Nurse-Patient Ratios on East Coast

[shhhh]

A fellow nurse has relocated here (West Coast) from the East Coast, and we work critical care together in a pretty large hospital that serves a lot of the state (meaning, we get our fair share of exciting cases). This nurse (lived and worked in NYC) once told me that it's very typical for nurses in East Coast hospitals on med/surg floors to have 5 to 6 patients on days, while night shift has up to 10, "and they're really sick patients. Like, way sicker than the patients that are on the med-surg wards here. The only reason anyone would be in the ICU is if they're vented. As soon as they're extubated, they're transferred to the med-surg floors." As far as ICU goes: "No one-to-one patients over there like here. Everyone gets two patients, no matter how sick they are. They're all vented and basically circling the drain."

I just question what this particular nurse told me, because not only is she well known for having an ego the size of the Good Year blimp (very knowledgeable and skillful, and don't you forget it!), many of us who work with her could definitely see her embellishing a bit to make herself look even more knowledgeable and skillful.

So... my dear allnurses... does any of that ring true for any hospitals on the east coast? If so, you all are pretty much demigods in my eyes. But if it's not true, that's great too because I'll be less terrified of relocating to NYC.

[mentalhealthRN]

I am in upstate NY--When I worked medical we had 5 on days and eves and nights had 12. The ICU in that hospital had 1:1 and sometimes 1:2 depending on the acuity of the pts. On my floor they had a mix of walkie-takies and really super sick people, up to 4 of the 24 beds could be vent patients. I was at the hospital with "good" ratios. The others were higher. At another hospital where I worked psych we had 10 on days/eves and 15 on nights. The medical floors in that hospital had 7-8 I think. Not sure about ICU at that one.

[shhhh]

Thanks for your answers everybody! I admire all of you for working in challenging positions over there. You all ARE demigods... and deserve ice cream sundaes. :)

This nurse also told me she thought I was a "sweetie" and a "cutie", so since you all basically proved she's apparently not a fibber, I MUST be sweet and cute, then! HAHAHA.

[JennyMac]

I work in NYC, and at my hospital, on a med-surg floor you'd normally have 8 patients on day shift, sometimes 9, on a good day 6-same goes for our telemetry unit. ICU is usually 2-3 patients. My floor is a mix of vents and tele, and lately it's been great having 5 patients--usually 1 or 2 are vents and 3 tele/medical patients.

[kcmylorn]

I have to say the same goes for here in NJ. I worked a tele step down floor in a cardiac/pulmonary hospital( the hospital called it med/ surg) but all pts were monitored, and3 days post CABG, cath w/ stents, vascular. The CVICU would clean out their unit @ 5:30 AM to make way fro the days fresh ones. I usually had 6 pt's on days and as quick as I would dishcarge one another would come- It was a wagon train of IVpumps, mediastinal chest tubes, capped pacer wires and arrythmia city. Some days I would discharge all and by 7PM I has a entire new team of 6. Felt like they came out of the woodwork.I worked Medical tele in Philly- 4-5 really sick tele pt's on days( alot of diaysis, drug abuse, schiz, bipolar, and HIV, homeless with this tel unit), 6-7 on nights and admissions from the ED count on it(the crack cocaine and Heroine crowd). I worked Neuro/neurosurg/neuro trauma in the city @ a big University hospital as travel/agency. We had 8-10 patient on nights- all trach'd and pegged. The NYC RN is telling Calif no lies. This is horrendeous over this side of the states. And these CEO's are making bank-2.3 million salaries a year. We need a BIG paddy wagon for these crooks. There is NO justification for this!

[kcmylorn]

It's specific examples like this that need to be told to Capital Hill, and the media. not the ambigious bull**** they hear from these "Nurse" in their ivory tower of the ANA, and think tanks!

[ganurse03]

Sad to said it's true in Atlanta.

[BrookeeLou_RN]

East Coast nursing is a very different world then west coast or even mid America. Most of East Coast has lower pa also... Used to be due to lack of unions.. now I don't know maybe just because they have gotten away with it forever! Some of SE is even worse.

[mpccrn, BSN, RN]

I worked in a level 1 trauma center in PA and the norm was 2 vented-swan'd patients to 1 nurse. In the hospital I work at now it's 2-3 patients to 1 nurse in the ICU, tele is 5 to one on days and 6-1 on nites.....not so good.

[evilolive, BSN, RN]

I work in CT on a medical floor. 5 patients per nurse at night max for my floor (we have 15 patients). The acuity ranges from "walkie talkie" ready to be discharged to ICU transfer who still looks like they're going to require a ton of care. It really varies on my floor. The most patients I ever had at one time was probably 7, when a nurse had to go home sick in the middle of her shift.

Even the five patients can be a handful. I should stop talking though, I'm lucky enough not to have 7-12 patients!

[ObtundedRN, BSN, RN]

Where I am, ICU is 2:1. I believe Tele units in my hospital is 4:1, and med/surg is 6:1.

As for the acuity of our ICU patients, they are very sick. Most are in the ICU for the need of intubation and sedation, vasopressors, and other titrated drips. If they are not on any of those, but still critical, then off to the progressive care unit. Which is actually called progressive critical care, and part of the critical care division since they are much higher acuity compared to typical progressive patients. If you are trach'd and vented, but not sedated, you would go to progressive care as well.

Is all of your ICU patients 1:1? While all of our ICU patients are very very sick, and in fact are sent to our facility from other hospitals because of the higher acuity we treat, I don't see the need for too many of ours to require 1:1. Unless they are fresh open hearts, or actively decompensating.

[mykrosphere]

this is just wrong and unsafe

:sofahider

i have the week off and i am tired of even thinking (about it)

i work in an ltach east/ midwest. 5 pts at night (although i have had up to 7

we supposedly do not have an icu unit anymore. 80 percent of our pts are trached/ half of those vented/ some on pressors/ sedation/ many out-of- their- mind- fall risks/ many weighing at least 300 pounds (double that for a handful), many full codes who shouldnt be and whose family cannot let go/ etc etc

8 pages of charting on each patient.

we are supposed to do our own labs (even though we have lab), and our own vitals and blood sugars (we have NA's), and process all orders (no unit clerk)

it makes me want to cry really....and know that i will never have my own family member there.

everyone is mad/ upset about something all the time- mostly family/ pts.

not to mention staff.

it wasnt like this before we were acquired by another company.

our pts are not regular med surg pts.

i wish they were!

i wish something could be done about this issue also.

there are so many nurses who need jobs, and so many nurses with jobs who could use the help!!!

[lckrn2pa]

Yup, it's a little true. ICU is rarely 1:1 unless on an IABP where I am. it's 2 or 3:1. Med surge is days, 5-7 and nights 8, sometimes 9, although not always that sick. Tele is days 5-6, nights being 6-7. Not that great. I live in the NYC metro area. My dad went on vacation to CA and had an MI out there. He wa sin the ICu post cath and called me and said "you have to come out here, the ICU is 1:1 and they just have to deal with me!" Tempting....

I think however CA is the best state because it is regulated nicely by Arnold Swartzenager(sp?)

That would be a negative, he actually tried to cut out the pt ratio's in 2005 he tried to suspend the law but was overruled in court.