Nrs/Patient Ratio

pickledpepperRN · Apr 20, 2006

It is truly a beautiful harmony at some hospitals on most shifts.

Unexpected helthcare emergencies or sudden influx of patients can happen with the best management and nursing team.

Unfortunately some facilities staff to the bare minimum required. ( I hear Tenet and HCA are among the worst chains) They ignore the need to increase staffing according to the needs of patients as assessed by the RN.

Our telemetry unit has two basic acuity levels. Ventilated patients, those with unstable vital signs, agitated confused patients, and others are staffed at 3 patients per RN. Stabe patients on cardiac monitors are 5 per RN. An LVN or CNA is assigned to work with two RNs as a team. An RN with trached or intubated patients gets an LVN.

RNs do all assessments. We don't co sign others charting. If the LVN suctions a patient, does dressing changes or tube feedings, or observes signs and symptoms he or she charts it. Unless routing the RN is always told.

On days there is an extra CNA for running errands and discharging patients.

There is a monitor observer at all times. Secretary from 7:00 am to 11:00 pm. At night the MT will answer the phone.

There is a charge RN with no assignment who relieves for meal breaks.

Sounds like heaven? Often it is really great. Some supervisors actually staff by acuity so it can be good even when acuity is high.

Others go by the described guidelines (matrix). It is MUCH better but not always ideal.

Threads from before and just after the ratio law went into effect:

https://allnurses.com/forums/f137/new-staffing-ratios-42518.html

https://allnurses.com/forums/f137/nurse-staffing-ratios-set-january-debut-45738.html

https://allnurses.com/forums/f137/1-1-2004-ratios-law-53202.html

https://allnurses.com/forums/f137/what-new-staffing-law-53215.html

Beary-nice · Apr 20, 2006

Hello from the midwest.
Im sure there has been a thread on this but i really dont have the wear withall to sit and sort through all of them and i cant seem to get the search to work. If anyone has the link to a good thread regarding your nurse patient ratios since the law passed please help.
My department head was discussing with us her hope for us to go to the same model as California nurses have with no LPN's on the teams. Rn doing TPC with a CNA. 1:5 or 1:6 ratio. Im just not sure this is such a picture of harmony she is wanting to portray. Can anyone help me out and give me some opinions?

We have recently went to something like this. Initially they wanted the ratio to be 1 RN to 4 pts but that lasted a week or two. They put the remaining LPNs on the floor to do CNA duties only. LPNs were no longer allowed to take admits, do assessments or teaching etc. They could however pass meds as permitted by their scope of practice, change dressings, do accucheks. Otherwise it was baths and walks only oh yes and vital signs if the RN was too busy to do her own. Like I said this lasted a couple weeks. The usual ratio has been 1 RN to 5-7 pts with the CNA or LPN responsible for 10-14+ pts. Now when I work, the LPNs have been taking pts again, not enough RNs. We have very high turnover. :uhoh3:

meownsmile, BSN, RN · Apr 21, 2006

Thanks for the links and info. Some of us working today were discussing this and actually it doesnt really sound any different than what we do now.

20 patients would still warrent 2Rn's, 2LPN's and 3 CNA's, the mix is just manipulated a little differently.

If you dont mind, spacenurse, then, do the RN's do TPC as far a oral meds, IV's, etc. Or does the LPN who works with the 2 RNs as a team do oral meds etc?

pickledpepperRN · Apr 22, 2006

The two RNs and LVN decide who will do what right after report.

Generally the LVN will work with six or eight patients with each RN assigned three or five.

Our staff LVNs are so good! We've worked together a long time. Usually we do rounds together introducing ourselves to patients and attending to anything urgent.

Then each RN does a 24 hour check of orders, test results, and progress notes.

Then while RNs begin complete assessments the LVN checks meds and gives routine oral meds. They can start a peripheral IV. One is better at IV starts than most so often helps anyone with a difficult stick.

Last time I floated there I cleaned a 'code brown' so our LVN would have time to start an IV on a patient who would have been SO distressed at a miss and restick.

If an LVN thinks there is a need for a PRN he will say, "How about giving ***?"

Unless it is something totally routine I will go reassess the patient. Then one of us will give the PRN is needed.

One of the LVNs relieves the monitor observer for meal and rest breaks.

We have a transporter/lift team for the whole hospital until 11:00 pm. It two young men. They help get patients back in bed. Then unit staff does the lifting and turning together.

We know our LVNs are able to assess but that we are responsible for the nursing process so we must observe and assess each patient assigned to us and document it. We admit patients together if possible.

This really pays off if we have a registry LVN. Recently we got a registry LVN who had been with the same private duty patient for years. She was appropriately nervous. Couldn't remember how to calculate dosages and didn't notice when a patient was short of breath. I couldn't have her suction my intubated and ventilated patient much less admit or assess.

Our charge nurse is a big help too.

meownsmile, BSN, RN · Apr 25, 2006

Thanks,