Is it just me? (Nurse/patient ratio related)

Nurses General Nursing

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Hope it's alright to put this under general discussion. I just wanted to get some other nurses' opinions on a new staffing grid that's supposedly going to be unveiled during our next unit meeting at work because I'm not sure if I'm overreacting.

I'm a new grad RN, a couple months shy of the one year mark. I work nights on a Surgical/Oncology floor. Mostly post-op orthopedic surgeries, abdominal surgeries, bariatric, etc. and maybe 1/4 Oncology patients, although we're seeing more and more of them and are working on getting all our nurses chemo certified. We also get medical overflow as well as many patients on telemetry. Assignments are not based on acuity.

When I was interviewing, I was told ratios were 1 nurse to 5-6 patients. The reality has been 6-7 patients per nurse and one PCT to anywhere from 10 to 30 patients. No LPNs.

On the rare night with 5 patients (only when we are accidentally "overstaffed"), it seems ideal to me. 6 is usually fine. 7 feels unsafe and is impossible most nights without cutting major corners. I often don't feel safe with 7 patients, and I leave work depressed after a night with that many. Of course, this is all relative. We all know that some days, 5 patients can be busier than 7, but I just mean in general.

There have been more and more nights with 7 patients and less with 6 lately. And now...word is that our staffing is being changed to a standard of 8 patients per nurse on nights. I've never taken 8 patients and can't even imagine it. IMO, it would be very unsafe for the patient and for our licenses.

So, I guess what I want to know is...AM I overreacting? Is this an acceptable ratio for the types of patients on my floor and I just "had it easy" with 6 or 7? I've never worked anywhere else, so I have nothing to compare to, but I'm just so upset about this and trying to figure out if it's just me (being a new grad, less developed time management, etc?) or if this would be unacceptable to even more experienced nurses.

Thanks in advance for your replies!

Specializes in Med Surg, LTC, Home Health.
I'm distracted from this by the sickle-cell patient in bed 4 who keeps pulling the curtain open and demanding her diluadid because god forbid she goes more than 1 hour without another dose.

Do I think that a medical floor nurse being so concerned about having 8 patients is overreacting? Maybe just a little. I think that our floor nurses always have at least 8.

Mikey,

It sounds to me like you work in a pathetic hospital. "God forbid" the pt in sickle cell crisis should have to go for more than an hour without another dose? That is certainly a hideous point of view that i can only hope is based on your large patient load and subsequently frazzled mind, and not a lack of knowledge or empathy. :down:

OP,

In my last med surg job, i had 6 pts almost all the time. That was too many as well, but it was possible to provide adequate care just barely with a little luck. I would certainly refuse 8 pts (or 7 for that matter).

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BradleyRN,

I completely agree! I work med surg and can handle 6 patients IF big IF I have a good CNA to help and they are not high acquity patients. I usually take 4-5 pts but refuse to take more than 6. I dont see how you can give effective or safe care to 7- 8 or more patients. It is not just a safety issue, it's a nurses' sanity issue and risk of losing license issue.

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In med-surg around here, it's common to have 7 patients on day shift with a tech, and 8 on evenings, and up to 10 on nights. You might have a tech for some or all, you might not.

Changing jobs won't help because all the hospitals are the same.

You do what you can, hope it's adequate, and carry . Or you go to ICU, home health, or private duty.

As for the ER nurse who is basically calling you a wuss because you want to give the care you were trained to give, don't listen to him. Hospitals have been staffing this way for years, and just because they do it, and we are forced to put up with it, doesn't make it right. He's working in an understaffed area and so are you. Right now the only difference between the two of you is that he thinks he can handle it and you realize that you cannot. Which is the answer to the wrong question.

The right question is, is this staffing grid helping patients get good, effective, timely care or hindering it?

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Specializes in Oncology.

No, not over reacting. I work strictly oncology, usually 100% BMT, some leukemia (non-BMT) patients if we're not full, occasional ICU overflow and we have 2 or 3 patients each.

Hanging chemo on a patient, when done right, requires a lot of attention and time. You *should* be checking blood return on the IV frequently, calculating the patient's BSA, and calculating the dose yourself, looking for discrepancies among charted weights or doses, reading any research protocol involved, triple checking the chemo orders, and educating the patient. Further, many chemo drugs require pre-meds.

Further, the more chemo you give, the more blood you'll be hanging. I hang 5+ blood products a shift routinely.

Becoming chemo certified will just reinforce that your staffing is inadequate.

I'm probably spoiled, but oh well. I feel like I'm safe. I feel like my facility affords me the opportunity to be a good nurse.

I think I'd have an even harder time if we had a wider variety on my floor- more to learn.

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Specializes in tele, oncology.
And when you regularly take 8 without too many people dying, then it will be 9 patients each. It's just going to keep going up and up until the money spent on extended hospitalizations and defending against lawsuits is obviously more money than paying for appropriate staffing. And don't forget that on top of "nursing" you also have to play cruise director and make sure the Press Gainey scores stay high!

