How many patients?

[sistasoul]

Hello all,

I am currently an aide on a telemetry unit and when I graduate in May I am hoping to work on the med surge unit in my hospital. I did a clinical rotation there and one of the nurses there told me she usually gets 5 patients. I would like to hear from other RN's how many patients they usually take care of. Five seems like a low number from posts I have been reading.

Thanks to all who respond

[nbnurse95]

I work on a surgical floor. We have 4 teams of 7 pt's each. Each team has one RN and one LPN. One RN in charge without pts. We have a secretary from 0730 - 1530, another from 1000 - 1800, and another from 1400 - 2200. We also have a "concentrated care" room for 3 pts and one RN. This is the staff when we're REALLY lucky. Often our charge nurse ends up with a team, or 3 RN's often split the 4th team so that one RN can staff our concentrated care room. This has been the norm recently.

[MedSurgLPN2005, LPN]

I work on a med/surg floor and I have up to 8 patients at a time, no less than 5. However, when you consider discharges and new admits, I've actually taken up to 10 in a shift (just not all at once). Funny thing is, sometimes it feels like 5 patients is harder than 15, depending on the patients.

[Fiona59]

I work on a surgical floor. We have 4 teams of 7 pt's each. Each team has one RN and one LPN. One RN in charge without pts. We have a secretary from 0730 - 1530, another from 1000 - 1800, and another from 1400 - 2200. We also have a "concentrated care" room for 3 pts and one RN. This is the staff when we're REALLY lucky. Often our charge nurse ends up with a team, or 3 RN's often split the 4th team so that one RN can staff our concentrated care room. This has been the norm recently.

Wow, you get good unit clerk coverage. We have one on days, one on evenings. Same for NA's. On weekends there is no evening coverage at all.

Late evenings is our staffing quagmire. We can never get those hours covered adequately.

[stalsrn]

I work on a surgical floor at night. We generally have 4-5 pts till 2300 then may get a 5th & 6th if we have a nurse leaving at 2330. Our floor is set up with 16 rooms on the north side and 16 rooms on the south side with a nursing station on each end. We almost always have one aide on each side. The new "rule" is that the charge nurse can take 1-2 pts max, if the rest of the staff are at their six patient max. There have been several times when we have had to close our floor to admits because the staffing office scheduled too tight.

[scaredofshots]

i work med/surg with 34 beds. we have 5-6 pts per rn or lpn at night 7p-7a and sometimes during the day 7a-7p. on days we have 2 aids, night we have 1 aide. we do our own admissions and discharges. day shift has a free charge that assists with admits/discharges/orders/md calls/etc. night shift charge nurse takes pts. we never have 7 patients. we do computer charting and med scan.

[Melinurse]

On our floor:

Days takes :

5-6 pts per RN

9-11 pts per CNA

we do our own admits/discharge/IV starts

PM Shift takes:

5-6 pts per RN

10-12 pts per CNA

Nights takes:

7-8 pts

15-17 pts per CNA

Weekend ( when management not around )

Day & PM shift takes:

6 pts. per RN may have to flex down in staffing because of " budget " which might give you 7 pts or 8 if 2 of the absorbed pts are going to be discharges

CNA's might have to takes up to 12-13 on days/Pms.

Nights on weekends:

well they just get screwed! ( sorry if that offended anyone )

At our facility, the budget is more important than the patient it seems. RNs are always advocating for the pt to management but we get the same old story of how bad our budget is and they can't do anything, blah, blah, blah........... how we should feel greatful we get the staff we do..............yeah I work with some awesome teamplayers who are there for each other, but somehow, it is not enough.

[BSNFiredancer]

I work nights. I have had as many as 12 pts with 1 LPN, 1 US, and 1 Tech. Nurses are becoming anxious about this issue, many are talking about leaving.

[Luv Nursing]

I manage a Med Surg unit in name, but we are in reality a PCU as we keep cardiac drips and insulin infusions.

Since taking over as the manager, I've instituted a 1 nurse to 6 patient ratio for both days and nights. I've done both shifts, as a floor nurse, and as the house supervisor on nights before this and do not buy in the "it's less busy on nights" theory. We do not have respiratory here at nights, so our nurses do all Nebs, CPT, I/S, etc. In addition, our ER has 1 doc, 1 tech and 1 nurse from 7p-7am and 1 7p-11p, so there is not really any additional help is the ER is busy and something happens.

I also am of the strong mind that medicine chages daily and our patient care should as well. We are a small hospital ( 1 in-patient floor for the hospital) that can house 18 beds, surge to 22 if necessary. We have tele and the drips as I mention before. The bigger hospitals think we are a bunch of bumbling idots because we don't have all the capabilities they do...but countless times when a patient is beginning to crash, I've had to beg the patient to let us transfer them to the bigger hospital. I've actually said before," your heart rate can not keep beating at 200 beats a minute for much longer" (despite medication and cardiovert) " if you were my dad I would beg you to transfer. If you don't want to go, I need to know what do you want us to do when your heart stops beating..."

These patients do not want to go because they DO NOT GET THE QUALITY OF CARE IN THE TIMELY MANNER they get here because of their larger ratios.

