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Med-Surg Topic of the Week .... Nurse to Patient Ratios

Posted

Specializes in Nursing Education and Critical Care..

I know this is a hot topic, but I am interested is some debate as well as healthy discussion on nurse to patient ratios on a general mixed medical & surgical unit.

As most of you know, I am a nurse manager and my unit is 40 beds. We have a total of 20 surgical beds and 20 medical beds. Most of the time, the medical census remains pretty stable, while the surgical census fluctuates all the time.

We have a general nurse to patient ratio of 1:5-6 on days and 1:7-8 on nights ..... with this we also have a secretary and nursing assistants with a CNA to patient ratio of 1:12 on days and 1:16 on nights. I think these are pretty decent staffing ratios and am interested in getting some feedback on what your med-surg unit is doing.

Thanks!

1:4 on days, 1:5 on evenings and 1:10 on nightshift. No nursing aids. Secretary for the day and half of the evening shift. One RN team leader for each shift who has no patient load. We are a 48 bed orthopaedic unit.

RNPATL, MSN, RN

Specializes in Nursing Education and Critical Care..

Your unit sounds wonderful. Ortho patients are pretty heavy, so I would imagine that a lighter ratio without aides probably helps out a lot. However, sometimes having an aide can really be helpful.

Two RN's (or one RN and an LVN). Ward Clerk from 6:30 a.m. to 10:00 p.m. most days. One or two CNA's. Our ratios are 6:1 max all the time due to California ratio law and that will change to 5:1 in January.

steph

I work on a 20 bed med/surg floor where we have one charge nurse who works days 6:30 to 3 mon thru friday. We work 12 hr shifts. Our patient ratio varies depending on the census. Usually we have around 15 patients most days. Our average is 3 primary staff with atleast 4-5 patients each. I've never had more than 6 patients and with most of them being ambulatory. No CNA's. We have only one LPN full time on days and nights has 2. RN's are responsible for signing off their charts if a RN didn't have that patient in 24hrs. We also have a unit secretary who works 8 hrs, 2 per day. Night shift has 3 nurses working most nights, sometimes 2 if the census is down. Most of the time if we are busy and happen to be short staffed usually we get a float from either OB or ICU.

General E. Speaking, RN, RN

Specializes in floor to ICU.

I work on a 28 bed med-surg floor. We have 10 pedi beds and use them as MS overflow when the pedi census is low. We work 12 hr shifts. This is the only hospital I have worked at where the night nurses have the same amount of patients as day shift. Five or six patients each. One charge nurse w/o patients. During the day we have 2 aides at night they have 1.

Too bad I can't hack night shift.... :crying2: More money for less work.

The floor I work on we do team nursing. Either an RN with and LPN or an RN with a CNT (certified nurse tech, a nursing student with at least one semester under their belt). The teams that contain an RN and LPN take more pts. usually 6-8 sometimes more when census is up. The teams that have an RN with CNT are not suppost to have more than 6. Basically because the student can't pass meds which means the RN has to do the IV and po meds, along with making sure that the CNT is doing their job right since they don't have a license.

starcandy

Specializes in tele stepdown unit.

We have modular nursing on my floor. On afternoons the ratios are 2:7-8 . This is a team of RN and one PCA or the RN has 4 patients alone. Modular nursing is when you have a set assigned group of patients regardless of acuity. I think this sucks sometimes when you have a heavy set and someone else is playing games on the computer.

live4today, RN

Specializes in Community Health Nurse.

Two RN's (or one RN and an LVN). Ward Clerk from 6:30 a.m. to 10:00 p.m. most days. One or two CNA's. Our ratios are 6:1 max all the time due to California ratio law and that will change to 5:1 in January.

steph

That info makes me want to move back to Cali come January! :) Which hospital would you recommend? Any travel nurses in your area?

schroeders_piano

Has 18 years experience.

Too bad I can't hack night shift.... :crying2: More money for less work.

I almost let this comment go by, but I can't.:angryfire I used to work Med/Surg on the night shift. Just because is it night, it does not mean it is less work for the nurses. I find it funny that a Med/Surg unit had to have a 1:5 ratio for the day shift, but one minute past 7:00 p.m. it is alright to have a 1:8 or 1:10 ratio. I realize that a patient's status change, but not that quickly. I have been reading throughout these boards about nurse retention. One of the reasons my Med/Surg unit couldn't keep nurses, was the day shift kept telling us how overworked they were and how we, the night shift nurses, didn't do anything all night. These statements were coming from a dayshift staff that had 15-20 patients. 3 or 4 RNs, 3 CNAs, a ward clerk, and case management nurses who covered lunches and breaks. Night shift had 2 or 3 RNs or LPNs and that was it. Sometimes we would get a ward clerk until 11 p.m. or we might get a CNA, but not always. The night shift also had to do the daily "chores" of the unit such as cleaning the nurse's station, checking the crash cart, restocking the rooms, etc. I was suppose to squeze this in between assessing 10 patients (or all of them if I was working with a LPN), passing meds, providing hygiene care, helping patients ambulate in the hallway (because dayshift was to busy) and doing doctor rounds with that one doctor that waits until 10:30 at night to come and see his patients. I don't normally get on my high horse, but for some reason this comment rubbed me the wrong way today. I will just apologize now to the people I might offend.

Schroeder

Too bad I can't hack night shift.... :crying2: More money for less work.

Oh my...

