I'm still the "new kid on the block" with a little over 1.5 years experience, all on a medical-oncology unit. I'm struggling with staffing, and how it clearly has nothing to do with the acuity of the census. After basically being told to shut up and deal with it, because it's just the way things are and nothing is going to change, I'm curious about others' experiences and staffing conditions. A brief survey to open discussion:
1. What type of unit do you work on, and in what state?
2. What is your nurse patient ratio, and how does it change between day-evening-night shifts?
3. How many supporting staff (nursing aides, patient care techs, assistants, secretaries etc.) do you generally have to help?
4. Do you have a charge nurse, and what are his/her responsibilities and duties?
5. Do you feel your staffing ratios are adequate (generally speaking - I know we all have good days and bad days) for your usual census?
To start on my end...
1. Medical-oncology unit (primarily). Our hospital recently closed the surgical unit due to frequent drops in hospital census. Surgical patients now are sent to the medical unit, and medical overflow patients are sent to us, or to the overflow unit associated with our telemetry unit. We also occasionally get surgical patients.
2. Day shift 5:1, evening shift 6:1, night shift 7 or 8:1. That being said, I've occasionally had 6 patients on D shift, or 7 on E shift.
3. 95% of the time we only have 1 aide for the entire unit (up to 23 beds). Every once in a while (rare enough to be a pleasant surprise), we will have 2 aides. We always have a secretary on D shift, but maybe 50% of the time on E shift. Night shift will have 1 secretary that travels between the units.
4. We do have a charge nurse. While they are reevaluating what the role requires, currently the charge nurse keeps tabs on every patient, including most of the major and important details of each patient, and overall plan. Most of them will make phone calls to the doctors if needed. It's sort of a hybrid administrative-floor nurse role. That being said, the night shift charge nurse also takes on a full patient assignment in addition to their charge duties.
5. Most of the time, ratios are not adequate for our normal patient population. We frequently have many total patients, physically demanding patients, and MR patients from the local community home. It's not totally uncommon to finish first rounds 2 or even 3 hours into the shift, between bathroom trips, total bed changes, medication administration, etc. Occasionally we have days where there will be no aide at all. Are there good days where staffing is adequate? Absolutely. But most of the time general consensus is that staffing is inadequate.
We also don't have a pharmacist on-campus 24-hours a day, so I'm curious how common or uncommon that is? Pharmacy is available from 7a-11p Monday through Friday, and I believe 7a-7p on weekends. So if we need a medication "off hours," the order must be verified by a central pharmacist 2 hours away, then *most* medications can be obtained from our house-manager.
