Nurse to Patient Ratio

lumbarpain, ADN, RN · Apr 9, 2012

I was a half and half RN once..... floornurse one day, then the next day supervisor.....in a 100 bed facility. Although I am quite capable of handling 35 patients....I couldnt do this. going back and forth from trying to get into a routine only for it to be devastated the next day was horrendous. Needless to say it didnt last.....I found out a nurse that had worked there before was coming back for her job. I was a patsy, and this was during The State visit!!!!!! Never ever again will I do such a stupid thing. They dont care about you, just as long as they have a body there so it looks good. If you develope a good routine with competant aides who are mostly full timers!!! thats a miracle within itself. But, most times its not that way.

Awesomepossum · May 16, 2012

I have the same problem, I'm on a med/surg ward with a lot of complex cases, like people who just had all of their guts taken out and are getting chemo. I routinely have 6-8 pts on a "good" day (we're only supposed to have 5 but hey, why keep nurses employed, we're so easy to replace right?!) and 8-12 on nights. Note many of these people end up on the unit because they're so unstable.

I can't quit because if I quit from the big company I can't get another job in the area and I don't have enough exp to transfer or get hired at the good hospital. I'm just screwed. :sniff:

lumbarpain, ADN, RN · May 16, 2012

Considering most Moms that have children have a tough time organizing/keeping house, working a job and just keeping sane with a family to care for...NURSES have an extended family so to speak on their jobs!!!! Taking care of elderly, the very demanding patients, critical patients as well as documenting all that you do, giving meds, dealing with distraught family members/ writing up reports, calling docs and auxiallary staff/organizing your CNAS/ Keeping yourself from getting sick/ and just Keeping your own life intact is just as stressful as it gets. 30 patients is FAR TOO MANY IN A SNF....and with critical patients...2 is more than enough!!!!!! SNF should have only 10 patients per nurse. Thats enough.

Asystole RN · May 16, 2012

Considering most Moms that have children have a tough time organizing/keeping house, working a job and just keeping sane with a family to care for...NURSES have an extended family so to speak on their jobs!!!! Taking care of elderly, the very demanding patients, critical patients as well as documenting all that you do, giving meds, dealing with distraught family members/ writing up reports, calling docs and auxiallary staff/organizing your CNAS/ Keeping yourself from getting sick/ and just Keeping your own life intact is just as stressful as it gets. 30 patients is FAR TOO MANY IN A SNF....and with critical patients...2 is more than enough!!!!!! SNF should have only 10 patients per nurse. Thats enough.

It is impossible to determine workload from a single aspect just as it is impossible to determine a full health assessment from viewing a single body system. Patient acuity, assistive technology, assistive personal, facility design, shift, work responsibilities, and unique patient characteristics are all very important factors that go into determining a "safe" patient load.

Having 10 confused, combative, total care, post CABG, vented patients with no assitive personnel that are more than 30 yards from each other would be not safe.

Workload should be the determinant of what is a safe nurse to patient ratio, not a number.

Asystole RN · May 16, 2012

Advice: Walk away and save your license.
What other help can we give?

This is not bad advice.

As long as people are willing to work in adverse conditions then the facility is going to continue to provide adverse conditions. I would add though as professionals who hold licenses and who are legally bound to protect the public that it is our duty to take action and intervene should we identify unsafe conditions that would threaten our patients.

The ANA code of ethics is clear on this and I am confident that all of our NPAs are clear on this as well.

allnurses Guide · May 17, 2012

National Nursing Shortage Reform and Patient Advocacy Act - S. 992 (Boxer)

This bill establishes requirements for acute-care facilities to provide registered nurse staff based on the acuity of patients provided that minimum nurse-to-patient ratios for each unit are met at all times. Registered nurses shall also have the obligation to act in the exclusive interest of their patients, and the right to be patient advocates.

