Nurse/Patient ratio

[rubyslippers]

Greetings from Louisiana:

I have been enlightened by several postings on this site in regards to nurse to patient ratios. Our unit is 20 station M-Sat, 2 shifts. We staff with 3 Pcts and 2 RN. Our FM (RN) covers us and our sister unit in same town but avoids working the floor (she does have much to do!).My question is this: In LA, PCTs are not allowed to do anything with caths -no put-on, take-off, or drsg.changs. Also, we have stick patients that are not advanced to 15 needles and/or have lidocaine prescribed that pcts cannot administer - these cases require the RN to cannulate the pt. Our pcts are great, but are limited as to the patients they can put on. One shift in particular has 9 cath pts! (yes- perm.accesses are being addressed for these pts.) The patient schedule is severely constrained by transp.problems and most cannot be moved around. So out of 20 pts on this shift, there is only 7 pts. that the 2 techs actually can stick and put on. On this day, it takes 45min to 1 hr to put on the 20 pts depending on how well the caths are working. How do other units apply the 4:1 ratio in these ituations? Thanks, RubySlippers

[DeLana_RN, BSN, RN]

When I worked in a 20-chair unit, we were staffed with 2 teams for 10 stations each; usually, there was an RN/LPN/PCT (or LPN/LPN/PCT) per team. The RN (or LPN) team leaders were responsible for 2 stations - set up, tear down, run the pts - and each of other team members had 4 stations each. Before PCTs could put on perm caths (they can do this now in the state) the nurses had to do this as well for the PCT's pts.

In addition to that, the team leader was also responsible for all assessments and meds (including heparin pushes) for the 4 pts in the PCT's pod (and sometimes, when there were 2 PCTs in the team, the nurse had to do this for all 10 pts). LPNs could most of what the RNs did (except for TPA).

HTH,

DeLana

P.S. Before PCTs could put on perm cath pts, they still had their assigned stations and did as much as they could for the cath pts - i.e., get them settled, VS, set-up, even unwrap the cath and soak it in Betadine or chlorhexidine (they could not, and still cannot, change the dsgs). Then the nurses would do the assessment, give the heparin and connect the pt. At this point, the PCTs could take over and finish putting the pt on. They were just not allowed to deal with an open catheter.

This might be worth considering for your unit - assigned stations/pts (assuming you don't have that).

[GeauxNursing]

here in TX we (PCTs) are not allowed either to deal with open-catheters, dressing changes. We can, however administer lidocaine, so we do all the sticks. We will get the BPs taken on the cath patients, get their temp, put the order into the machine, and get them soaking. Then we call for the nurse, who will come and hook them up and assess them, then run away to do another one, while the techs put the info into the computer, bring up the blood pump speed, etc. We were, at one time, also bogged down with catheters. Our poor nurses were running like crazy to get them all on. On our TTS shifts currently, there are 5 afternoon caths and 1 morning cath, all these put on and taken off by the ONE NURSE who works these days. It is really hectic. We, too, are restricted by public transportation schedules that hinder our ability to switch around schedules. Most of our caths, lucky, are just waiting on placement or maturation of their AVF's/Gs.

Anyways, we have 20 stations, but only 16 in use on MWF, 2 shifts. 4 PCTs, 2 nurses. Each PCT is assigned to a section of 4 patients. the patients come in at their assigned times, usually in 15 min. increments. The assignments are done a week in advance so everyone knows where they are supposed to be. And the cath pts are assigned to diff times to try and alleviate the time crunch for the nurses (with the exception of TTS, where they are all here at the same time!)

hope that helps.