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.
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.
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.
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.
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?
Specializes in Med/Surge, Psych, LTC, Home Health.
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. 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.
For the most part from these posts, I haven't seen many day shifts taking 7-8 patients....that is what it is at my hospital. 7:1. 7A-7P, AND 7p-7A. Charge, sometimes, aides sometimes, acuity, we don't staff towards acuity. Numbers only. We have the highest nurse/pt ratio in the entire area.
Sorry for all of you night shift peeps...that the ratio goes UP! That whomps. I couldn't imagine taking care of 8-10 pts at ANY time, DAY or NIGHT! When patients go bad, they go bad.. I don't think they say, "oh, let me not take a turn for the worse during the night, they have more patients". I don't think they can choose a TIME. So why should administration CHOOSE a time for staffing ratios to change??????????????:uhoh21: OH, but 7 is also too many at any time.
I work night shift also and that comment burned my butt too. I agree with you 100%. Usually those that make comments like that thinking that night shift has it easier than dayshift has NEVER worked night shift!!!!!!!! I have worked ALL shifts, they are ALL tough. Nursing is not an EASY profession!!!!!!!
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.
i work on a neuro/stroke floor and our max is 1:6 but usually we have 1:4 or 1:5. we have many total care patients, and our population also has a tendency to do very strange things (like crouch and poop on the floor or claw out all of the lines while screeching) so i feel like i can give good care with a 1:4 ratio; 1:5 and i don't have time for a real lunch; 1:6 and i am out of my mind trying to keep up.
we have PCT's as well. theya re assigned max seven or eight. im not sure./
I work on a thirty-two bed medical specialty unit (endo, neuro, stroke, renal, rheum).
We have a charge nurse and a clinical support & development nurse Mon - Fri (non-clinical) 0800 - 1630, a resource nurse (no patient load) morning and afternoon, and a ward clerk from 0800 - 2000 Mon - Sat, 0800 - 1600 Sun.
The ratio is the same for AM (0700 - 1530) and PM (1300 - 2130) - 1:4; at night it's 1: 8 or part thereof. At present we have four closed beds because we don't have enough staff to meet the ratios, so we on nights have seven patients apiece. I'm currently resourcing, so I have that, plus my seven patients, plus traipsing down to cas to do peritoneal dialysis on a patient with peritonitis.
Ratios are law here, which allows us to close beds when we're understaffed. No negotiating with admin, no deferring to higher powers that be: no staff, no beds. I'm sure that's what's reversed the attrition trend in Victoria and brought more nurses back into the system :)
PS No LPNs and no CNAs but we do have a patient attendant help with washes Mon - Fri
Our unit does Tele/Stroke/Med-Surg, so we get quite a mix.
The night shift comment irritated me as well. I agree, it was the assumption that we don't do anything that bothered me. SO not true!
I get around 7-8 patients with a tech. We have only two techs for around 40 patients so we have more licensed support if someone goes bad. We have a monitor tech at night who does the measurements of the strips, stuffs the charts and puts in the orders for the admissions; we do the assessments, meds, help the techs with the heavier or more confused patients, answer lights, assess the monitor strips, and the 24 hour chart checks. Of the nurses on the unit, at least 2 have to be Tele nurses on the unit at all times.
I insist on taking a break and eating a little something around 0230 because if I don't I get really spacey at some point when I really need to be on my toes.
I have only been a new grad/med-surg nurse now for 11 months and consistently get 7-8 pts, sometimes 9. Last weekend (nights) I refused a 9th patient (new admit) because of the acuity of my other 8. I know I made the manager mad, but who's butt is on the line anyway? I told him, fire me, write me up, I just can't do it.
I am seriously worried about losing my license or my mind at this facility. No time to eat, sit, or catch a breath... it sends me home in tears. But, I signed a contract and have another year to go. At this point, I don't care what I owe--I just want out and am looking for another job. I feel it was a mistake to take a "free ride" from this facility in the first place by having them pay for my schooling in advance. And the shame is, I really like med-surg, but not when my patients are widgets- instead of humans. I am really comfortable at 1:6- even 1:7---
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. 
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Georgia peach RN
76 Posts
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: