How to help with ratios

DavisaRN9 · Aug 15, 2013

About nursing ratios. Let me say this: It is NOT about whether a nurse 'can handle' a certain patient load, it is what the patient, all of the patients in that 'load' are in need of, due by way of nursing attention. It is about what the patient truly needs--and is NOT about the nurse. Too many times, especially with 'older' more experienced nurses when orienting/precepting on-coming, usually new graduate nurses, they convey an attitude of competition, and failure---in order to impress the 'newbies' with their expertise, while simultaneously informing them (the newbies) of how difficult, how hard, how impossible it is to address ALL patients needs---yet they are still here. The over-whelmed, over-worked, RN has learned to account for their failures, their imperfections, to being assigned huge patient loads, saying, "I'll just do the best I can. See if YOU can do as well." This is NOT patient oriented! The culture of bedside RN nursing is, unfortunately, more focused on what that nurse is expected to accomplish in the time span allotted (which usually extends beyond 12 hours) and how difficult it is to succeed in accomplishing all in that time frame, rather than what that nurse has actually done. Failure to adequately address, treat all of the needs of the amount of patients they have been assigned, is seen as an endurance of stature of that nurse--and serves as an excuse because of it. The number of patients assigned to an RN and their un-identified, uncommented acute care status is both an excuse for the RN to fail to meet their patient's needs, and a reason for the efforts that RN attempting to accommodate the tasks they were given. Its called heroism---sacrifice in the efforts to accomplish. And this is a habit, a culture, a way of proceeding that most bedside nurses do to get through their shift. All may have tried at one time to perform their best--but all have learned they cannot because of hospital demands, patient loads...so they do the best they can initially, then accommodate to just doing enough to get through the shift. And to justify failure---blame scheduling and blame patient acuity. Neither of these has been adequately acknowledged or dealt with in most U.S. states. Why? Answer: Money. Hospital health care is a BUSINESS!!! Nurses comprise the bulk of company expenditures in the way of salaries. So, keep the salaries while adding to the nurse's work load. Why not? More patients equal more money. Its BUSINESS!!! And returning patients, those who were discharged too soon, inadequately educated upon discharge, incur post operative infections because of both----are admitted, yet again, and are cash-cows for the hospital's business. So it is no wonder hospitals ignore, are deaf to, any and all complaints or concerns coming from the nurses. In "AT WILL" states any complaint/concern coming from a registered nurse is seen as reason for termination--and is stated as "Not a Good Fit". And so it goes... Keep silent to management. Do just enough to thwart killing a patient. ***** about it all to a preceptee, play victim, then come back the next day...............

Altra, BSN, RN · Aug 16, 2013

Hello, I was reading about all of the staff cuts going on many places, some cuts have even happened in my area thankfully not at a hospital I choose to go to. I was wondering if there is anyway someone who is just a patient could help make a difference with staffing and patient ratios? I would love to hear some ideas. Nurses have helped me so much I’d love to help them out. My legs might not work, but my mouth sure does!!

Thank you for your interest in this important subject!

If you Google-search "states considering nurse - patient ratio laws" or something similar you can find multiple links and see if legislation has been proposed in your state. Then it's time to get politically active -- contact your local state legislature representative(s). Spread the word.

Federal legislation has also been proposed - U.S. Senate Bill 739 National Nursing Shortage Reform & Patient Advocacy Act. Contact your senators.

S.739 - 113th Congress (2013-2014) - National Nursing Shortage Reform and Patient Advocacy Act | Congress.gov | Library of Congress

You can also express your support for the concept of formalized nurse - patient ratios whenever you get a survey from a hospital provider.

Esme12, ASN, BSN, RN · Aug 16, 2013

Thank you for your interest in this important subject!
If you Google-search "states considering nurse - patient ratio laws" or something similar you can find multiple links and see if legislation has been proposed in your state. Then it's time to get politically active -- contact your local state legislature representative(s). Spread the word.
Federal legislation has also been proposed - U.S. Senate Bill 739 National Nursing Shortage Reform & Patient Advocacy Act. Contact your senators.
S.739 - 113th Congress (2013-2014) - National Nursing Shortage Reform and Patient Advocacy Act | Congress.gov | Library of Congress
You can also express your support for the concept of formalized nurse - patient ratios whenever you get a survey from a hospital provider.

THIS ! THIS! THIS!^^^^^^^^^^^

Wheels! THANKS FOR CARING!!!!! BEST LINE EVER!!!

Nurses have helped me so much I’d love to help them out. My legs might not work, but my mouth sure does!!

SoldierNurse22, BSN, RN · Aug 16, 2013

Let me say this: It is NOT about whether a nurse 'can handle' a certain patient load, it is what the patient, all of the patients in that 'load' are in need of, due by way of nursing attention. It is about what the patient truly needs--and is NOT about the nurse................

While I completely agree with the sentiment of your post, I strongly disagree with the bolded portion above.

Until they replace me with a robot, I am not just a nurse--I'm another human being. And I can't do my job correctly or safely if I'm not given a manageable load of patients, allowed to pee/eat/drink on shift, able to work in a safe environment, and given the respect and communication due from physicians, PT/OT, Rad, etc.

