Nurse patient ratio

TamNurse · Dec 28, 2003

I'm only a first year ADN student but as a CNA on a medsurg floor I am frustrated and frightened by the seemingly unsafe nurse patient ratios. We're always short-staffed. Acuity is rarely considered. The RN's are understandably overwhelmed. Judging from the messages posted, these are fairly common conditions.

I'm curious about MAGNET hospitals. They sound too good to be true. There are fewer than 80 hospitals in the country which have been granted "magnet" status by the American Nurses Association. 4 to 1 ratios, reduced nosicomial infections, lower mortality, reduced length of stay, reduced nurse turnover....

Has anyone been involved with a magnet hospital? They sound like the answer!?

Nurse Nevada, RN · Dec 28, 2003

I have been working in the Las Vegas Area as an Agency RN for 4 years and am now leaving the state. Med-Surg units here are increasing the nurse-to-patient ratios and cutting out Nurse's Aids. The hospital conditions are deplorable. It's the hospital's responsibility to provide "safe patient care." I worked in the ER of a newer hospital here. Patient's were lined up in the halls on gurneys, sitting on the floors with blankets and there was only 2 Aids in the entire ER. It was filthy dirty.

I also worked in a brand new hospital where they had 14 patients on a unit with only myself and another LVN. The unit was not stocked, couldn't even get drinking water unless you went to another unit which meant leaving the patients. We had no Aid or Unit Secretary. The Charge Nurse was located in a different unit of the hospital. We had to spend most of the day answering the phones. They called this unit "Med-Surg Hold." I don't even think it was legal to open this unit of the hospital yet, but they wanted to fill more beds and make more money at the patient's expense. I was so angry, I wanted to call the local news team but didn't have time. I complained to the manager and her response was "so are you going to walk out on your shift?" 2 of my 7 patients in my opinion should have been in CCU as they were very unstable.

I started a petition to lower the nurse-to-patient ratio some time ago in this state to follow California. Currently, Legislature has appropriated a review committee assigned to study the situation which is supposed to take 2 years.

I won't participate in hospital greed in this state any longer. The hospitals afformentioned are building more hospitals here right now but can't properly staff the ones they have. In my opinion it's only going to get much worse.

Please visit my website for more info on the nurse-to-patient ratios in Nevada:

Nursing Nevada

lee1 · Dec 28, 2003

Originally posted by gaulkari
I have been offered several jobs and have turned one down because the nurse patient ratio was eight to one on night shift. I accepted a job at a hospital with a five to one ratio nights. When I explained to the nurse spec. why I wasn't accepting the job she made the comment that new nurses always "think the grass is greener somewhere else". Both jobs were in oncology. Does anyone out there feel like eight to one is acceptable? I would like to know what you think is really a reasonable nurse pt ratio.

Absolutely not acceptable 8:1. If more nurses were like you and stood up to this type of abuse, maybe the working conditions would have changed by now and we would not have lost so many RNS at the bedside. Sooooo, despite the research showing increased mortalities and comorbidities, complications related to increasing staff/pt ratios this type of cost cutting continues!!!! Why is that noone wants to think of patient safety other than the direct nurses giving the care? How do we make THEM responsible for these irressponsible behaviors? A public awareness campaign on staffing????? Maybe if the public knew to ask MORE questions especially in this regard, things would change quicker. For example, you know that you or someone you know is about to be hospitalized---you call and ask what the staff nurses ratios are and what kind of nursing model they follow.

nursenatalie, ADN, RN · Dec 28, 2003

I work on a surgical unit which is a little different from straight med-surg. During a typical week we don't have "medical" patients only post-op patients that have co-existing medical problems. Since the flu outbreak our beds are constantly full with medical overflow and the other night all my patients were medical patients. Our ideal ratio is one nurse to six patients but it often teeters to 1:7,8. It is not too bad to have 7-8 medical patients but when our ratio is 7-8 fresh post-ops then it is hard to handle. I am going to make a point to talk to the nurse manager each time we are at 7-8 patients a peice because my fear is that with no complaints as often as it has happened lately she may begin to expect us to take 7-8 a peice....that is NOT going to happen with one CNA per 24 patients and no unit secretary.

