Nurse/Patient Ratios

Judee Smudee, ADN, RN · Aug 1, 2005

I have been coming to this site for about six months now and no one has given a better synopsis of the situation than you. It looks to me that the only thing that is going to stop the problems that you describe are nurse patient ratios mandated by the goverment. Trusting healthcare leaders to do this is just not working. Their only motivation is the bottom line. Gosh you sound like a great nurse. Two thumbs up to you for realizing that your responsibility to the patient goes way beyond just getting through a shift safely. Nurses have to become activist in many different ways if patient safety is really our main concern. I recently retired because I was becomming so fearful about patient safety in the face of rising patient loads. At age 60 I was more frightened than I had ever been before of making a mistake. Would you believe they would haul us in to give us lectures about medication safety, fall prevention and infection control and then send us out of lecture room to care for 24 patients with only an RN, LPN which was me and two aides. I just could not stand the hippocrites I was working for anymore. Signed up for my pension.

justmanda · Aug 1, 2005

I have been coming to this site for about six months now and no one has given a better synopsis of the situation than you. It looks to me that the only thing that is going to stop the problems that you describe are nurse patient ratios mandated by the goverment. Trusting healthcare leaders to do this is just not working. Their only motivation is the bottom line. Gosh you sound like a great nurse. Two thumbs up to you for realizing that your responsibility to the patient goes way beyond just getting through a shift safely. Nurses have to become activist in many different ways if patient safety is really our main concern. I recently retired because I was becomming so fearful about patient safety in the face of rising patient loads. At age 60 I was more frightened than I had ever been before of making a mistake. Would you believe they would haul us in to give us lectures about medication safety, fall prevention and infection control and then send us out of lecture room to care for 24 patients with only an RN, LPN which was me and two aides. I just could not stand the hippocrites I was working for anymore. Signed up for my pension.

Thanks for the kind words. Regarding the fall prevention lecture you talked about, we had several patients one week who kept crawling out of bed and the doctor wouldn't let us restrain them..nursing management wouldn't give us a sitter because it wasn't in our budget and (keep in mind we have 6 and 7 patients) and then low and behold, one of them had a fall. Can you believe we were actually lectured on the importance of patient safety and they set a GOAL for us for the next month...UGH!!!! It is both SCARY and laughable. What is truly hilarious about it is that we, THE NURSES, told the powers-that-be that the patient was going to fall and THEY...the one's who ignored our requests, were the one's giving us the lecture. :rotfl:

Judee Smudee, ADN, RN · Aug 1, 2005

Thanks for the kind words. Regarding the fall prevention lecture you talked about, we had several patients one week who kept crawling out of bed and the doctor wouldn't let us restrain them..nursing management wouldn't give us a sitter because it wasn't in our budget and (keep in mind we have 6 and 7 patients) and then low and behold, one of them had a fall. Can you believe we were actually lectured on the importance of patient safety and they set a GOAL for us for the next month...UGH!!!! It is both SCARY and laughable. What is truly hilarious about it is that we, THE NURSES, told the powers-that-be that the patient was going to fall and THEY...the one's who ignored our requests, were the one's giving us the lecture. :rotfl:

If they give you the lecture if a fall occurs it is on your head and not theirs. If State and Joint commission can mandate the lecture why can't they mandate patient ratios.

Bluespruce · Aug 1, 2005

I have been coming to this site for about six months now and no one has given a better synopsis of the situation than you. It looks to me that the only thing that is going to stop the problems that you describe are nurse patient ratios mandated by the goverment. Trusting healthcare leaders to do this is just not working. Their only motivation is the bottom line. Gosh you sound like a great nurse. Two thumbs up to you for realizing that your responsibility to the patient goes way beyond just getting through a shift safely. Nurses have to become activist in many different ways if patient safety is really our main concern. I recently retired because I was becomming so fearful about patient safety in the face of rising patient loads. At age 60 I was more frightened than I had ever been before of making a mistake. Would you believe they would haul us in to give us lectures about medication safety, fall prevention and infection control and then send us out of lecture room to care for 24 patients with only an RN, LPN which was me and two aides. I just could not stand the hippocrites I was working for anymore. Signed up for my pension.

I wonder if you worked for a VA hospital? I've noticed the worst ratios & circumstances for patients there on med/surg floors.

Bluespruce · Aug 1, 2005

I wonder if you worked for a VA hospital? I've noticed the worst ratios & circumstances for patients there on med/surg floors.

