Nurse Patient Ratios for Med Surg, Step-down, ICU

HouTx, BSN, MSN, EdD · Jul 25, 2008

If you're looking to benchmark, I would suggest that you obtain information from the Labor Management Institute.

http://71.39.108.170/LMI/

They have conducted (voluntary) staffing studies for many years and publish a quarterly newsletter (Perspectives on Staffing & Scheduling) that contains valuable info on ratios for all types of clinical areas and facilities.

marieparn · Aug 4, 2008

The unit I manage is a 31 bed Med surg unit that mainly has GI, dialysis, and some peds patients. Many of our patients are at our facility in excess of 3-4 weeks due to their very complicated surgerys. We also have Telemetry capability but if there are cardiac drips ordered the patients are transfered to our "TELEMETRY" Cardiac Unit. I am allowed 9.1 NHPPD for my unit and I have an ADC of 27 I am able to staff 6 RNs and 5 Care partners (CNA or LPN) for days and evening shifts and for Nights I have 4 RN's and 3 Care Partners. My goal is to have this staffing every day but like everywhere else call ins vacations etc.... Our ideal is to have 1:5 and no more on days/eves and 1:7 on nights Hope this helps

OCRN · Aug 4, 2008

I manage a 24 bed medical unit. We have a 1:5 or 1:6 nurse to patient ratio with 7.86 HPPD. The FY09 budget has totally wiped out CNA's in lieu of Tech's to have more licensed staff with the plan of "modified primary nursing."

JoycMarr · Oct 19, 2008

ICU --always 1:2 ratio, or 1:1 if it's a very "busy" pt (such as fresh post-op CABG), all RN staff

Stepdown Unit (this unit has cardiac drips, insulin drips, and long-term vent pts)--always 1:4 or 1:3 if pt team includes vent pt, all RN staff

Med-Surg--1:6 on days, 1:7 on nights

CNA ratio for all units--1:10 on day shift, 1:15 on nights

annabanana1219 · Oct 19, 2008

i have seen it vary from one nursing speciality to another as well as from facility to another. i have done rehab at 1:6 or 7 and am now starting a rehab job that is 1:8. that is do-able in rehab. i have also done long term acute care (kindred- used to be vencor) and that was a 1:8 ratio of multi-system failure type pt's! i have done other ltac's that were 1:5 or 6 pt's and that was more reasonable ratio. i wish that the admin's in hospitals would realize that the more burdened the nurse is with a heavy load the more likely a tragecy will happen and then the hospital will be liable.

LEN-RN · Jan 1, 2009

annabanana

i wish that the admin's in hospitals would realize that the more burdened the nurse is with a heavy load the more likely a tragecy will happen and then the hospital will be liable.
unfortunately, not just the hospital. our nursing licenses are one the line.

Wade21, ADN, RN · Feb 1, 2009

I work on a PCU and our ratio is 1:5. On the MED/SURG unit its 1:6. What makes all this in "numbers" secondary element is LEVELS OF ACUITY! Numbers matter not if you have 5-6 pt.'s that are total care and your spread thin. My hospital, like a lot of hospitals, look at numbers. "Well, you only have 4 pt.s so we can give you another admission" even though the 4 pt.s you have require high levels of care.

What needs to be done is not ratio, but pt. load based on a classification of levels of acuity in the determination of how many pt.s a nurse will be assigned.

(Levels 1-4, as an example).

I am in agreement with the last post about preventing a tragedy but you can have 6 pt.s who require light to moderate care and your able to provide them with a proper level of nursing care and then be loaded with 6 pt.s who require higher levels of care and be spread "too thin" with the result of pt.s recieving inadequate care

; the pt.s suffer and so do you(with your license).

nyreaRN · Feb 1, 2009

I work at a step-down unit. 1:3 is our ratio, if we get a 4th patient, that patient is totally ignored!

Wade21, ADN, RN · Feb 1, 2009

That is unfortunate!

USAVARN · Feb 11, 2009

I am a new manager less than 6 months of a medical/telemetry floor. Even though it is a telemetry floor, we do not handle any type of cardiac drip, insulin drip and it is against hospital protocol for a nurse on my floor to push lopressor....so we are a step, step down medical/telemetry floor. The maximum number of patients on my unit is 23. I am just getting an understanding of the NHPPD rules! I admit my nurses are busy but I also see alot of mis-classified patients because the nurse doing classifications for that shift play with the numbers. I am trying to change that mentality and further educate about a balanced assignment. I am from a very busy level 2 trauma center where I was an ER nurse, then an ICU nurse so I have to admit that alot of the nurses who are complaining to me about not having enough help have time management issues. I admit too that many of our patients are not full care, alot are behavioral issues and a few are 2 person assist and a majority of the patients become placement issues so they hang with us for awhile while our social workers find them a nursing home, etc. Only license (RN/LPN) and assistants are used for my NHPPD. I recently had our unit cap lowered to 18 due to staff vacancies. Despite this I am still getting complaints from nursing that their loads are too high. Tonight when I left we had a census of 12 of which 3 license staff and one nursing assistant were on. I have even calculated the NHPPD according to each shift. I do agree with acuity that looking at staffing is more than looking at numbers. I get so frustrated. I hear complaints from my nurses but I get complaints from my bosses about why my nurses report they can't handle a 1:5 or 1:6 assignment. In some regards reading all these posts I can report to my nurses that other hospitals are having the same issues. Sorry for rambling, just a bit frustrated.