Med-Surg Nurses, questions about staffing/ratios/CNA's???


Hi there. I am an LVN, I work on a very busy Surgical floor, but we do get medical patients from time to time. The nurse to patient ratio for us is 5 patients to 1 nurse. We have 30 beds on our floor, most of which are full all the time. We get 2 CNA's to help, if we are lucky and we get a charge nurse. The charge nurse covers the LVN for pushes and piggy backs. Currently we also have a unit secretary who during the week days we have coverage from 7A-11P. The weekends we currently have one 12 hour secretary.

On our floor we do sometimes get patients other than surgical. We get oncology patients and tele patients (Their ratio on their floors is 4:1, but we still are 5:1 when we get them on our floor) If you work on a surgical floor then you will know the load. We do a lot of ortho, so we get hips, knees, backs etc along with chole's, appy's, gyn surgeries, turp's. Anything. Our manager requires vitals on our floor to be taken Q4. No matter how many days post-op the patient is. Our CNA's used to do this for us, but recently they have taken that duty away from the CNA's and given it to the Nurses. The CNA's are now responsible for ALL the bed baths on the floor. In a perfect world, if we had 3 CNA's for a floor of 30 patients this would not be too bad. But our CNA's are doing 15 baths a day, plus trying to help with call lights.

Now, our manager wants to decrease the CNA's hours to 8 AND only give us ONE CNA per shift. For 30 patients. As it is the nurses already do all Q4 vitals, so we are doing vitals 3 times a shift in addition to passing meds, answering lights, doing procedures, dressing changes, chart checks etc. Also our manager has instituted 1 hour checks. We need to physically go into the room and sign a sheet with our signature that we have been in the room and asked the patient if they need pain meds, bathroom, positioning etc. Some of the patients look at us like we are nuts coming in hour after hour and signing a clipboard.

On the weekends they are now taking away our 12 hour secretary and she will only work 8 hours. She will not arrive before noon because the manager says that no Dr.'s come in before noon on the weekends. She's never been there on the weekend. There are A LOT of Dr's there early on the weekends! So now the nurses are faced with doing vitals, answering the unit phone, entering our own orders, passing AM meds on 5 patients, answering their lights, taking them to the bathroom etc. Anyone who has taken care of a post op patient, especially a hip, knee, back etc knows the amount of time it takes to get them up and into the bathroom. It's not like you can walk in and just take them to the bathroom, there is equipment, walkers etc. We will NOT have any of this extra help.

So what's it like to work on YOUR floor?

Personally I feel like I am putting my license on the line with these changes that are starting this weekend. We already feel like we don't have enough help, and they are taking more away.


28 Posts

hi there! im an RN from amarillo texas and we have similaraties on the type of floor we're working at. I also work on a 32 bed surgical/trauma floor and guess what we get 5-6 patients primary care (without a CNA). I sometimes do relief charging and i still get the same patient load. In most times i feel sorry for my patients and feel bad about the work environment I am with too bad texas doesn't have strict nurse-pt ratios. On the other hand i have probably sharpened my skills in monitoring this patients cos in my case u need to be always on guard for narcotic overdose, signs of PE, bleeding, etc. I have a 3 yr contract with this hospital and im just very glad it will end by next month. imagine 3 years of dangerous nurse working environment.


10 Posts

I'm working on a med/surg floor where we typically have 6 nurses (always RN's) when we have a full floor of 23 patients, with 3 CNA's and a unit secretary. Unit secretary coverage occurs from about 6am- 10pm, although on weekends we only have a unit secretary from 7:30 am- 7:30 pm. Staffing numbers of nurses/CNA's is based on the overall number of patients on the floor- if there less than 23 patients we have 5 nurses for 22-about 20 patients, and lower numbers of nurses depending on the situation. The charge nurse typically does not have any patients, and the goal is for the charge RN to do paperwork go to meetings and help the other nurses on the floor.

Our staffing levels are generally quite good, if you compare them to many other hospitals nationally

I'm curious- are all the nurses on your floor LVN's? I'm curious since you highlighted that the charge nurse has to help with piggyback meds and pushes- so in that sense I'm assuming- but I don't want to you know what happens when you assume.

The fact that you are doing Q4 vitals on everyone even with CNA's is ridiculous- you have so much to do already with a patient load of 5 patients. Some days I start the day with five patients, and depending on the acuity of patients and day I see the difference in care- You're simply catching up versus getting ahead and being proactive.

Now, many hospitals have instituted goals with hourly rounding, my hospital has also, however we don't have to go sign a clipboard in a room. That's like when you go to the bathroom at a fast food place and the staff signs a clipboard to assure the room is clean- GIVE ME A BREAK!!! I think that's horrible, and if our manager instituted that I'd tell them that I was insulted.

Your manager sounds out of touch with your unit and like he or shei s out of touch. Perhaps she should try to work the floor a day and see what it is like for staff. I think you need and your colleagues- fellow nurses and CNA's need to come together to verbalize your concerns for patient safety and patient care. The CNA's also probably feel the same way. Linda Aiken's nursing research studies have shown that as nurse patient load increases, so too does patient mortality.

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