Need opinions here on safe staffing ratios people!

86toronado, BSN, RN · Apr 15, 2009

Are you in NY? Just curious, I know our lobby day is coming up.

To answer your question, (and I'm not an RN yet so I don't know how much weight my opinion will have) but in a critical care setting like ICU, CCU, PICU, NICU, etc. it should be no more than two or three patients per nurse-but some will say no more than 1 or 2 I'm sure. On a regular med-surg floor, I'd say not more than 5 if they are on heart monitors, and not more than 7 if they are not, but that could vary by shift (more to do on day shift than nights, in general).

That said, you might have better luck getting more responses by posting this thread in the general discussion section, as it's probably a more active forum.

Good luck at Lobby Day!

KneKno · Apr 15, 2009

I think everyone working will have a different idea of "safe staffing." A quick google search found these 2 articles, the first is more technical, the second a quick review of California ratios. Good luck!

This is from Dept HHS, re: LTC facilities. Compares various states with ratios, how implemented, additional issues including political information.

http://aspe.hhs.gov/daltcp/reports/8state.htm

This is about California, has some info about the states mandatory ratios

http://www.medicalnewstoday.com/articles/93160.php

cjcsoon2bnp, MSN, RN, NP · Apr 15, 2009

First of all let me say that I wish you good luck, what your doing is really cool and its important to be a part of nursing advocacy and the democratic process. I will say that you need to have a really good idea of what your purposing for safe staffing ratios before you speak to your area leaders. "Safe staffing ratios" is different depending on who you are talking to, for example this is what I would define as safe staffing ratios based upon my experience.

Hospital setting:

Critical Care Areas (ICUs, Stepdown Units etc.)

1 - 2 patients per nurse

Non Critical Areas (Such as Med/Surg)

Day/Evening Shifts in Med/Surg w/o Telemetry

6 - 7 patients per nurse
10 patients per nurses aide

Day/Evening Shifts in Med/Surg w Telemetry

5 patients per nurse
10 patients per nurses aid

That's just my opinion on those areas, I think you need to speak to nurses in different specialties and do some research on the effects of lower staff-patient ratios on patient care versus higher staff-patient ratios on patient care and be prepared to discuss how lowering the nurse-patient ratios have worked in other states. Good luck! :)

!Chris :specs:

Julia RN · Apr 15, 2009

your topic is a great choice for your lobby day.

if you are lobbying as part of a group or organization, you will likely be provided with the specific legislation or bill that they support.

most of the state staffing ratio bills seek to set a maximum number of patients that an rn can be assigned to care for in a given unit, and require facilities to establish a staffing plan that meets those requirements. in addition, the plan must provide for adjustments of patient assignments based on factors like acuity, availability of support services, level of competency, etc. the adjustments would be to have less patients per nurse under certain conditions. the bill should provide that direct care nurses participate in formulating the staffing plan for the facility.

some additional resources for you:

http://www.nysna.org/advocacy/activity.htm

a2264 would establish minimum nurse-to-patient ratios in all healthcare facilities. this bill was agreed upon by labor unions in new york state that represent registered nurses. memorandum of support

http://www.massnurses.org/legislation-and-politics/safe-staffing

http://www.protectmasspatients.org/

wish you success at lobbying and your chosen profession!

MikeyBSN · Apr 17, 2009

This would be my recommendation:

Day:

Heavy Trauma or post-open heart surgery pt: 1:1

CCU and ICU patients: 1:2 or 1:3

Stepdown: 1:4

ED: 1:5

Peds floor: 1:6

RMF: 1:8

Night Changes:

Peds floor: 1:8

RMF: 1:10/12

Pediatric Critical Care Columnist · Apr 17, 2009

Peds 1:6 on days and 1:8 on nights is NOT safe. Children are at high risk for entanglement and due to their size are usually unable to disentangle themselves before they strangle. They don't have the ability to communicate their needs and eliciting information is time-consuming. They're total care. Parents don't always spend 24 hours a day at the bedside and when they do, many of them don't do anything beyond diaper changes, "because of the tubes and wires". Kids are also much more unpredictable than adults in that they compensate far longer and crump far faster than any big person. They need close observation when they're sick, not necessarily q15min but at minimum hourly. So IMHO, peds hould be 1:4 on days and no more than 1:6 on nights.

For many of the same reasons, PICU patients should never be 1:3. If they're in a condition that allows 1:3 care, they shouldn't be in PICU anymore.

