caths and meds for the techs.

8-1 during cruisetime for staff breaks

RN charge no more than 15 alone

30 with a non charge RN backup

thats about right and everyone has time to double check the work so no one crashes...one lawsuit r/t crash will eat up the profits of exceeding these numbers..imho

also the RN needs an ICU background...things can get very hairy when you shift electrolytes and take 5 kilos at the same time...but still its amazing how many problems arefixed by a 500cc slow bolus of 0.9NS and putting the pt in Tberg

I'm not sure where you work but I've never done a single day in the ICU..Don't get me wrong ICU nurses are great at what they do.. 1 or 2 patients not a room full..They are intimidated by that many people. I've worked in 38 station units.

I worked in a unit in NC with 20 stations and most of the time I was the only licensed person in the building. I presently work in a 24 station unit many days as the only RN in the building..

Many states have ratios for techs MD 1:3, DE 1:4 PA 1:5.. The problems arise when techs are limited to what they can do.. In MS they can't cannulate.. OMG to think I would have to do all cath care, cannulate, and do meds.. Now that's over the top..

The way to get staffing ratios, such as CT has, in dialysis is to work with and petition the BON in that state..

The other way is to vote with your feet.

Yes it includes a change over.It's non stop and they have difficulty retaining staff. We do have a couple of D.A.s (dialysis assistants) but they don't put patients on or off or do observations. They mainly help strip the machines and re-line. They also help make up the beds etc. The nurse puts the patients on, takes them off, does the meds, bloods etc herself.We don't have techs or LVNs. The DA's have no qualifications in nursing.Our unit has 42 stations but it is split into 2 sides with 12 stations on one side and 10 on the other.

I have never worked in ICU either. Although in acutes we have to go to ICU to dialyse patients who need haemo, unless the patient is on CVVH, in that case the ICU staff do it themselves.

What do all the abbreviations stand for? LVN/DE/PA?

Yes it includes a change over.It's non stop and they have difficulty retaining staff. We do have a couple of D.A.s (dialysis assistants) but they don't put patients on or off or do observations. They mainly help strip the machines and re-line. They also help make up the beds etc. The nurse puts the patients on, takes them off, does the meds, bloods etc herself.We don't have techs or LVNs. The DA's have no qualifications in nursing.Our unit has 42 stations but it is split into 2 sides with 12 stations on one side and 10 on the other.

I have never worked in ICU either. Although in acutes we have to go to ICU to dialyse patients who need haemo, unless the patient is on CVVH, in that case the ICU staff do it themselves.

What do all the abbreviations stand for? LVN/DE/PA?

LVN Licensed Vocational Nurse. Two states in the USA use that designation. California and Texas.. All the other states use LPN Licensed Practical Nurse

They are nurses just below RN's ..Most are very knowledgable, hard working nurses. I was an LPN for 17 years.

DE is Delaware a small state in the USA on the east coast and PA is Pennsylvania..

Sorry have to remember the net reaches far and wide...

Where I work it is one staffmember (be it RN, LPN, Tech/ PCT.. regardless) to four patients. We have three sides.. (twelve stations) so each side has four patients. We have a nurse or tech for each side. There has to be an RN in the building at all times. She, too, has a side (four patients) just as do the others.

As does the charge nurse. If I'm charge, I have my four patients, and two other staffmembers to cover the other two sides, four patients each.

We have one extra staffmember in charge of "water" for the day as well. This could be one of the nurses (yes, even the charge nurse) or a tech.. we rotate. That person does all the mixing of the bicarb, fills and trades out the jugs, does the water checks, stocks, does the water cultures and LALS, etc., and helps out on the floor during changeover.. to help strip and set up machines, etc. He/she obviously doesn't do them all.. but helps wherever needed most during this chaotic time.

Our techs do catheters (after six month training/orientation), but do not do the assessments.

I still say NO dialysis staffmember should have more than three patients apiece.

Thanks for the explanation regarding abbreviations. It sounds as though LVNs are similar to our enrolled nurses. Enrolled nurses here too are very hardworking and knowledgeable. Some more so than many RNs I know.

When I was completing my nurse training I learnt a lot from ENs who were doing their conversion courses.On many wards the RNs mostly didn't want to show students anything and seemed to think their role was to treat students like dirt.

Where I work we don't have much to do with the water. We have a maintenance team who service and fix the machines when faulty and they also take care of the water, RO system, cultures etc.

I would agree that 3 should be the max.number of patients to each staff member.According to my union rep it should be a minimum of 1:4. In acutes 1:2. but in practice even this is rarely the case unfortunately.

Thank Everyone For Your Replies...and Insights. Your Ratios's Sound Wonderful....but Now.i Have Another Problem.......i Work As The Night Shift Rn For Dialys...........but Here Recently Have Had To Work The Nocturnal Shift As Well.........and Do My Night Shift As Well......when Does The Abuse Stop?! When Can We Say No......to This Staffing Abuse Of Nurses?? Please Give Me Some Input......i Am At My Wits End..........i Feel........as Though I Am Not Valued At All..........but Just A Body To Fill In Gaps When They Feel Like It!!!!!!!!!!!!!!!!!!

Well... let me say ONE THING! It is YOUR license on the line!

This happened to me today! I was told that Monday 10/3 that I would open with 11 patients with 2 staff members. We have NO reuse tech, no water person, no secretary, just 2 people. Me (RN Charge) and a tech. Period. I said NO WAY! If there are not at LEAST 3 people to OPEN (5a-8:30a) I refuse to put the patients on. Period.

Amazingly they found help. Our 4th persons will arrive by 8:30am Monday.

I am speaking to our Medical Director about it this weekend. I am sick of it.. my patients whom I have know some for almost 7 years, and the newer ones DO NOT DESERVE to be put in this position. Myself and the tech do not deserve to be put in this position. MY COMPANY doesn't deserve to be put in a position like this (law suits galore if there was an emergency!).

I stick to my guns and speak my mind... appropriately however. I REFUSE and will continue to REFUSE to give care under-staffed to the point I FEEL my patients could be in jeapardy.

It is YOUR responsibility as a nurse to be the patient advocate! YOUR license is on the line. Document everything and I suggest you keep it all in writing if possible (email), if you discuss this issue in person, as soon as you leave, document it... in a Word doc. with date, time, etc. Keep a running log of issues. Be prepared to act on that, and inform the higher ups as needed. IT IS YOUR JOB AS AN RN TO DO THIS!