:yeahthat:

We take six patients regularly on my tele/oncology floor; assessments and vitals are q4, for a total of 18 rounds of assessing and charting a night if we're full to start. Our medical floors have gone as high as ten a piece lately, but norm is supposed to be 7. I've been pulled on nights when they are 8:1, and even though that means only eight assessments total and one round of charting per patient, it still seems ridiculous. Med-surg patients just seem whinier and more demanding than what we get in general; we may have one or two out of six who really suck up your time, but the med-surg teams seem to have at least three or four who do.

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Wow - you people need to unionize! California has staffing levels to protect us - we have 3 pt on our stepdown unit, 5 on med-surg floors, and 1-2 in the ICU. If we take a 4th on our stepdown unit, we're considered the hero of the day. And ding that many is ridiculously hard! With California's recent budget issues we were at risk of losing our CNAs (we have already lost our hospital LVNs) but the union stepped in and protected their jobs -for now.

There is no way all of you nurses will get a fair shake without collective bargaining - it will take time, but it is the only answer - is there any way you people can contact SEIU (that's our union) or whatever union exists in your area to see if there may be some help??

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Thanks for the input, everybody. I found out last night that I'm not the only nurse on the floor who's upset about this. It reassured me to hear that even nurses with 10+ years experience are worried about it. Many say they're going to voice their concerns at the staff meeting and will begin looking for new jobs if the change occurs. I'm not sure if I believe that or not. I've learned that most nurses around here aren't willing to vote with their feet and will end up eventually accepting things like this after a period of venting about it.

I like almost all of the people I work with. Originally, I'd planned to do my year of med/surg and then move on, but then I'd decided to stay, after all. With this new development, that's just not going to happen. I'll be sad to leave my co-workers, though.

I think I might try stick out the next couple months and then look into home health. But honestly, I'm worried about even two months of a 1:8 ratio on my floor.

And to think, we're a newly-awarded magnet status hospital. I hear that the day the magnet people came by, they made sure to have the best nurses scheduled on days with a 1:4 ratio. Oh well, I'm sure the 'M' looks nice on a billboard.

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eight patients is the norm on my floor. last night was one of the worst nights in my short nursing career. two rn's called off...leaving 3 rn's to care for 32 patients on a busy med/surg floor. needless to say, we each had 10 patients. i struggle with 8 patients...10 just absolutely buried me.:uhoh3: charge nurse says " this ain't so bad, we were getting 11-12 patients just two years ago, staffing is getting better!"

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eight patients is the norm on my floor. last night was one of the worst nights in my short nursing career. two rn's called off...leaving 3 rn's to care for 32 patients on a busy med/surg floor. needless to say, we each had 10 patients. i struggle with 8 patients...10 just absolutely buried me.:uhoh3: charge nurse says " this ain't so bad, we were getting 11-12 patients just two years ago, staffing is getting better!"

wow. i can't even imagine taking care of 10, let alone 7 or 8. 6 is pushing it for me.

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Specializes in med surg.

Devi, I think you have a good reason to be worried about this nurse/pt ratio. I also work on a med surge/onc unit. I am on days and now we usually have 6 pts. When I started 4 yrs ago we had 5. Our night shift nurses have 8 pts. We work in teams, RN and CNA. I am so disapointed the nurse/pt ratio is going up. These cancer pts require/deserve/need more time and special attention. There is no way I can give it to them when we have 6 pts during the day!!!! It is unsafe and sad at the same time. In my area of the country, I think this is common practice......I wish I could have 4 pts and spoil the hell out of them. Now I am barely keeping up.

To Mikey from ER.....You seem to be saying ER pts are so much harder/more acute and we should be able to manage 8pts at a time too?? At least you have docs on the floor......I deal with the exact same kind of pts on my unit. GI bleeding, crazy bad ETOH w/d, SOB spo2 at 80 % on 5L nc, really sick dying cancer pts with temps 104 who need nausea/ pain meds Q2/and are getting CHEMO!!!!! They ******* DESERVE to get their meds on time!!!! And my pts are supposed to be stable! Its BS!!! And management tells us our pt satisfaction is going downhill...GEE I wonder why??? Sorry for venting...I think my problem is I actually care about the pts. I want to do a good job for them. We are just set up for failure though when they keep upping the nurse/pt ratio.

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Specializes in Stepdown, ECF, Agency.
eight patients is the norm on my floor. last night was one of the worst nights in my short nursing career. two rn's called off...leaving 3 rn's to care for 32 patients on a busy med/surg floor. needless to say, we each had 10 patients. i struggle with 8 patients...10 just absolutely buried me.:uhoh3: charge nurse says " this ain't so bad, we were getting 11-12 patients just two years ago, staffing is getting better!"

whthfk ???!!!

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i would start looking for a new job ASAP.

Bingo! Look for a place that staffs each unit based upon actual acuity, rather than ratio.

Hospitals and nurses often use ratio as a basis for staffing, often because it is "fair". When this is done, the care is just that... fair. Not good, not excellent, but just fair.

There are times when acuity requires a nurse to be assigned fewer patients; other times indicate the assignments to be somewhat more. The challenge for each unit of any given hospital is to determine acuity (i.e., in a Surgical unit, the number of fresh post-op patients would be a factor). In other words, give me the seven or so patients (especially on night shift) if they are S/P Appy or Chole and more than six hours post-op.

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