MikeyBSN · Apr 18, 2009

Peds 1:6 on days and 1:8 on nights is NOT safe. Children are at high risk for entanglement and due to their size are usually unable to disentangle themselves before they strangle. They don't have the ability to communicate their needs and eliciting information is time-consuming. They're total care. Parents don't always spend 24 hours a day at the bedside and when they do, many of them don't do anything beyond diaper changes, "because of the tubes and wires". Kids are also much more unpredictable than adults in that they compensate far longer and crump far faster than any big person. They need close observation when they're sick, not necessarily q15min but at minimum hourly. So IMHO, peds hould be 1:4 on days and no more than 1:6 on nights.
For many of the same reasons, PICU patients should never be 1:3. If they're in a condition that allows 1:3 care, they shouldn't be in PICU anymore.

I have 4 peds patients as a nursing student. Our hospital was inner-city and every kid I ever had in that hospital was child services case. I never saw a parent on the floor, never, not once. We had to do the "babysitting" as well as the nursing. If you have a good PCT staff, they should be helping with the diaper changes and basic needs of the babies. I do agree that the "ped" derivitives should have a lower nurse:patient ratio in general, just not that low.

live4today, RN · Apr 18, 2009

I commend your professer for having his/her nursing students take part in this very worthwhile assignment! :yeah:

When you go before your state senators, DO the nursing profession justice by NOT just mentioning "numbers" when talking about "safe staffing ratios". DO emphasize the necessity to keep those staffing ratios flexible based on needs of the patients being considered. It only takes one patient going sour, or one patient to tie up a nurse for various reasons to send those "numbers" crashing...rendering them meaningless in reality, no matter what's on paper. :twocents:

On Med/Surg, it should be mandatory to have NO MORE THAN five per nurse, BASING THAT RATIO on the ACTUAL acuity level of each patient...not based on acuity levels we do today with such a broad range for "Acuity Level III" stats we have today...which makes MOST med/surg patients "fall into that level III category" which most Med/Surg Nurses know is hogwash. :icon_roll

It should be mandated to have one nurse per every three to four patients on inpatient units at all times...even on evenings and nightshifts. Patients are sicker today than ever before. Patients take up much more time than ever before thanks to the "the patient is always right rule" and "the patient calls, the nurse jumps YESTERDAY" rule, then add the "Visitors can stay 24/7 rule, and wait on them to keep the entire clan happy" rule.

In order to offer excellent service -- minimizing patient wait times, visitor/family/patient complaints, and patients need to have their nurse more up close and personal.........more...not less...nurses per patient are needed. Does that cost money? Absolutely! Hospital Owners/CEOs know that BEFORE going into healthcare businesses, so the pressure needs to start at the top before the hospital is even built and opened for business. They want to make money and stay afloat? Do it right from the planning stage, and not take it out at the cost of the patients and the staff that care for those patients. Patients equal dollar signs to healthcare business industry folk, BUT...to nurses......patients-R-our-business...we expect to give them the best care...not half-azz backwards care. :twocents:

KneKno · Apr 25, 2009

To anyone working within mandatory ratios: How does this work for lunch breaks, or if someone needs to respond to a code or rapid response? At the hospital where I work, ICU and step-down nurses both respond to code blues, and and ICU and CCU RN responds to rapid responses. If nurse ratios are set, who watches the off the floor RN's patients? Even for lunch breaks, the ratio wouldn't be correct if another RN is "watching" more than the set number, right? Curious, Michele

Pediatric Critical Care Columnist · Apr 25, 2009

I worked on a PICU that had a strict 1:1 ratio for intubated patients; it was hospital policy. There was no cross-coverage of intubated patients. Someone had to physically be at the bedside so during breaks a resource nurse or the charge nurse covered. If the patient at the next bedside was not intubated and was a floor patient waiting for a bed, that nurse could cover the intubated patient but s/he had to be at the intubated patient's bedside; if her patient needed something the nursing attendant would see to it. If the resource nurse or charge nurse were covering a break and there was a code called, the nurse assigned to the patient returned to the bedside. Automatically and without hesitation.

TuTonka · Apr 27, 2009

Thank-you for a wonderful message. I hope all states adopt the nurse/pt. ratio that Cal. Has. They also now have specialty teams under various names per facility that come and take over a pt that MAY be crashing which frees up the floor nurse to cont. the best possible care to their other pts. It would behoove all US states to adopt these also. Today more than ever the pts are paying more and receiving less for their $$. If you can help your state deliver better care maybe even more lives and personal life styles will be saved. Thanks to all participants.

TuTonka