Nurse patient ratio

[Daisy]

Since the topic is patient ratio, I work in a larger city hospital and when I was hired 6 months ago they told me 6-1 on a day shift with a CNA being shared with another RN. It sounds nice but it never happens. We usually don't have the CNA and now they are slowly squeezing in patient number 7 without officially telling us. When hospitals push their customer service, patients and their families expect four star hotel accomodations. Nurses can't do all that hotel stuff and get nursing work done and be satisfied with what we do. Are we satisfied, do we like our jobs at all? I work with young nurses ( 1 or 2 years in the business) who are already burned out. Who is going to save them and the profession?

[Owney]

Originally posted by Daisy

Nurses can't do all that hotel stuff and get nursing work done and be satisfied with what we do. Are we satisfied, do we like our jobs at all? I work with young nurses ( 1 or 2 years in the business) who are already burned out. Who is going to save them and the profession?

Sure we can do that hotel stuff. I became one of the best hosts in the business the day my hospital told us that our next raises would be linked to our Press Ganey scores. Never mind that every time one of my patients coded I was the last one to know because I was getting water, coffee or food for the visitors!

Who is going to save them and the profession? I would place that responsibility squarely on the shoulders of nursing schools. Instead of "RAH RAH" and "ATTAGIRL" lectures, why don't they give us at least a glimpse of the real world of nursing?

I did learn some reality while I was doing clinicals way back in the 70s. The floor that we worked was one of the best in the city. After I did primary care on my 1-2 patients I was answering call lights for all the other patients whose nurse was too busy to answer. I frequently took down the 3-day old I&O sheet from a patients bedside, since it might not even have my patients name on it. (It probably was filled out for the guy who had gone to the morgue yesterday). While I was there the hospital laid off the dietary aides in a "cost saving measure." We can get the nurse to feed grandma, she's not busy anyway. That month I saw an article in one of my nursing journals about the incidence of malnutrition in elderly admitted hospital patients.

Nursing programs should weed out the fast burnouts while they are taking their prerequisites. They could just arrange for 2/3 of every lecture class to have sick kids at home, or have them mandated on their part-time jobs. That way the 1/3 of the class could "do the best they can" at taking notes for all the absentees. The instructors could tell them how poorly they did the work of 3 people. Grades would not be based on either classroom or written work, but solely on, "What someone, who doesn't like a student, said about them." This would closely parallel what all of my performance evaluations have looked like. They always say, "we heard that" or they will cite one poor incident as my EVERY DAY performance (or lack thereof). After all, if my boss tells administration that I'm a good nurse, they might have to give me a raise, and she has to account for the department budget.

There has got to be a warm place downstairs for the hospital administrator who came up with the concept of profit-sharing for Nurse Bureacrats. Why should you complain about working short? Every nurse who

is NOT working on your floor is another dollar in your bosses pocket. Don't you want your boss and your hospital to "live long and prosper?"

If nurses do not fix nursing nobody else will. Look at what has happened in California. They passed a state law mandating patient-staff ratios. This is only the second day that the new law is in effect, so we'll have to give it some time to test it. What I do know that if nurses had not taken the initiative, that law would never have become a reality. If it really works, I'm gonna do what I can to get the same law passed here, and maybe even nation wide. If I see no relief on the horizon in a year or two, I may just have to move back out there.

Don't just whine about the sad state that nursing has become--DO SOMETHING! Form a "meetup" group or start a string on this site dedicated to trying to fix our profession. I was born a nurse. I didn't even discover that until I was in my mid thirties. After 20 years I am not burned out, although my most recent career challenge gives me every right to be. Every day at the bedside reminds me how much I love nursing.

Do not fret over the crap that you hear from your boss. It just amazes me how the bureacrats think that they can pay us a living wage for cleaning up fecal matter, and that they think they can HELP us by giving us more of it! Do not take those patient complaints home with you. Do what I do. I tell those stinkers off in the locker room or in my car. I like to go the the supply room, or the filthy utility room to tell someone off "in absentia." (Sometimes I yell and throw things around--it feels pretty good, everyone should try it!)

When I get home, all I have left are the warm fuzzies that my patients and their families have given me today. Then all I have to do is say a little prayer in thanks for getting me through another day.

:kiss

[gaulkari]

Hey Oweny,

Sounds like you had a bad day, hope tomorrow is better!!!!!

[Owney]

gualkari,

Please read my post on retaining workers etc. If you read the part about how I have made myself burnout proof years ago, you will see that I believe there is no such thing as a bad day.

Please read the entire string, started by spacenurse. Every nurse or anybody else who has the slightest concern about health care should read it several times.

If you think my last post on this string makes me sound whiny or just ranting, please read it again. I did read it again, and I think I offered several suggestions for using the energy of getting worked up can be put to positive use to solve our problem.

If I sound too emotianal for an older male, it's because at my age, I have finally given myself permission to openly cry in public. I reserve the right to masquerade as a Gay or a Jew for an excuse to be more sensitive and nurturing than anybody's mother.