Also, I have a question for you in re: to this situation being that I'm a new nurse. In general, should you chart that you've requested such & such because of your reasonable fear that pt could fall out of bed & injure him/herself? I wonder if charting that is ok & I wonder if it'd help your license. Of course, from the hospital's liability standpoint they may not like u to chart this kind of stuff. What are your thoughts on the matter? It seems one way you're looking after your own license & the other way you're just looking after the hospital's liability.

justmanda · Aug 1, 2005

Also, I have a question for you in re: to this situation being that I'm a new nurse. In general, should you chart that you've requested such & such because of your reasonable fear that pt could fall out of bed & injure him/herself? I wonder if charting that is ok & I wonder if it'd help your license. Of course, from the hospital's liability standpoint they may not like u to chart this kind of stuff. What are your thoughts on the matter? It seems one way you're looking after your own license & the other way you're just looking after the hospital's liability.

The problem with charting "Nursing administration notified and refused to allow sitter" is that it just SCREAMS sue us. An incident report is where this information is normally directed. On the other hand. When you tell a doctor what's going on, in any situation, you can write..."Informed physician that patient continues to crawl out of bed. (give a brief run down of their vital signs) no new orders received" If it goes to court, the incident report will be on file for the case to reveal your attempt to get help from administration and the chart will show that you informed the doctor of the patient's unpredictable behavior. HOWEVER: when patients fall, nurses are blamed. That's just the way it is. :crying2:

justmanda · Aug 1, 2005

I wonder if you worked for a VA hospital? I've noticed the worst ratios & circumstances for patients there on med/surg floors.

Nope..work for a community hospital.

pickledpepperRN · Aug 1, 2005

If they give you the lecture if a fall occurs it is on your head and not theirs. If State and Joint commission can mandate the lecture why can't they mandate patient ratios.

Ratios don't make things perfect but they are SO much better than what you are going through.

The patients described by justmanda seem like they should be in ICU (at a 1:2 ratio) or step-down (1:4) if they were here.

If not for ratios and the support of my fellow CNA nurses i would be like you and retire. It took a lot of education and experience for me to learn what i know. I think my patients and colleagues benefit from me as I do from them. Still a few more years left, if my health holds up.

I would either write why the assignments are unsafe for patients and get others who agree to sign it also. I would keep a copy and give the original to my manager and the medical director of the unit or hospital.

If I really needed the job, felt the letter would cost me the job, and there is no other job available I would fill out an incident report EACH time. It may be every day. I might fill out two and make sure one gets to the hospital attorney. I would also call the doctor charting what I told the Doctor and a word for word quote of hte response. AND i would keep a journal with the staffing numbers (no HIPAA violations), what we did,dated and written after every shift. I've been told those hold up in court years later.

The letter is beat, puts the responsibility for the fall or worse on the facility where it belongs.

All the best to you. I've been there and it is just plain wrong to do this to patients and nurses. No wonder there is a shortage!

oramar · Aug 1, 2005

HOWEVER: when patients fall, nurses are blamed. That's just the way it is.

Whatever goes wrong the nurse is to blame. Managers will try to shift the blame to you. Doctors will try to shift the blame to you. Hospitals will try to shift the blame to you. Insurance companies will try to nail you to the wall.

Bluespruce · Aug 1, 2005

Whatever goes wrong the nurse is to blame. Managers will try to shift the blame to you. Doctors will try to shift the blame to you. Hospitals will try to shift the blame to you. Insurance companies will try to nail you to the wall.

Thanks for all your responses...I guess as a new nurse if I'm put in any of these situations I'll just have to fill out incident reports (before I think something really bad might happen) & then of course chart what I notified physicians about that could turn into potential issues. It's nice to have the seasoned nurse's perspective & advice!

I don't get what you mean though by "The letter is beat, puts the responsibility for the fall or worse on the facility where it belongs."

...what is the letter you're referring to? I just want to make sure I understand.

Thanks!

elthia · Aug 1, 2005

where I work at we usually have 2 RN's, 2 LVN's and one aide for 30 patients on an evening shift. We do "team nursing" , there are two halls and an RN does IV's, assessments, for a hall and is responsible for patient care for 6 patients, along with RN responsibilities and interventions for all 15 patients on that hall. The LVN does PO and IM meds for a hall and is responsible for patient care for 6 patients. The charge nurse has RN responsibilities, IV's, patient care, is responsible for classifying all patients by the acuity system, verifying all orders written that shift on all 32 patients and all other charge responsibilities. The aide does VS for the floor and has patient care responsibilities for 6 patients.

I used to assign the aide to fill all water pitchers, stock gloves in rooms, do the chemsticks for the LVN's,and answer other nurses call lights during the major med pass times but I recieved too many complaints and got in trouble becuase it was "too hard on the aide". :angryfire I have worked every aspect of the "team", and believe me the aide has it the easiest. I can't even give the aide more patients than 6, because that's "not fair either".