Just Wondering: CNA to Patient Ratio on Your Unit

[pRNss808]

To make a long story short: Had a loooong 8 hour shift on a Med Surg unit (42 bed capacity). In our last staff meeting, the manager has decided to decrease the CNA load from the previous 9-12 patients to 6 (Day & Eve)-8 (Night) patients to improve patient care and decrease the fall rates. Nurses still have 5-6 patients regardless of the shift. With that being said, I feel like I'm doing more work and working harder now than before. Don't get me wrong, but I really appreciate my CNAs and the work that they do because they do a lot better than I could ever do it (and faster). My mom is a CNA at the hospital I work at and I hear the things that she has said about her unit (Long Term Care). I seem to be answering more call lights for diaper changes, emptying urinals, refilling water, and etc. The CNAs take their "mandatory" breaks, have time to talk story with other co-workers in the hidden corners of the unit or in the kitchen having a "dinner party" while I'm running around like crazy. I have a pedometer on me and I walked almost 8000 steps on my shift. [*Sigh* There's my ranting for the day and hopefully I can sleep.]

So I was just wondering what your unit's CNA to Patient ratio is and if you have had experiences similar to mine. And what have you done to minimize the situation? Maybe I could make some suggestions with my manager or something.

[ChristineN, BSN, RN]

I voted 9-11 as most med-surg floors in my hospital have a tech-to-pt ratio of 1:10. However, some floors do have a 1:6-7 ratio on days in order to have more people around to have more techs help with AM care so nurses can get through the med pass.

I do not think CNA's having less pts is the problem. Having only 6 pts would be amazing. I think that the problem you are complaining about may be a poor work ethic.

[pRNss808]

There defintely is poor work ethic amongst majority of the staff (nurses and CNAs). I constantly hear, "I don't care," and "Whatevers." Call lights are lighting up the floor and bed alarms are going off like crazy. I even see staff walk by a call light without even peeking in because, "that's not my patient." CNAs complain when they have more than 6 when 12 was doable in the past. I'm constantly always offering to help, regardless of how busy I may be. I will answer a call light or help a patient that's not even under my care, but will do it anyways. Because no matter what, I will always be busy. There's always something that needs to be done. What if that patient was your own family member? Wouldn't you want someone to help them? I rarely take a break, although I should. My definition of a break is to actually sit down and focus on my charting.

I was just curious what everyone's ratios were to sorta prove a point to my manager that most CNAs have a lot more patients to care for than what our unit is currently caring for now. That the problem to our falls and decreased patient satisfaction surveys is not the ratio but in their care (and work ethics).

[thelittledoe]

I answered both 12-14 and 15 or more. I am a PCA on our med-surg floor (it's supposed to be just surg, but a lot of med-surg overflow is brought to us). There are 36 beds on the floor and 3 PCAs on day shift (12 patients each) and 2 PCAs during some evenings and most nights (18 patients each).

This also depends on patient population, but we are usually at 85%-100% capacity. Luckily we have a great staff and most of the PCAs and nurses will help out with patients who are not necessarily "theirs". There are the occasional nurses though who won't do "PCA" work, i.e. changing incontinence pads, taking patients to the restroom

[nurse4sale]

We had techs (same as cna's, but they did ekg's and bs) on our Med/Surg floor and they did their job no matter if they were short staffed or not. They were very good and we (nurses) hardly ever had a problem with them. The reason for our floor running so smoothly was our Nurse Manager. She was wonderful.

[pRNss808]

The CNAs would NEVER get 18 patients each. Nowadays, anything more than 9 they're already ******** and complaining. I had one literally looked in their union contract. There are several nurses on my shift that are very notorious for not helping out their aides and other nurses. Regardless of how busy I am, I try to help out. Even though they are not my patient. Because if it were me laying in that bed, I would want someone to help me out. If that patient were my own mother, I would want them to care for her as soon as they can. And hey...what goes around, comes around. There will be many times when I myself may need help.

Sometimes we can't help it if we're short-staffed or we get slammed with admissions. Two big hospitals closed down a little over a year ago. Many times Med-Surg patients are being held in ER, waiting for a bed to open up on our unit. If 12 was managable at one point. 6, 7, 8, or even 9 (at most) are doable. I just don't understand them. I know acuity is a major factor. But at my unit, acuity gets thrown out the door (this is for another thread).

Majority of out patient population are the geriatric.

This is my thing: The time spent complaining could have been time used to take care of a patient.

[pRNss808]

I wish our CNAs could at least do blood glucose checks. But then the problem would be reporting abnormal values to the RNs. No excuse not notifying the RNs because we all have iPhones using the Voalte system.

[thelittledoe]

Wow, it sounds like some of the nursing staff on your floor needs a reality check. We do blood glucose check on our patients too. Our patients are mostly middle aged with quite a few geriatrics and some younger folks mixed in. There are usually about 6-8 patients on the floor on isolation precautions and usually about 4-6 bariatric patients (can mostly case for themselves) and 4-6 ortho patients (who need a LOT more help). The rest of the patients are a mix of general, uro, gyno, etc. surgeries (which lie somewhere in the middle when it comes to care). Just figured I'd give you some background on the floor.

[Underoo]

our CNAs are usually 7-10 and they do vitals, baths, feeding, I&O, EKG, bladder scans. No foleys or blood draws or blood sugar checks. They work hard, but they do complain about their loads and I think "seriously, I had 15-28 patients as a CNA, you don't know how good you've got it!" I think 10 or less is good, they have time to spend time with the patients when the nurse can't.

[Morainey, BSN, RN]

It depends on the shift - on days we have 1:6-10, same on evenings, and then on nights one aide can have 10 and up. Once we had 18 patients and one aide.

[PediLove2147, BSN, RN]

It depends on the shift but usually during the day our CNAs have 8 patients. They are responsible for VS, bathing, feeding, I&O, EKGs, and blood sugar checks. The fewer patients the CNAs have the better for me because they are able to do their job. It's not fun when they're understaffed, they give you attitude if you ask them to do something.

Evenings usually have 10 and nights 12 or so.

[SoCalGalRN]

I work in an acute care hospital in Los Angeles on the night shift. We get one CNA for 27 patients. We get 2 CNAs for 28+ patients. If we have 27 patients, the CNA is usually assigned to 14 patients, the rest are primaries. It's really bad.