nurse-patient ratio

MicheleRN2000 · Apr 4, 2003

I work on a 25 bed general medicine floor. The patients are usually divided up into 3 teams, one team w/ 9 pts. and the other 2 w/ 8 pts. On day turn, they have an RN-LPN-NA combo per teams. Evenings usually about the same, except maybe only 2 LPNs to split the floor. Nights we have 3 RNs (if we're lucky), 1 LPN most of the time, and 2-3 NAs. It's not unusual to have only 2 RNs for 20 pts, which is unsafe. Our acuity numbers are high most of the time...with confused patients, comfort care pts, isolation rooms...but none of that is taken into consideration. It's tough most of the time. No wonder no one wants to work in a hospital anymore. I hear they're telling nursing students how bad it is on the floors. That is encouraging.

kmlunar · Jun 19, 2003

I promise not to whine anymore! We don't staff with any rhymn or reason here however usually on days the ratio is seldom more than 5 or 6 to an RN/LPN with 3-4 aides on shift. pm's is slightly higher depending on census. We have a mixture of medical(COPD,CA) cardiac(tele,CHF) ICU stepdowns and post surgical with the occational ortho mixed in.

kmlunar · Jun 19, 2003

28 beds with 2 lock up rooms!

reunion30 · Jun 20, 2003

I sure LOVE some of those nurse to patient ratios I have read about. The hospital I work at in North Central Florida ratios are 1:8-13 days, but nites are usually better believe it or not. Their ratio can be a low as 1:6. The hospital now is working toward going to Primary Nursing which means 1 or NO aides to assist with lifting, moving, v/s, ie NO HELP even when the patient weighs 250-300 lbs and you are ALONE to move their DEAD weight. The ratios on a whole are 2 nurses to 17 patients which APPEARS to be not so bad until you realize the Charge Nurse ie the RN takes a MAX of 4 WALKIE-TALKIE patients and the LPN gets the rest ie a ratio of 1:13 patients minimum. With odds like this, no wonder the young are steering away from Nursing in general. There are NO SUCH THING AS UNIONS to help us protect ourselves. Florida is a RIGHT TO WORK STATE, in other words:: if you want to work, you do it THEIR way. If you find you can NOT lift that 250-300 lbs. patient alone and complain, well that is a real NO NO. I was just challenged after many years to have another physical to PROVE I can lift that amount ALONE. I was NOT allowed back to work until I had a signed doctors note stating I could, and my PAYCHECK was held until that time. So now I ask:: Where is the fairness in this situation to encourage GOOD NURSING PRACTICES??????

Hellllllo Nurse, BSN, RN · Jun 21, 2003

As a new grad and while supposedly on orientation on a surgical unit, I was given 9 pts to care for alone. One useless aide (but that is another thread) for the whole floor.

And they just couldn't understand why I quit!

Gator,SN · Jun 21, 2003

Med/Surg ratio of 1:6/ with one RN, One LPN and one CNA. We did team nursing. On Nights it was 1:8.

LPN's do IV's and an assessment and CNA do the basic patient care. The RN's are still busy beyond belief. Team nursing is new here.

Gator

live4today, RN · Jun 21, 2003

Where I work, we have mostly a 1:5 ratio on days (I work 12 hour days). We have discharges, direct admissions and unit transfers going on constantly. At times, it feels like I'm taking care of more than five patients at a time. The patients are mostly high acuity, but our hospital does not look at acuity levels anymore (a recent change). Fine by me since I have never seen acuity levels matter anywhere I've ever worked. The patients are sicker with multiple organ parts undergoing some disease process or another, therefore there are many doctors from different specialities writing orders on patients that it's hard to keep up with it all. I do NOT see where my place of employment shows any respect for their nurses.....sad reality, but true as I perceive it. Nursing is much worse today than it was six years ago when I left nursing. Why did I return??????

That's another post! :nurse:

NurseGr39 · Jul 21, 2003

Wow, lots of posts. I work on a 26 bed M&S unit we usually have 4 or 5 nurses on days w/ 3-4 aids, 3 nurses on evenings w/ 1-2 aids and 3-4 nurses on nights w/ 2-4 aids. Our manager wants us to change to team nursing (we are currently primary nursing) and is looking for our input as to how to develop the teams. She wants 2 teams of 13 a piece. What is reasonable staffing for this? How about delegation of duties w/in these teams. Any input appreciated.

Nurse on a Mission :)

BeeStrong · Aug 20, 2003

I work in a 250 bed hospital in a mid size city in Oregon, Oncology unit of 21 beds; staffing on days: 3-4 pts, usually 3 CNA's plus sitters when needed; eves': 5-6 pts with 2 CNAs and nocs 6-7 pts with one CNA, 2 if over 18 pts. This seems to be working well. When I worked back East, they would pull our One Cna on days to be a sitter or whatever and RNs would have to give all baths, meds, treatments, sometimes even be ward sec. when they called in. It was horrible. I would never work on the east coast again, Ever!! I have worked both with acuity systems and without; the acuity system took a lot of our time to fill out the forms and then it seemed that it didn't matter; it was always the "butts to beds" that counted. That's my two bits after 25 years in nursing, thanks, Bee Strong, RN

RN-PA, RN · Aug 20, 2003

Originally posted by reunion30
I sure LOVE some of those nurse to patient ratios I have read about. The hospital I work at in North Central Florida ratios are 1:8-13 days, but nites are usually better believe it or not. Their ratio can be a low as 1:6.

What is the deal with less patients on night shift? Our hospital staffs 1:6/7 ALL 3 shifts. Granted, we had trouble keeping nurses for night shift and they went through a rough period of 1:10-12 Pts. But with the incredible amount of activity we experience on days/evenings (post-ops, admissions, transfers, going for tests, etc. etc.) copmpared to the activity on night shift, I don't understand my hospital's "one size fits all" staffing. That's great for nights to have 6 patients-- they get busy, too, but other shifts should be staffed commensurate with the amount of activity and needs. (I plan to speak up about this-- and other issues-- as I recently was asked to represent my unit on a hospital-wide retention committee.)

norinradd · Oct 3, 2003

Forget policy. Every time we complain about ratios we are told "they are merely guidelines, you take what you are given".

I work med/onc. The most I have had with a CNA is 16, 13 without. 25% are onc with either chemo, blood or frequent PRNs not to mention the overflow we get from PCU/ICU.

Even then it wouldn't be so bad if they excepted best effort, but they keep adding demands on our time and set up systems that makes only the nurse at fault if something is missed.

Does anyone know of a resource to argue better staffing?

BeeStrong · Oct 4, 2003

There are resources available thru the ANA website if you are researching staffing ratios and patient safety; they have done a lot of research on this subject; there recently was a newspaper article about the latest research that pt outcomes are better when nurse:patient ratios are lower; surprise, surprise; but at least they actually have research now to back up something that nurses have known all along. The acuity systems I have seen do not keep up with the rate of admissions so I feel it is better to have the Charge make the decision on staffing; not many systems will staff acc to admission rates; at my hospital we "[pend" 3 " patients just to account for admissions; we are a 300 bed hospital; 22 bed onc/med/surg unit; 5 RNs days, 2-3 cnas, 5 RNs eves, 1-2 cna, 4 RNs eves 1-2 cnas, usually 1:5 pts days/eves; 1:6 or 7 on noc shift.