see2mee · Dec 28, 2003

Well, I WAS concerned about my new job. Now I'm scared to death! I just graduated with an ADN, and I am starting my first job on Jan. 12. I will work PMs with a max. of 8 patients. The manager said it does usually work out to be 7 or 8. I'm hoping this isn't as bad as it sounds as it is a subacute unit. I'm still very concerned, though. This is not a nursing home. It's in a hospital. I know I will still have patients with IVs, TPN, and whatever else. I will have 6 weeks of full-time orientation before I start my part-time PM position, so I'm hoping to get a lot of good experience in before I am on my own, but I am very nervous about the ratio.

BTW, I really need this particular position because of the schedule. I was also offered two different labor and delivery positions, and that is really what I wanted, but I had to turn them down because of the schedule. It's kind of a long story, but, for the time being, I am not free to have my schedule jump from shift to shift. My 17-year-old daughter is disabled and needs nursing care at home. I have that available, but it won't work if my schedule is always changing. I really need to work this subacute job until she is settled in a group home...probably at least a year from now.

So, are 8 patients still too many on a subacute unit?

Thanks

Catherine

gaulkari · Dec 29, 2003

The job I originally turned down with the 8:1 ratio was at a magnet hospital. I love the hospital, but I don't understand how a magnet hospital can have that kind of ratio. One thing I did notice is that they have a large number of imported nurses. Maybe they are more tolerant of that ratio.

barefootlady, ADN, RN · Dec 29, 2003

Just wanted to reinforce my opinion that 8 patients on ANY floor is too many. I agree with those posters who have said acuity plays a big part in how well the shift will flow. But, in today's hospital, patients are sicker, nurses are doing more complicated dressings, IV's, PICC lines, medications, and the list can go on and on. The paper work is enormous. If you have a doctor that will not answer your page or is not easy to work with that increases your work load and stress level. Nurse managers are not interested in patient safety, good staffing ratios, and good morale levels of staff. I truly believe that the only thing they are interested in is the bottom line budget, if they will get a bonus, and if a warm body is present for duty. No matter if that warm body is a new nurse with little or no experience. They are there and counted just like an experienced nurse. I need a job, I want to work, I love giving good care to my patients and seeing them progress back to a state they can go home, of if they are dying, I want to keep them comfortable and allow them and the family time together. I am seriously considering an agency position, not because I want to work agency, but because I will stay off the political issues that plague staff nurses, will expect to be dumped on with patient acuity, and will not be expected to "know the routine" so if I need help I can ask for it without feeling like the Charge nurse is being overtasked.

I wish all the new nurses a good experience in their new career, but remember, Nursing is in crisis and it is up to the new generation of nurses to help change what is going on in hospitals and nursing homes. I only have about 5 more years to work, so I will not be able to do much but I do speak up when needed, and I will continue to do so.

Sorry for the length of the post but I am just really amazed at the way hospitals still take us for granted.

wjf00 · Dec 29, 2003

I wonder if I could ever keep up in Med/Surg. My NICU assignment this past weekend was 1:1 with a 34 weeker on NCPAP, with a H/L. Thank God we don't float to Med/Surg.

rmprn · Dec 29, 2003

I used to work for a hospital that achieved "Magnet Status."

To be honest, I think it's a bunch of crap. The application for Magnet Status is HUGE, there are lots of meetings and hoops to jump through, paperwork to be filled out. That must be how you get it, because the reality I worked in was not consistent with "magnet" guidelines.

I can tell you that in working there for 2 years, I had 3 patients in ICU/CCU about 75% of the time. At times I would be tripled and one of my patients really should have been a 1:1 (they almost NEVER allowed pts to be 1:1 because they didn't have the staff for it). Our charge nurses always had an assignment, in additon to being responsible for staffing both units for the next shift. No aides and lots of times no secretary/monitor tech either.

The ratio on tele there is 7-8pts on days and 10 on nights. Way too many!!

