How many patients?

Luv Nursing · Aug 27, 2008

Dear Beachlover,

You're not rambling, you're venting to keep your sanity so you can go face another day.....somehthing nurses everywhere understand. Here's another thought for you and for Melinurse, Come October...CMS guidelines will go into effect for many things....one being patient falls. Basically, it is expected no patient should ever receive and injury from a fall, or should even fall. This of course is crazy because unless you have a staff member attached to every patient's side, you can not control what they do, no matter how many protocols and processes you have in place. Starting October, anything that is related to a fall, diagnostics, extended stay in the hospital, tx, etc., will not be reimbursed for by Medicare....and the hospital will have to pay for it. That alone is a good argument for more reasonable ratios. Once the hospital is shelling out money regularly for these types of things.....compare the cost of staffing to that and it's no contest.

As for "running your mouth about being united", you're doing the right thing. We have a group of managers where I work, who work our butts off. If there is a committe, chances are we are on it, not by choice. We do EVERYTHING you can imagine, include researching regulations and such that are really other emloyee's responsisbilities ( HR, HIM, etc) because we know they are looking us in the eye lying, or bending the policy to whatever suits them at the moment. While doing all this, we get continually slammed by these same people....and we all feel like flipping someone off and then running for the hills on a daily basis.

While we feel this way, we've discovered the trick is We all have to have our "that's it, I'm outta here" days on a different day. That way we can vent and the other can remind us that yea, it really sucks and makes our lives totally difficult, but even though we feel like we're spinning our wheels, we KNOW we can't accomplish anything if we're not here. And as our awesome DON states, We are here for the patients and for our staff.

Be really good at your job, be respectful when going against the powers that be, and never back down when it comes to your patients or your license. Good Luck!

jbrnsuga41 · Sep 2, 2008

I work 7p-7a shift on med-surg telementry unit. We have 20 beds. Staff is 3 nurses and 2 aides depending on census. Patient ratio is 2 nurses taking 7 patients and the third taking 6. Very few of the nurse will help each other. I've been a LPN for 24 years and currently in school to get RN. I've only been back in hospital since July and have lost 7 pounds. No time to take breaks. Don't think I'll be staying after graduation. Wish management would hurry up and figure out why the nursing shortage. Thanks for letting me vent.

lilmisstiger94 · Sep 3, 2008

I work a med-surg that has 16 beds - we just got rid of our semi-privates & changed them to privates (hallelujah!!) We work 12 hour shifts (I didn't realize 8 hour shifts in the hospital were still around) Our ratios are 5-6:1 - when we have the staffing. Night charge nurses take a full load. We have an awesome manager who works nights and days depending on need and tries to listen as much as possible & fix what she can. Life is not always easy; but it does go on. The paperwork is the killer here. They keep adding and adding and adding to it. Duplicate charting takes up more time and cuts into patient care - but the administration machine keeps putting it out there. I worry with flu season peeking around the corner - we haven't had a slow period yet.

Free_Spirit63 · Sep 6, 2008

I work on a 40 bed (private & semi-private rooms) med-surg unit with a patient population ranging anywhere from 2 days old to 102 years old and telemetry. We work 12 hr shifts. We don't have an IV team and at times we have one transporter for the entire hospital (only at times because they keep quitting....wonder why?). Nor do we have a charge nurse, we do have team leaders who normally end up being chart control nurses, and we have a unit ward clerk.

On days:

1:16 for Team Leaders (but I've had as many as 33 patients with no other RN on the unit)

1:6 for RN or LVN caregivers, sometimes 1:7 when there's no choice.

1:14-16 for CNA's

On Nights

1:20 for Team Leaders (but it's normally 1 TL no matter how many patients there are)

1:6-7 for RN or LVN caregivers (it is rarely 1:7 because the nurses refuse)

1:20 for CNA's

Of course patient acuity is suppose to be taken in to consideration and at times it is, particularly for night shift. Our ratios were higher 1:7-8 on days and 1:8-9 on nights but we fought to change it a few years ago. Now they are creeping up again and we are being told that the majority of hospitals have ratios of 1:8 so we should count ourselves lucky.

Our updated staffing policy no longer has set ratios for the med-surg unit so we no longer have the protection of a policy which is frightening. The writing on the wall seems to be in neon paint...ratios creeping up, taking set numbers out of the policy, etc.

There is such an overwhelming sense of powerlessness for nurses when it comes to patient ratios. Time and time again evidence clearly shows the relationship between safe nurse staffing levels and shortened length of hospital stay, reduced errors, complications and re-admission rates and, of course, improved patient outcomes, as well as increased staff satisfaction, morale, retention and decreased turnover rates. All of these directly reduce the cost of doing health care business. So why is there such a push against safe ratios?

It will be interesting to see the research that comes out of California once minimum staffing laws have had enough time for reliable study...time to prove what nurses have long been fighting for.