Day Vs. Night Ratio?

  1. Does your nurse to patient ratio change from day shift to night shift? Do you think it should? Do you think it's fair if it does or doesn't?

    Ours doesn't. Max 6 patients on days, max 6 patients on nights. While I don't think night shift should have more than 6 patients, I would like day shift to be capped at 5 patients. I wouldn't say that it's not fair that we have the same amount of patients on day shift, but I still feel it's easier for night shift to handle 6 patients vs day shift.
  2. Poll: Does your patient ratio change from shift to shift?

    • Yes, and it should.

      32.00% 16
    • No, and it should.

      12.00% 6
    • Yes, and it should not.

      26.00% 13
    • No, and it should not.

      28.00% 14
    • I have other opinions and will explain in detail.

      2.00% 1
    50 Votes
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    About DEgalRN

    Joined: Jun '10; Posts: 457; Likes: 964


  4. by   classicdame
    as a former night nurse I will add that people do not all go to sleep and stay that way all night. Many nights we were running with new admits and caring for those already admitted. I think the ratio should be the same each shift.
  5. by   0402
    I work nights, and I think that we should be able to carry a higher ratio. Days on my floor should be 1:4-5 and nights should be 1:5-6. I don't base this on time for pt care or admits, but moreso on discharges. Discharges are so involved and convoluted as to what the RN has to do, that doing more than on in a shift, along with pt care on any more than 5 pts becomes fairly impossible. Our staffing matrix allows for these ratios but day shift is generally short-staffed, even more than night shift, and they have been carrying 6 and 7 patients, which is unsafe and pushes a lot of day shift work onto night shift (yes, I understand that nursing is 24 hrs, but this is more than that).
  6. by   canthelpfalling
    Have you ever worked nights? I've done both, and it is NOT easier to have 6 on nights. Pts don't sleep. Bed alarms and call lights are constantly going off, pts with sundowners are all over the place, we get 1-3 new admits per RN at night. Days are busy, but so are nights and nights are in no way easier.
  7. by   Nightshiftsk
    Discharges - the reason I will never work days . When I have to do one at night I hate it. And the paperwork and med forms are always changing. Once had to apologize to a pt. and explain that I just couldn't figure out the
    paperwork. Luckily he was A & O x 4 and just wanted to get the hell out of there. Drove me crazy though.
    Last edit by Nightshiftsk on Mar 22, '12 : Reason: Typo
  8. by   PediLove2147
    I don't know about other floors but on days the nurses deal with admits (from ED and PACU), discharges, new orders, and family members. Night shift gets the occasional admit (only ED), no discharges, the occasional new order, and usually no family members as our hospital has visiting hours. I have done both. It is just busier on days. So yes, I do think a nurse can handle a larger patient load on night shift.
  9. by   SweetRNJ
    I work days.. on days we have 3-4 patients..which i think is a very good ratio.. our staffing is very good on our floor so i'm not complaining. PM shift if pretty much the same as day shift ratio... 4 is usually their max...unless we are really short staff or we have a call in
    Night shift on out floor has 6 patients max.
  10. by   ninja-nurse
    Days at my hospital is supposed to be 4-5 per nurse (note the emphasis) while nights is 5-6 per nurse. We get more admits but less discharges (which is fine) but we have NO HELP. Secretary only till 2300 and usually NO tech for 6 patients per nurse. If we had help, the higher number would be fine, but without it... Half of these patients don't sleep. And the elderly patient who's a doll during the day? Absolute PSYCHO at night - combative and trying to fall out of bed every 5 minutes.
  11. by   rn/writer
    I work postpartum--moms and newborns. We get admissions around the clock, and the babies can't tell time so many of the mothers are awake throughout the night. We night shift nurses usually have a little more time to help the breastfeeding moms learn what they're doing. And we can do some of the mountain of teaching our patients need before dishcharge.

    Day shift has an extra nurse or two when there are a lot of discharges expected, and that only makes sense.
  12. by   Barley
    We have 6 patients days and nights, but I think it should be 4-5 max on days and 5-6max on nights. For us, there are things day shift has to deal with that night shift does not typically deal with: discharges, patients going off/coming back on floor for testing/procedures, phone ringing off the hook, new orders, having our work flow interrupted by discovering PT/OT/Speech/SW/dietician/MD/etc is in room working with patient, multidisciplinary rounds. I was told at the interview for my job that day shift is typically 5 patients per nurse and will occasionally go to 6, but since last spring, we've been running consistently at 6 for all nurses on day shift.
  13. by   turnforthenurse
    The ratio should be the same. Contrary to popular belief, night shift staff do not just sit around and do nothing all night and have patients who sleep all night. Oftentimes there are a lot of patients who DO NOT sleep during the night. You have the sundowning/confused patients. You're short on resources on nights, too...there is only one MD in house. We have no pharmacy after hours; we have to rely on our nursing supervisor to get us medications that we do not have on the unit. Bad things typically happen at night time, too - the codes, the patients who fall, patients who stroke out, etc. We have to transport our own patients to tests after hours which takes up time. Sometimes radiology can bring the patient back but not always. We seem to get a lot of admissions on night shift, too and yes, we do discharge patients at night! Discharges usually happen before 2100-2200, though. We still deal with family members - oftentimes we have at least one family member staying with a patient.

    In short, night shift can be BUSY, just a different kind of a busy. I do not think the ratios should increase for the night shift staff, though. And for the record, I work on a progressive care unit. We used to have a ratio of 1:4 but because of staffing, it's now 1:5 and occasionally 1:6, which is absurd for this level of care imo.
  14. by   LeggyNurse
    Those patients that hit the call light all day are still hitting the call light throughout the night. Still needing to be cleaned every hour (with no aids) and still wanting pain medication every hour on the hour. I'm not complaining because I love my job but night shift is not all fun and games. It depends on the patient load just like it does for day shift.
  15. by   windowrn
    I am a new grad (4 months in so far) so take this for what it is worth. Both days and nights are very busy on our unit. I work a medical tele unit in a 900 bed hospital that takes 5 both days and nights. During days, we have a UC, charge with no patients, unit manager, CNM, techs with a 9-1 ratio and doctors on the floor. Nights we have a charge who often has to take 2 patients if we had anyone on call before she can call that person in, 12-1 ration for the techs, no UC, no docs on the unit, no manager, etc. Days typically starts with 5 patients, but very often they are discharging patients and having patients off for lengthy tests, so they frequently do not have 5 on the floor all day. We almost always start with 3-4 on nights and are all the way to ratio by morning. I do 1-2 admits almost every shift. I think it's a little telling when we fight to see who gets to start with 4-5 rather than 3-4. My nights are so much easier typically when I start with 5 rather than 3-4. I have done admits and discharges and I find admits to be way more time consuming. ER tends to send unstable patients in pain and I often wind up tied up in a new admit for 90+ minutes. At least once a week one of the nurses is calling response on a new admit and they often wind up leaving for the Unit before they ever get settled. Waiting on a doc to call back at 0300 when your patient is in afib w/rvr with nothing by po lopressor ordered is stressful.

    I think both are very busy. Personally, I like the flow of nights - fewer tests, docs, families, etc. Nights do have 24 hour chart checks, careplans and a few other daily charting requirements that days don't have to deal with. I don't think we should have more than 5 on nights, but 5 on days seemed like far too many when I precepted there. I don't know if with more experience it wouldn't have been quite so overwhelming (I really didn't have my time management down at all before I switched to nights).