So for me, hearing a facility has "magnet status" does not impress me.

If anyone else has different experience, I would love to hear it.

:)

see2mee · Dec 29, 2003

Well, I definitely would not be taking this subacute position if I weren't in a bind with my schedule. I was thrilled to be offered the labor and delivery positions, and I was looking forward to 12 weeks of full-time orientation before going to my part-time schedule. I just can't handle a constantly-changing schedule of that position along with my daughter's needs, so that's that. This was the only position I could find with a schedule I could work with right now, so I'll at least give it my best shot. I'm finding myself dreaming (not nightmares...not yet anyway) about how I'm going to organize my day. It's obviously on my mind a lot.

Catherine

goober4699 · Dec 29, 2003

I do not exatly work in hospital with magnet status. However, the hospital I work in has been invited to apply for magnet status, do to it's low infection rate, low nurse turnover and excellent patient care rates.

I have to add that I work as a unit/secy per diem and have for the last few years. Lately, because I am a soon to be nursing student I have been granted by the nurses to do a few tech related tasks such as BG's, EKG's, apply tele monitors and take vitals.

I never worked on a med surgery floor, in fact I have always worked in intensive care. However, one day I had the unfortunate experience of being pulled to the urology floor and I was absolutely miserable. I was treated rudely and the nurses were incredibly unhappy. They had four patients at the most and yet they still had the most disgusting attitudes I have ever come in contact with.

It got me thinking about just how likely we were to be grated magnet status when some of the nurses were so incredibly rude and ignorant. I have however been informed by my mother that this floor has the worst reputation in our hospital and most ppl would not allow their dead cat to be treated there, so perhaps it was just that individual group of nurses and not the attitude amongst all the floor nurses, at least I hope not.

Owney · Dec 31, 2003

Great string. Thanx gualkari for starting it. Really liked what barefoot lady had to say and nevada nurse for why she's leaving her state was enlightening. Really liked hearing about the crapola on the delivery end of the "magnet" BS thats always clogging up my mailbox. As nurses we expect to spend our lives cleaning up other folks' poop, but does the system have to load our mailboxes with it too?

After working in ER, in the same system for 20 years, I was unaware that any nurse anywhere ever thought about patient ratios. If you ask my most recent boss about it, her only HONEST answer would be, "So solly, no speeka de eengleesh."

I remember the first time I took report in ER. I'd been an RN about 2 weeks. In our level 1 trauma center an LPN, a tech, and I took report on 40 trauma patients. I don't know why the guy bothered. By the time he got to patient number 2, I'd forgotten everything he'd told me about number 1. By the time he finished report on number 40, my scrub pants were filled with number 2.

If you want to see how bad nursing sucks, read a book by Echo Heron. Her account of her last shift as a nurse tells it all. If your son or daughter thinks they want to be a nurse INSIST that they read her books. If they still want to be a nurse, they must be cursed the same way I am. God created me--born a nurse. I LOVE being a nurse and can (with enough Tigan) work at it for another 10 years. Now the trick is...to find enough sick people for me to help without too much crap from the system.

Whenever you work without enough staff you ought to feel good that your hospital and your boss (most of them are on profit sharing) are making more money. Don't you want your hospital and your boss to live well and prosper? Don't you feel pretty stupid working for somebody who is so dumb they will pay you twice as much money to do the job of your tele.tech/ward clerk and aide, even though you do it half as well?

Aren't you ready to stand before Saint Peter so that you can tell him how well you did the work of three people? Do you think ol' St. Pete will understand when you tell him why grandma fell down for the last time of her life, after laying on her call light all day and all night?

Four things are pretty clear; 1. Nursing sucks, 2.It's gonna get a lot shittier before it gets much better, 3. Why the hell didn't I study harder in high school? 4. Why can't I pick the right powerball numbers?

Life is like a shit sandwich. The more bread you have, the less shit you taste.

Happy New Year,

:kiss

Oh, things'll be better in twenty-o-four.

'Cause I won't be workin' in hell no more.