No honey, I gave up believing that there is any such thing as bad weather, bad people, or bad days. Such concepts are quite useless, if not counterproductive in my thought process. If God made everthing, how could anything be bad? I do believe in the concept of good and better.

Good, better, best.

Never let it rest,

Until the good is better,

And the better best.

--Unknown

Every day that God gives me to make the world a better place is a gift more precious than gold.

LOVE:kiss

[bungy]

Oh man, I'm so glad I live here (in Melbourne, Australia).

We've had legislated maximum ratios of 4:1 (plus in-charge) for AM/PM and 8:1 ND since 2000. More acute wards can claim lower patient numbers per nurse, and ICU/CCU/NICU/Delivery are 1:1 and ED is 1:3 for all shifts.

This move alone has brought huge numbers of ex-RNs back into the workforce, so that it has actually been easier to cover the shifts since the commencement of the ratios than it was prior to them.

Come for a working holiday, and enjoy the difference!

[K O'Malley]

I worked in MICU till just a couple of years ago. The nurse to pt ratio was 1:3 and on some weekends it would be 1:4. Management said we could handle it because we had a nursing assistant, some days, some shifts. We also had a unit secretary, some days, day shift. The other ICUs there were staffed the same way and you can imagine what the floors were like. We had some incredibly dangerous occurrences like pts extubating themselves and everyone was too tied up with crashing pts to go check the alarm. In addition, we would often have one or two nurses off the unit transporting pts to the floor or to tests in Radiology. Yet this hospital always received accreditation with commendation from Joint Commission.

[live4today, RN]

If the Joint Commission of Hospitals would only STOP telling the hospitals WHEN they plan to visit, MUCH would be learned and "caught" about how bad the hospitals really are, and how much stuff is really hidden and lied about just for their little visit each year. Wish I knew the phone number, I'd call them up and tell them to visit the hospital's unannounced for a change if they reaaaaaaaaaallllllllllllllllllyyyyyy want to see what is happening inside those hospital walls. :chuckle

[mayberry]

Although I have worked in nursing for a few years I just started on an IMCU floor working nights. Routinely we have 5-6 pt's and our assignment is often changed at about 11pm b/c we get a Med/Surg nurse (no offense) who are not permitted to take drips and often don't read the tele strips; therefore,after doing most of the work for the patient we wind up passing our pts. off so that we can take admits. Many of my coworkers have expressed concern over staffing levels. So, despite the fact that most of the night staff is new to critical care or new grads we are feeling who happen to like what they do but are frustrated, tired, etc. (the more experienced staff have also expressed many of the same concerns). On the good note I happen to like to company/hospital I work for but it would be interesting to see Joint Commission come in unannounced and what their report would say.

[TriskixRN]

Cheerfulldoer,

I agree wholeheartedly:wink2:... JACHO should make their visits unannounced or more random so there is no "prep-time" for the hospital to get their stuff straight. I think that might help a bit.

As for staffing ratios ... so far the ones I have dealt with have been terrible in LTC; skilled rehab; Alzheimers; and hospitals!

8 - 12 hour evening / night shifts in LTC would have b/t 25 and 45 patients to 1 nurse (and one or two CNAs).

8 - 12 hour shifts in skilled rehab were roughly the same with an RN either on a special unit or on call.

8 - 16 hour shifts in Alzheimers were 6 - 20 patients to 1 nurse (plus one or two CNAs on eves and one on nights for over 8 patients)

12 hour nights in OB-GYN would start with b/t 5 and 7 patients and at 11pm, oftentimes change getting a whole new assignment and/or the patient load would increase from the existing patients being divided up by the charge RN (whom was not required to take patients) and then to top it off I had to take any new admits as well; the load was up to 10+ per nurse at times regardless of acuity. More than once I found myself at 2 a.m. with three or four fresh c-sections (or gyn surgeries

What is approperiate? In my opinion and experience : No more than four in the hospital; no more than 8 in skilled/rehab; no more than 6 in Alzheimers; and no more than 20 in LTC per nurse not per staff member! We need our support staff ie: CNAs on every shift if we have more than 4 patients or if we are in Alzheimers units!

That is my limit for efficient quality and safety... every patient over that caused my effieciency to drop, and safety / satisfaction was comprimised for all involved.

[Suziebee]

Hi, I nurse in New Zealand and at present we are fighting to have our patients ratio's 4:1. This we feel is a safe ratio. At times we work 6 - 7 patients per nurse. We all need to be working actively, refusing to work in unsafe conditions.

[TigRN]

To all those out there wishing JCAHO would make unannounced visits -- my understanding, at least here in California they are now doing that. You will know the year, but that is it. They could show up on our doorstep tomorrow.

[tommyr]

Does anyone have the stats on patient to nurse ratio in hospice? We live in a rural area and 20-40mile drives between patients is the norm. Right now we are carrying 12 patient to FTE. The same nurses are doing on call. They are burning out, but our administrator feels they should be able to carry 15-20 patients. Can you give me an idea of your ratios?

Thanks,

TommyR