Also, personal research has shown me that many med surg units are trying to get to a 1-5 or 1-6 ratio. I don't think it is unreasonable. However, no matter what, ratios must take acutiy and staffing ability/experience into account before any decision is made.

[Melinurse]

Also, personal research has shown me that many med surg units are trying to get to a 1-5 or 1-6 ratio. I don't think it is unreasonable. However, no matter what, ratios must take acutiy and staffing ability/experience into account before any decision is made.

I like the idea of only having a 1:5 ratio whether it is day or night. As I mentioned before, our hospital is putting more emphasis on the budget right now. So many nurses are leaving, and it is the experienced ones too. Now I just started and this scares me. I like having experienced nurses around to " give me input " if oneof my pts. is not doing well. I value their knowledge. So now at night the " most experienced nurse " has been there for 2 years and she just put in her notice. And yet the management cannot understand why and/or are not willing/or able to fix it.

To be honest, I am also thinking of leaving. I've only been an RN for 6 weeks but, I wanted to provide safe, quality care and I feel I cannot do that where I am. ( I've been with this facility for 7 years ) I am even willing to move. I am just looking for a facility where the patient nurse ratio is acceptable for good , safe, quality care. I like to be able to give my pts. the etra TLC while they recover and feel I cannot do that where I am.

[Luv Nursing]

Quick thought- I totally understand where you are coming from, and trust me, your department manager doesn't like nor much less agree with staffing from a budget perspective, but budgets do have to be taken into consideration. For instance, is there a process if the census is low, that people can be placed on call and reasonably compensated? Managers spend a great deal of time proving on paper why there are days that 5 patients are much worse than 12 or 15. The 1:6 ratio is in place because that is what I feel to be appropriate based on our drg's, acuity levels, etc. I am EXTREMELY FORTUNATE to have a DON who supports their department managers and who puts Patient care and safety First, Middle, and last, and would be fired before putting anyone in potential jepordy.

Having said that, before you leave, talk to your dept. manager. If I were your manager, I would ask you to write a letter to me stating your concerns and your real thoughts of resigning; emphesizing it is not about money, but about the patient's care, safety as well as yours. Let your manager know you understand it is often out of their hands (many are in a position that if they don't do what the higher up's want, they'll be fired and someone else will be hired to do it.) but you feel the Executives need to know the seriousness of all the experienced nurses leaving and your nervousness as well. Then I would take that manager to next in my chain of command.

A large departure of experienced nurses usually means one of two things... 1) A group of staff who has "run the floor" for a long time and has usually gotten away with everything (they are above the P&P's) are now being held accountable

or

2) There is a real problem with patient care and safety as well as staff safety. Anyone and everyone has to ultimately protect themself...and if that many experienced nurses leave because they are worried for the patient or for their license...well someone will hopefully listen.

I wish you the best of luck and remember.....there's teamwork, and then there is integrity. When you feel like you are having to truly compromise your integrity, it is time to move on.

[Melinurse]

Quick thought- I totally understand where you are coming from.

There is a real problem with patient care and safety as well as staff safety. Anyone and everyone has to ultimately protect themself...and if that many experienced nurses leave because they are worried for the patient or for their license...well someone will hopefully listen.

I wish you the best of luck and remember.....there's teamwork, and then there is integrity. When you feel like you are having to truly compromise your integrity, it is time to move on.

Thank you for your quick thought. Very perceptive. And unfortunately true. We just had a staff mtg regarding the budget and how far it has gotten out of control. My concern is patient safety as well as my license. I am a new nurse who has had to write 2 incidence reports because of patient falls. I take full responsibility however, 1 happened while I was doing chest compressions on another patient. The 2nd was when we were really stretching our CNA patient ratio ( 1 CNA to 13 pts on day shift ) I did look in on my pts every hour or less but it still happened. Our CNA model used to let us have a 6 pts to 1 CNA on day shift and we used to have a 1 RN to 5 pts on day shift staffing. We also had alot less falls and pts seemed to be happier with our care. When we mentioned this and asked for a compromise at the staff mtg. we were ignored.

You sound like a wonderful manager, we need more like you, who are willing to explain and willing to listen.:yeah:I hope I find a manager like you.:wink2:

[beachloverRN]

I work on a Med/Surg Unit in NM. We have 7-8 patients with 1-2 techs for 24 patients. I use to work Tele and we had 5 max, but even that has changed. I had the worst day today and find myself wondering what we as nurses can do to get Administration to let us do our jobs safely and actually give good patient care. They staff our hospital on numbers not acuity and I think that is a problem. I am orienting (HAHA) and had 4 patients today, one went for a heart cath, one needed 3 units of PRBC's after surgery for a hip and humerous fx she obtained in our facility getting up the the bathroom cuz they brought her up at change of shift and she got up alone--WOW__and the other two were busy patients too. With all my experience I was running like mad.....then of course the CNO came up and did surprise rounds. Told our charge who also had 7 patients they would write him up if we had our EMU's unlocked in the hall. This is NUTSSSSSSSSS!!!!!!!!!!! Now the charge is going to transfer off the unit, too much responsibility can't do the job well under the current working conditions. Me with my big mouth keeps telling everyone we need to unite...oh well I am babbling sorry just needed to unload....tx for listening and good luck...