This is part of nursing's cultural problem. Many of us are naturally inclined to put others before ourselves. The problem with that is we end up getting overworked and overstressed and letting the patients down.

Really, the question is, what is best for both the patient and the nurse who is giving care to that patient? Because we all know that in healthcare, by doing what is best for the nurse, often, you're also doing what's best for the patient.

Pudnluv, ASN, RN · Aug 17, 2013

And returning patients, those who were discharged too soon, inadequately educated upon discharge, incur post operative infections because of both----are admitted, yet again, and are cash-cows for the hospital's business.

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These patients are definitely not cash cows for the hospital. They are money suckers. Patients who return due to be discharged too soon or who develop complications after surgery are not charged for their visits. The hospital actually has to eat the cost of readmittance or follow up surgeries. It is never in the hospitals best interest to have a patient return within 30 days of discharge.
Better nurse to patient ratio has been shown to decrease post op complications, nosocomial infections (which extend patient stays at the hospital's expense), falls and the myriad complications that occur due to falls, also all at the hospital's expense. It is definitely in the hospitals best interest to incur the cost of adding nursing staff, than to incur the costs of all the complications that can and do arise due to unsafe nurse to patient ratios.

SeattleJess · Aug 19, 2014

About nursing ratios. Let me say this: It is NOT about whether a nurse 'can handle' a certain patient load, it is what the patient, all of the patients in that 'load' are in need of, due by way of nursing attention. It is about what the patient truly needs--and is NOT about the nurse. Too many times, especially with 'older' more experienced nurses when orienting/precepting on-coming, usually new graduate nurses, they convey an attitude of competition, and failure---in order to impress the 'newbies' with their expertise, while simultaneously informing them (the newbies) of how difficult, how hard, how impossible it is to address ALL patients needs---yet they are still here. The over-whelmed, over-worked, RN has learned to account for their failures, their imperfections, to being assigned huge patient loads, saying, "I'll just do the best I can. See if YOU can do as well." This is NOT patient oriented! The culture of bedside RN nursing is, unfortunately, more focused on what that nurse is expected to accomplish in the time span allotted (which usually extends beyond 12 hours) and how difficult it is to succeed in accomplishing all in that time frame, rather than what that nurse has actually done. Failure to adequately address, treat all of the needs of the amount of patients they have been assigned, is seen as an endurance of stature of that nurse--and serves as an excuse because of it. The number of patients assigned to an RN and their un-identified, uncommented acute care status is both an excuse for the RN to fail to meet their patient's needs, and a reason for the efforts that RN attempting to accommodate the tasks they were given. Its called heroism---sacrifice in the efforts to accomplish. And this is a habit, a culture, a way of proceeding that most bedside nurses do to get through their shift. All may have tried at one time to perform their best--but all have learned they cannot because of hospital demands, patient loads...so they do the best they can initially, then accommodate to just doing enough to get through the shift. And to justify failure---blame scheduling and blame patient acuity. Neither of these has been adequately acknowledged or dealt with in most U.S. states. Why? Answer: Money. Hospital health care is a BUSINESS!!! Nurses comprise the bulk of company expenditures in the way of salaries. So, keep the salaries while adding to the nurse's work load. Why not? More patients equal more money. Its BUSINESS!!! And returning patients, those who were discharged too soon, inadequately educated upon discharge, incur post operative infections because of both----are admitted, yet again, and are cash-cows for the hospital's business. So it is no wonder hospitals ignore, are deaf to, any and all complaints or concerns coming from the nurses. In "AT WILL" states any complaint/concern coming from a registered nurse is seen as reason for termination--and is stated as "Not a Good Fit". And so it goes... Keep silent to management. Do just enough to thwart killing a patient. ***** about it all to a preceptee, play victim, then come back the next day...............

I've only just started in the healthcare industry, working as a CNA for a few months at a combined TLC/TCU facility and starting nursing school in the fall.

It is chilling to see you so accurately describe the culture I'm encountering among both nurses AND CNAs. The even dark side is that some staff learn how to maximize their slacking. Neglecting patients who are too far gone into dementia to complain. Skimping on oral care, getting somewhat independent patients to wash hands after toileting, charting things that didn't really happen. (Truly? Moving the patient's legs while repositioning him is 15 minutes of ROM exercise?)

I reported to my supervisor about a patient who lay in her own waste for almost two hours because I could not get the help I needed to comply with the two-person assist care plan. The "supervising" nurses refused to get involved; the other CNAs played a passive-aggressive avoidance game to keep from having to help with a patient that was "not theirs." My managers initial response when I told her? Upset that the other CNA on my unit had taken an hour for her meal break. "We have to fix that! No one can ever have more than 30 minutes." But what about the issue of patient care? "I haven't received any complaints from a patient." Oh really? Two different standards depending on the patient's ability to advocate for herself? How bad does it need to get before we address the standard of care issue? Or is even contributing to someone's death acceptable if no one complains?

Have a moment of feeling helpless and disillusioned, I guess...