In the old days, 10 patients on med/surg?

Editorial Team / Admin · Apr 15, 2015

Back when I was in nursing school, one of the hospitals I did clinicals in had a ratio of 1 RN to 10 patients. However, they used team nursing, so there was an LPN who passed PO meds and a CNA who did most of the ADLs/bathing/toileting.

Libby1987 · Apr 15, 2015

Back in the 80's patients stayed well into feeling well enough to wear their own pajamas. Sit down, they would have their cosmetic bags on the bathroom counter, wore make up the last day or two of their stay.

They were bathed daily.

Every room had their own supply and linen closet. We went through BOTTLES of Keri Lotion, none of this watery stuff.

So many volunteers, Ladies Auxiliary, Candy Stripers (I was a Candy Striper, thought it was boring though)

I don't remember much of charting. VS, I&O's flow chart type stuff. We did have to count Narcs at change of shift.

Each unit had their own station with a shared kitchenette, I think I had 10 patients with an CNA and over saw a LVN who had 7 patients and did their own personal care. but my memory is failing. I much preferred having 2 RN's and 1 CNA and was only responsible for my own. (I worked on a GYN med/surg station).

There were some floating CNS's on each floor that had 6 stations.

We were expected to give docs our seats at the desks so there was that..

dudette10, MSN, RN · Apr 15, 2015

Libby, would you be able to take 10 typical patients now? Why or why not?

MrChicagoRN, RN · Apr 15, 2015

I think I had much more than 10 on a team.

but, people often weren't as sick. Would check in the evening before surgery for their work up: h&p, anesthesia, labs, etc

Would stay longer, receive a leisurely w/u, a test today, another tomorrow etc.

still remember someone staying 7-10 days for r/o occult bleed. Person was fairly healthy, and could've been done as an OP.

Libby1987 · Apr 15, 2015

Libby, would you be able to take 10 typical patients now? Why or why not?

I could only speculate but say I had stayed in acute care, I would have to say that both the work and acuity has at least doubled, so no, not even remotely.

Ruby Vee, BSN · Apr 15, 2015

I had 5-7 patients on day shift, 14 or 15 at night, and somewhere between that on 3-11. For one thing, we worked as a team, especially on the off shifts. For another, patient stays were longer and so you usually had one or more patients who were independent with ADLs and toileting. For another, there wasn't as much charting. The longer I've been in nursing, the more redundant charting has become. It takes a lot less time to grab a chart and scribble your vital signs, assessment and a note than it does to find an unoccupied computer station with a working mouse, wait for the software to boot up and then click through pages and pages of redundant documentation that is designed to help someone who is doing a study to find the information THEY need rather than to help the nurse at the bedside to chart efficiently. And when you put down your paper chart, you can pick it up again and continue where you left off. It's not always that easy on the computer . . . especially if you're called away in the act of entering your I & O and when you come back to your charting, someone else has taken over your computer station, the provider is in your chart viewing the I & O and you're "locked out" from charting or you cannot remember exactly where you left off. There's no way to stick a convenient pen in the chart . . . .

Patients and families were also far more respectful of nurses and our time. There weren't as many frivolous requests, we weren't expected to satisfy every whim and we weren't feeding entire families out of our tiny "snack fridge." People were grateful for the cup of ice water you brought, not demanding that you bring them some "warmer ice water." We had more freedom to plan our time -- answering a call light every three minutes with some ridiculous demand ("I need a softer patient gown," or "I want some apple juice for all 18 of my cousins here") seems to slow me down some.

IVRUS, BSN, RN · Apr 15, 2015

Back in the 80's I worked nights and had 10-15 patients too on night shift, but we had team leading. That meant that one RN had his/her own CNA and you worked as a team taking care of each one. It was MUCH different back then, vs. now. In 1999 when I went back to working hospital it was so much different: one nurse to three patients in ICU, and one to seven on Telemetry. Auugghhh... That was scary. Every day I feared for my license and wanted to evoke the Safe Harbor Act. To be on telemetry and do primary care for each one of the seven patients was insane. I passed all food trays, took my own VS, bathed and got up my patients, and provided all medications and wound treatments/trach care etc. The only thing that was good about that was that once I started at 615AM, 7pm occurred seeminly 15 minutes later because I was oh so busy... and heaven forbid I got a post cardiac cath patient! No techs, no medication aides... Truly don't miss those days.

meanmaryjean, DNP, RN · Apr 15, 2015

I would routinely have 10-12 M/S patients (with one CNA) on nights, and these folks were reasonably ill. The big thing for me was we did not have to sign into a computer every time we wanted to chart (paper charting- much faster) AND we did not allow all the guests who had to be fed, bedded and kowtowed to. Also- one pretty much never stopped moving!

MunoRN, RN · Apr 15, 2015

A large portion of the med-surg patients 10-20 years ago are now in nursing homes or even home far sooner than they were then, and the patients that were higher nursing acuity back then, and on floors with lower ratios, are now on regular med-surg.

amoLucia · Apr 15, 2015

Did hospital in the late '70s to early '80s. Most of what other posters have expressed was the norm. Computers did not exist yet and the hooey-ha for 'customer service brownie points' did not exist.

I do remember that pt assignments most often were clustered closely together so we didn't have to run from 1 hall to a 2nd hall to a 3rd hall.

Med passes were REALISTIC. All meds were given 10-2-6-10 (9-1-5-9), not something different every dang hour. We gave prn pain meds too. Lots of injectables - talwins, demerols, MSO4 with the tubexes and carpujects (that were abundant). And pain WAS managed.

There was 1 med cart per hall with designated med nurse (nurses). That cart could stay 'parked' all shift because I remember when we could actually pour our meds into little soufflÃ© cups and put them on a special 'med tray'. We would then walk down the hall into the rooms with the tray to give our meds. Also the reliance on IV therapy with freq IV meds/pumps was almost negligible.

And today has become sooooo much more 'tasks-to-do' oriented with multiple nebulizers and all that glucometer monitoring with pOX as the 6th vs now.

I also see a shift in administration's focus being now more centered on satisfaction scores, budget constraints esp as r/t governmental regulation changes, and other bureaucratic initiatives from JCACHO, DOH, OSHA, HIPAA HIPAA HIPAA, CDC, etc. All of these have NOT made nursing (and healthcare) any easier.

So yes, many things have changed. Acuities, EMR, unrealistic customer service with lack of respect for staff, pharmacy/med administration, expanded IV therapy, other increased tasks and therapies, govt over-regulation, and a decline in employee satisfaction, recognition & loyalty (both TO & FROM admin).

The sad thing is that these changes have infiltrated to other areas of healthcare (LTC/SNF, homecare, education, pvt practice, etc).

We're all affected.

TNurse4u · Apr 15, 2015

The old days? I work in a small community hospital -med/surg floor...today I had 8 pts -and one post op on the way. In recent days we are expected to take 9 patients and provide quality care..it can not happen. It is unrealistic to say the least. Patients suffer poor care, and we suffer fatigue and hunger, I do not get a break, drink or lunch. I am exhausted.And feel like a poor nurse for not giving patients good quality care.