Wanna hear about my night last night? I was the only RN plus three LPN's. We got five admissions. I had a pt I had to call and get a bolus for b/c his BP was bottoming after IVF @ 150 all day, a pt recieving blood, a toddler /c a terrible SpO2, a postop colon resection, a pt /c sepsis, two chest pains, a pt in DT's, a LOL in CHF /c MSC, got another postop emergent colon resection, a pt in traction to be prepped for surgery, a pt /c CRF and COPD, a pt that had to have emergency transport to a cath lab, three low Hgb's I had to call and MORE blood products to give, a pt /c an ammonia of 190 and SO confused, elevated cardiac enzymes I had to call, not to mention all the total care patients we had on the floor. BTW, none of the LPN's are allowed to do IVP or hang blood, and we don't have aides or a ward clerk. We do EVERYTHING for our patients. Do you think one person on my crew last night had a spare second to take an extra breath?

Why can't all shifts respect the hard work we ALL do and agree that ALL shifts are hard?

I will say it ONE MORE TIME: JUST BECAUSE IT IS DARK OUTSIDE IT DOESN'T MEAN THEY SLEEP.

Off my soapbox now, didn't mean to hijack the thread.

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 28 years experience.

I'm disappointed to hear that you think 7-8 is a decent ratio for night shift. But that's probably because I've recently went back to a floor with those kinds of ratios and am seriously struggling. I don't necessarily feel unsafe, but feel overworked, especially with the paperwork. I'm getting better but 8 patients is too much.

I could provide most excellent care for 6 patients max.

Georgia peach RN

Specializes in GI, ER, ICU, Med/Surg, Stress Test Nurse.

I work in a rual hospital our staffing is based on the patient census and they use this formula:

# of pt. X 4.4 (hrs)/12 (hr shift) so if we have 15 pt's it goes like this 15 X 4.4=66/12=5.5 staff this includes the charge nurse, then we can have 4.5 others, when the census drops then someone has to go home. we have two wings to staff at times.

:balloons:

DutchgirlRN, ASN, RN

Specializes in OB, M/S, HH, Medical Imaging RN. Has 33 years experience.

I almost let this comment go by, but I can't.:angryfire I used to work Med/Surg on the night shift. Just because is it night, it does not mean it is less work for the nurses.

I don't want to offend anyone so I will speak for "only" the hospital in which I work. The difference between day shift and night shift is like being in two different hospitals. I have worked both shifts. Days is crazy, you're lucky to get 10 minutes to wolf down some lunch. Nights is busy, but not crazy until about 10 PM. Then there is not a thing to do until 5:00 AM. It is soooo boring and the shift goes by soooo slow. Our ratio is 5-6: 1 on days and 6-7: 1 on nights. We have a unit secretary from 7a - 11p and CNT's with a ratio of 10: 1 for each shift. I hate working nights and I think they deserve the extra differential for doing it. More power to night nurses! I did it for 12 years. I just hate it when they complain to days how busy they were, when I was there also, and know for a fact they along with myself sat on our butts for at least 7 out of the 12 hours. I know this is not the same in all hospitals. I am only speaking for my own.

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 28 years experience.

I know this is not the same in all hospitals. I am only speaking for my own.

Can I come work there. Nothing to do for those long hours would be nice.

During that time we're doing the extra duties assigned to nights (fair because days is too busy to) and doing charting for 8 patients. I've had only a couple long boring nights in my job. It's the paperwork that takes up those hours. My patients don't sleep either, they're in pain or anxious. Also we admit all nigh. Trach care, dressing changes, admissions, on and on and on. :)

Why wouldn't you take them at their word when the complain they were busy? I agree 100% days is much more busier and I'm sure I couldn't do it, even with lower ratios than nights, but don't negate a night shift workers right to vent about their job.

During days we are staffed anywhere from 1:2-4, depending on the acuity of the patients. Honestly, I only remember a few times it was actually 2 patients.. but it does happen. Along with that we typically have 1-2 CNAs on our floor helping with the baths. If anything else needs to be done we basically have to beg. We also have 2 secretaries during the day and 1 on evening shift. The majority of the nurses on my floor work 12 hour shifts so on evenings it stays about the same - 1:3-4 with only 1 CNA for the evening shift. On nights we usually have 1:5-7 with no CNAs. It is usually busy also. I don't remember the last time I just sat around waiting for something to happen. During days/evenings the charge doesn't have any patients and they help out where needed. On nights they take about 3-4 patients.

nursenatalie, ADN, RN

Specializes in Surgical.

Depending on how our staffing is, or like now we have one nurse out on maternity leave and one out for surgery; the usual is 1:4-6 on days and nights are 1:5-8 on nights. I work nights and have had 9 post op patients. We are surgical only. I have very few nights that I am not busy, busy. If I have a less acute group of patients then I will try to do things that are often neglected when we are very busy, then of course we get an admission and the down time is over. I still have a hard time believing the nurse that said she sat on her butt for 7 of the 12 hours, no one was in pain, wandering, pulling out iv's...nothing! Did these people even need to be hospitalized if they can go this many hours on auto pilot while you warmed a chair?

NurseCard, ADN

Specializes in Med/Surge, Psych, LTC, Home Health. Has 13 years experience.

I work on a post-surgical floor, but we also take care of peds, urology, oncology, and the overflow from the medical floor.

I wish I worked in a state where nurse-pt ratio was set by law. :o At my hospital, it all depends on how many nurses we have scheduled and/or how many brownie points the nursing supervisor (who does our scheduling for each shift) wants to earn with her superiors by scheduling as few people as possible.

Generally though, on day shift it's 1:5 for nurses and up to 1:10 for techs, on evening shift 1:6 for nurses and up to 1:12 for techs, and night shift can be anywhere from 1:6 to 1:10 for nurses and about 1:12 for techs.

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