Med Surg Staffing Standards - Are there any?

RN1989 · Jan 28, 2008

I have never seen anything that is considered a "standard" regarding staffing. Most of the time I deal with inadequate staffing. I am thinking that you must be in heaven if they are allowing you to come up with what you feel is your own staffing grid. Normally you just inherit the grid that the hospital has had forever with a few changes made by the CNO when they are trying to save more money.

Personally I believe that 5:1 is a good number. Unfortunately this is nearly unheard of for a medsurg unit anywhere that I have worked. Most places have cut medsurg staffing to 6-8:1 on days with CNAs (if they have them) getting 12-15:1.

My suggestions to you would be to contact other medsurg managers in your area who work in hospitals similar to yours (rural vs urban/suburban). Call the operator of the hospital and ask for the name and outside number of the medsurg manager and then just give them a call. Most would be willing to share how they do things.

If you can get the old records that have the floor census, the number of employees used, etc. that would be a help when you are trying to justify nurses if it goes against what you have in the budget. I am accustomed to getting monthly reports where this type of thing, including how much money was generated from the patients on the floor and how much money was spent on nursing staff, that can help you work on a staffing grid. Be ready for a fight if your recommendations don't jive with the CFO's (which is all the time).

Ginger35 · Jan 29, 2008

RN 1989,

Thank-you for the response. I really do appreciate it. I work at a small rural hospital.

Once I received my 1st quarter report (fiscal year begins & ends Oct 1), I was informed I was over budget. After finding out that piece of information, I came up with a staffing matrix until I can comb numbers apart. I am trying to maintain a ratio of 1:5 on days, 1:5 on evenings and 1:7 on nights effective immediately until I can put the data together. Unfortunately, those that I trusted to downstaff when census decreased (charge nurses & house supervisors on evenings & nights - mostly on the weekends)- just didn't do it for whatever excuse. So, now that I have numbers to prove overstaffing issues - they will just have to deal with the current staffing, which I still think is more than generous - even when taking acuity into consideration.

So, with my new staffing ratio currently - my staff are crying the blues. They are using the banter they can to prove that these ratios are unsafe. I just can't believe it. I guess they were use to having it easier than that. This is just a general Med Surg floor that typically gets GB, Appy, colon resections, CHF-ers, COPD-ers - etc. It's not like they have to take on any major drips other than maybe a heparin drip, invasive lines or any majorly complicated cases. This kind of complaining just makes me sick :barf02: Especially, knowing what I know and comparing notes with others to confirm what I was thinking.

Believe it or not, my CFO has issued a HPPD for my floor at 13.3 - I can't believe that either. Something just isn't right with that. I was thinking that an average HPPD was around 8 or 9. Talk about frustration!!!

Longhorn Mama · Feb 1, 2008

Ginger - I work in a similar situation as yours in a rural hospital with a 35 bed Med/Surg unit as Nurse Manager. My HPPD is 8.5 and is getting ready to be lowered. I would kill for even 9. I have the same problem with the weekend charge nurses not adjusting the staffing to the census, so I either have to call and tell them what to do on weekends, or leave detailed written instructions. I having a staffing grid that I've developed that I would be happy to share with you if you'd like - but it doesn't always paint a true picture in terms of acuity. We do some drips on the floor like Cardizem and that requires closer monitoring; we're trying to be restraint-free so I frequently have to take someone off the floor to be a sitter. I would love to talk!

Ginger35 · Feb 2, 2008

Lonnghorn,

Thank-you! I would love to talk too. I attempted to send you a private message / e-mail - but it looks like there is no contact info listed for you.

I have mine on here. If you are uncomfortable listing contact stuff - please feel free to use it.

I would love to compare notes.

Sincerly,

Ginger

SarahK73 · Feb 27, 2008

I manage what used to be a 20 bed that is now a 30 bed med-surg unit. Our staffing matrix is 1:5 but we have been short staff so my night shift has been taking 1:6 occassionally with nurses aides to help at a 1:7 days and 1:10 night ratio. We are just finishing budget and I am asking for increase from 9.8 to 10.0 ppd. My biggest problem right now is the huge amount of admission/discharge/transfer activity that occurs on a daily basis. The extra hours I want to put towards a charge nurse with no patients for M-F 8 hours a day. I recently met with somone from Missouri that said her ratios are 1:8-10 for a med-surg floor which seems outragous to me. What is everyone doing for charge nurses do yours count in the matrix and do they take patients?

Sarah

patwil73 · Mar 4, 2008

My hospital has recently adopted a new staffing matrix (change from an acuity based system) that = 1RN to 4 pts on days, 1RN to 5 pts on eve, and 1 RN to 6pts on nights. They should always have an unassigned charge and 1 pca for up to 12 pt's.

The difficulty with an acuity based system is that often acuity is not what takes up the most time. An Rn can be stuck in a patient's room half the night - and that pt could be a walking, talking, young independent individual who just happens to complain a lot. So on our acuity system he would score very low and hence the unit would be staffed with less even though the patient's were very "heavy" in terms of time spent with them, rather than "heavy" in terms of acuity.

One thing I have discovered with the change is that whatever model you adopt, staff will hold to it. On the acuity system they had teams (an RN and PCA) and could take 6 on days. Now since the matrix says 4, they will scream and holler if you go above that number regardless of the reasoning (we don't have the staff to meet the matrix at high census times).

What I have discovered as a nursing supervisor on nights is that often it is the availability of support staff that makes a big difference. Does your hospital provide secreteries, lift/transporters, extra pca help to answer lights and run labs, an admit/discharge RN, etc? Providing support makes it much easier for the floor nurse to care for her patients and goes a long way in quelling disgruntlement.

Hope this helps,

Pat

classicdame, MSN, EdD · Mar 13, 2008

the problem with settling on a number is that one patient can consume all your time and another day you manage 5-6. Try to establish an acuity rating or another manner in which individual situations can be considered. Get input from your charge nurses. If Admin talks about having more money spent in your dept on staff, be prepared with figures to show that more staff = more productivity and greater patient satisfaction. Not to mention employee satisfaction. Hope this helps some.

kaz355 · Mar 21, 2008

Staffing mix is definitely where the balance comes in. Where are your hours best spent? Only you can answer for your unit. If your CEO is giving you 13.3 hours, be careful. You also have to look at your budgeted dollars. Those hours have to be balanced with your mix. A 1:5 pt ratio is great on a Med/surg unit. If you have heavy ortho pts, lots of ambulation etc, your NA will be extremely important. Also consider, do you have transport, an IV team, and other support services?

Let me say, staffing a med/surg unit isn't the easiest thing to do. Sounds like you are working your way through learning your new role. Best of luck. The rewards will be big when you get this figured out. One word of advice, use your staff to help you. If they know the budget parameters and help you design the staffing pattern, they will help you stick to it. I was able to keep an RN and eliminate a unit secretary after 1100 based on the charge nurse input.

GOOD LUCK.

PJ rn · Aug 1, 2009

I just started a new job on the med/surg floor. adc is usually around 18-20 but has been running full 30-34, staffed for 18-20. npratio is 1:7 days and 1:8 nights supposedly but have found that ratio goes out the window when beds are open and there are admits.

Does anyone have a template for a staffing budget or staffing plan? Thanks

brimama · Feb 6, 2010

I have 60 employees and 37 beds. My HPPD is 8.7

I am able to staff 7 nurses and 3 techs on days and nights( 12 hour shifts) The charge nurse floats and helps everyone.

I have a secretary on days for 8 and nights for 8 hours.

My staff is very happy when they have 7 nurses which is 80% of the time.

You will always be over budget with the HPPD that is set for you now.

brimama · Feb 6, 2010

If you let your staff know how you are doing on the budget they can become part of the solution.