Read the full text of S. 992, introduced by Senator Barbara Boxer, May 12, 2011

Safe RN-to-Patient Staffing Ratios | National Nurses United

Asystole RN · May 17, 2012

National Nursing Shortage Reform and Patient Advocacy Act - S. 992 (Boxer)
This bill establishes requirements for acute-care facilities to provide registered nurse staff based on the acuity of patients provided that minimum nurse-to-patient ratios for each unit are met at all times. Registered nurses shall also have the obligation to act in the exclusive interest of their patients, and the right to be patient advocates.
Read the full text of S. 992, introduced by Senator Barbara Boxer, May 12, 2011
Safe RN-to-Patient Staffing Ratios | National Nurses United

I have yet to see a study that has shown that mandated nursing ratios have improved patient safety or somehow improved patient outcomes. To use only numbers to determine a safe work load is like only assessing the right hand to determine overall health.

allnurses Guide · May 17, 2012

quote from herring_rn
national nursing shortage reform and patient advocacy act - s. 992 (boxer)
this bill establishes requirements for acute-care facilities to provide registered nurse staff
based on the acuity of patients
provided that minimum nurse-to-patient ratios for each unit are met at all times. registered nurses shall also have the obligation to act in the exclusive interest of their patients, and the right to be patient advocates.
read the full text of s. 992, introduced by senator barbara boxer, may 12, 2011

safe
rn
-to-patient staffing ratios | national nurses united

i have yet to see a study that has shown that mandated nursing ratios have improved patient safety or somehow improved patient outcomes.
to use only numbers
to determine a safe work load is like only assessing the right hand to determine overall health.

of course you are right. to use only numbers would make no sense. that is why the ratio is based on acuity.

all units i know of have "core staffing" below which they will not go. think of the ratio as the most number of patients that may be assigned to a registered nurse.

to this must be added monitor techs, clerks, and other nursing staff such as an

rn

when patients severity of illness requires frequent ongoing assessment, intervention, and change in the care plan.

lpn/lvns or another

rn

need to be added when there are routine nursing functions such as suctioning, tube feedings, dressing changes, and routine medication administration.

when acuity is high due to the patient not being able to perform adls a nursing assistant, lpn/lvn, or

rn

will be needed.

there are studies. a major study led by

linda h. aiken, r.n., ph.d., f.a.a.n.,

one of the nation's most eminent nurse researchers, provides compelling evidence that california's landmark

rn

-to-patient staffing law reduces patient mortality.

http://www.nursing.upenn.edu/chopr/documents/aiken.2010.californiastaffingratios.pdf

she had studied nurse staffing before --

http://jama.ama-assn.org/cgi/content/full/288/16/1987

Jodi Dotson · May 17, 2012

Well talking about nursing ratios, Long Term Skilled Facilities you get 25-30 patients per shift and night close to 50. Some are long term others are Skilled rehab and you run "Literally" to get all medications , wound care, treatments and just pray to god that no 2 patients code at the same time. I live in small community and trying to get into traveling nursing. I love what I do it would just be nice to enjoy where I am at. thanks

allnurses Guide · May 18, 2012

Long term care really needs better ratios.

ChicRN, MSN · Jun 29, 2012

Well talking about nursing ratios, Long Term Skilled Facilities you get 25-30 patients per shift and night close to 50. Some are long term others are Skilled rehab and you run "Literally" to get all medications , wound care, treatments and just pray to god that no 2 patients code at the same time. I live in small community and trying to get into traveling nursing. I love what I do it would just be nice to enjoy where I am at. thanks

I find it interesting how SNf can get away with this! I personally think of it as unsafe since nursing homes aren't what they used to be. Some are basically medsurg acute care! I have a mix of geri & some adult on our floor. It's unsafe for the nurse & patient. This amount of stress is how nurses get burnt out licensed or not! I'm a new grad whos only been in acute care and find these places extremely worrisome for all. The nurses don't take breaks or eat lunch during charting or not at all. Heck, drink water is a luxury w/their time constraints! And overtime to catch up on their work everyday, now that is just too overwhelming. It's ridiculous how there are no strict rules w/nursing ratios to protect nurses in these type of settings & that due to our economic times they suffer. It's awful..

lindarn · Jun 29, 2012

Nurses will never get better ratios until we ALL organize with the NNOC, contact law makers concering the unsafe conditions, reach out to the public and get their support. Teachers do it all the time- that is how they get what they want, have better pay, far better benefits, and a pension they can actually retire on.

Nurses have never learned to fight for themselves, and organize. They bought the big lies. How unions are, "unprofessional", yet teachers, who are educated far and above what nurses are, have been unionized since forever. What is "unprofessional" about having the freedom to protect our patients, earn a salary that is commensurate to the education that we do have and the huge responsibility that we have for our patients. I can answer that- nothing.

Unfortunatelly, the, anti union, "martry marys", of the nursing profession have done nothing but hold nursing back, and are responsiblity for the dismal situation that the nursing profession is in today .

JNHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW