Is 7 the new 5?

Soliloquy, MSN, APRN, NP · Sep 28, 2012

Yeah I listen to the nurses complain about this. Recently at the hospital I work/extern at, the nurses on the Med/Surg floor were complaining that the day before there were 18 patients (when I got there there were 17) and only TWO nurses and ONE tech. That's crazy dangerous. Where's the culture of safety?! One nurse ended up having to work overtime because they were unable to locate another nurse to replace her at the time.

Many of the nurses on the floor I'm at often do have to deal with up to 7 pts and that's considered like "the norm" with only one tech to assist the entire floor. They complain and complain and complain and administration's response is often that the nurses are just being lazy and not willing to do their job. And I just don't see that as really true and fair.

You work hard, you try your best to provide a safe environment, but then you don't get the support you feel you ought to. Nurses can only do so much with the resources they have.

All hospitals aren't like that though...some really do take good care of their nurses.

DutchRN09 · Sep 28, 2012

Yes, where I came from in the Midwest, nurses had 7 pts 3-11, I don't know about a night. Where I currently am it varies from 5 to 7. Mostly 7 though on general floors. I have 2, but am in ICU, and 3 in ICU stepdown, which I think is 1 too many.

Nurse ABC · Oct 1, 2012

Do you work at my hospital? That's been happening a lot lately and no one is happy about it. Most of our floor is looking for another job which is sad because every one of them say they actually like our floor but they can't deal with the workload. This has been happening after management did a survey on our floor to see why we have such a huge staff turn-over.

Capco56 · Oct 2, 2012

Seems to be the consensus that this is becoming the norm. We have surveys too, which don't amount to alot of changes. We even have a union that can't seem to resolve the issues either. It is sad that this is the way nursing has evolved. The ridiculously complicated computer documentation on top of the heavy patient load makes it virtually impossible to be an effective nurse, and no matter how much manaement says they want to reduce turnover, it is exactly this type of management that causes it. New nurses come and go and even leave the field due to burnout. Why can't hospitals figure out they are directly causing such financial hardships on themselves by not hiring the extra staff to reduce burnout of their nurses, thus, retaining them in the end. The only hospital I didn't see this practice was at a Magnet hospital that I worked at in which the norm was a 1:4 ratio on an inpatient palliative care unit. It was sweet! But then again, I guess that's why they're a Magnet!

NurseHotFlash · Oct 4, 2012

I just returned to Med/Surg after 2 years in Home Health (nurse for about 10 yrs total). I'm appalled that administration thinks nothing of calling off nurses and loading the ones working with 7 patients! Is anyone else encountering this? I feel like my entire shift is putting out fires and flying through documentation so that I won't get caught in overtime. Then when nurses leave, the reaction is "why"???

On my floor, we have six always, but have been promised 5 patients for months. At times we get 7, but not often. We are supposed to have walkie/talkies, but we call codes often. I wonder what the answer is. I am thinking of ICU. Just tired of the rat race.

ukjenn231 · Oct 6, 2012

I often have 7 since I moved to Florida, the ratios were not that bad in Kentucky.

However, the hospital I work at does not cancel people and then overload the staff.

nightengalegoddess · Oct 6, 2012

From what I know from administrative type people: each patient is charged not only for the price of the bed and all of the expected treatments/studys/labs/meds given; but also for a nurse. So each patient is charged for the nurse of the "bed"...the less nurses the hospital can have working at one time, the more money they will accrue because each patient is paying one single nurse's pay for that shift. (Or rather, their insurance, or your tax dollars...whatever).....So if you are getting seven patients rather than what is safe...which would be five, tops; blame the money making needs of the hospital and the CEO who is getting wealthy off of our exhaustion.

The funny thing is; when the lawsuits come around( because it is indeed unsafe to continually care for seven patients in a Med-Surg setting), I think all the money the hospital thinks it has saved will be eaten up by lawyers. I may be wrong, the hospitals may have steady lawyers for these situations which are already fixed in the budget. But it IS funny that CEOs don't seem to last at any hospital for very long.....all these crazy patient to nurse ratios they like to give us seem to have no repercussions to them.

It does anger me. We are here to do a good, thorough job. And though I find it IS possible to do so with seven patients; over time, the life of an RN must shorten. Of course, administration doesn't care about that because there will always be new RNs...and administration can pay the less experienced ones less also.

I have also seen this kind of strategy over and over again when the staff is there steady for a few years, their pay has steadily risen per hour..ratios are safe.....then all of a sudden it becomes important to have this 1:7 ratio. I honestly think it is a way to get rid of higher waged RNs for new ones....because no one will stay at a hospital with these ratios for any longer than necessary. Just so much better to work at a magnet hospital that can't give you more than four to five patients.

ukjenn231 · Oct 17, 2012

Just so much better to work at a magnet hospital that can't give you more than four to five patients.

I just have to point out about "magnet hospitals...." When I started as a new grad, I worked at an excellent Magnet hospital that had excellent nurse-patient ratios. In MS 5:1, tele 4:1, PCU 3:1. Strictly enforced. This hospital lost it's magnet status and so is no longer a magnet institution but still maintains great ratios.

Now I work in a hospital system with several Magnet facilities that all give up to 8 patients on tele. It gets renewed as Magnet status each time around. So it can't really be said that the magnet hospitals "can't" give you more than 4-5 patients.

nightengalegoddess · Oct 17, 2012

My bad. I had no idea that a magnet hospital could renew with such ratios. Honestly, I thought that the ratios were one of the criteria. There must be a heck of a lot of excellent nursing going on in those tele units to keep up with magnet virtues/conditions/requirments with that kind of patient load.

ASL916 · Oct 22, 2012

We are a Magnet Hospital as well. 6:1 ratio, and we rotate when it 7:1

RNmomof3boys · Oct 25, 2012

Wow! I shouldn't complain when I get 5 pts!!! We normally have 4 patients and when it's crazy 5. Most of our floors at my hospital do 4 pts at night and 4-5 during the day. I do not envy any of you that have 5-8 patients. That's crazy and unsafe!