Nurse/Patient Ratios

pricklypear · Aug 1, 2005

I'm curious to know about the nurse/patient ratios in other hospitals. I am in central Florida on a Cardiac/Telemetry/Med-Surg floor. We take all kinds of cardiac drips, BP drips, Insulin drips, Heparin drips and we are now taking 7 patients each. I work 7p-7a and we have to file all our labs from the previous shift, stuff our charts and draw our morning labs. We have a charge nurse (me sometimes) and she takes six patients. Gone are the days when we could actually develop a therapeutic relationship with our patient, now it has become: do what you have to do to protect your license. I have a co-worker who just came to our hospital from a different one in Florida...they took 10-12 patients each (no drips though). It is truly a nightmare. The management says they care about the patient..NOT TRUE. They care about the numbers. The only time they care about the patient is when one of them is injured/dies under questionable circumstances and the hospital may be sued. Then, they just fire the RN, report her to the nursing board and go about business as usual. Whatever happened to having time to comfort a crying patient or giving special attention to a confused, elderly patient? No time to actually TALK to your patient, other than to say "I need to start an IV on you" Do they have water in their pitcher? I don't know. Would they like an evening snack? Who cares. I have to go take a set of q2 vitals on my guy on the cardiziem drip who's heart rate is in the 130s. God forbid anyone goes bad during a shift...that's when your six other patients have to fend for themselves --that's when your license is blowing in the wind. I understand there is a nursing shortage, but that excuse won't fly when I'm in front of the nursing board! If there is such a nursing shortage, then give us 7 or 8 patients, but hire more CNA's...hire a phlebotomist to do our labs, hire a file clerk to file all the paperwork. Anything that doesn't require a nursing license needs to be done by ancillary staff. The fact that the management in my hospital hasn't taken these steps to allow the nurse to really know her/his patients and take care of them properly re-enforces my belief that it is all about the numbers. Whheeww...glad I got that off my chest. Tell me about your hospital.

Sounds like where I used to work. And that was BEFORE it got bad!!! I thought 7-8 usually, 9 if worse came to worse was bad when I first started there. I got used to it. Got used to charting briefly, doing very specific assessments. Thank God for Tele - at least you could tell if someone was going down while you were buried up to your cheeks in charts doing reviews.

Then, it got worse. Over a 6 month period, we went from 3 nurses and a aid for 27 pts to 2 nurses and maybe an aide on a regular basis. That's 13-14 pts a piece! Then, the night that made me quit. Me, an LPN (who graduated in the 70s and hadn't worked for 20 years until about 4 months before), a float aide. 26 pts. I went to my manager that morning, thinking that the staffing that night was a unfortunate oversight, but no - it was fine by her. She said, "I really don't see the problem, she's a great LPN" The problem was that I was solely responsible for 26 cardiac patients. Some of them 24h post CAGB. I did ALL the IV meds. ALL the phone calls. ALL the labs. Exactly 2 weeks later, I was outta there. From what I hear, things aren't much better almost 3 years later. I'm truly surprised there haven't been any lawsuits. I will never subject myself to that again. I'd rather make minimum wage at a fast food joint.

Bluespruce · 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".

Wow! I can't believe these ratios...I was hoping that was more or less a thing of the past, but I guess not. In the metro area where I live I haven't heard of more than 7 pts per nurse other than at the VA hospital. Was this at a more rural hospital? Being a new RN & having just done aide work for a while though, let me tell you doing vitals on 32 pts is virtually impossible.(especially if it's q4 & your're supposed to answer all the lights - it can't be done really) They'll be asked for several different things & not just the vitals upon visits to each pt room to do the vitals. Anyways, I don't think their job is necessarily easier (but of course I'm not there). To me it sounds like you're all working your xxsses off & risking your licenses at the same time. Of course the aide gets paid substantially less too...I don't think I could ever be an aide long-term (for more than a few years). They really work hard, don't get the respect they deserve by many & have a super physical & important job.

GGodwinRN · Aug 2, 2005

I'm curious to know about the nurse/patient ratios in other hospitals. I am in central Florida on a Cardiac/Telemetry/Med-Surg floor. We take all kinds of cardiac drips, BP drips, Insulin drips, Heparin drips and we are now taking 7 patients each. I work 7p-7a and we have to file all our labs from the previous shift, stuff our charts and draw our morning labs. We have a charge nurse (me sometimes) and she takes six patients. Gone are the days when we could actually develop a therapeutic relationship with our patient, now it has become: do what you have to do to protect your license. I have a co-worker who just came to our hospital from a different one in Florida...they took 10-12 patients each (no drips though). It is truly a nightmare. The management says they care about the patient..NOT TRUE. They care about the numbers. The only time they care about the patient is when one of them is injured/dies under questionable circumstances and the hospital may be sued. Then, they just fire the RN, report her to the nursing board and go about business as usual. Whatever happened to having time to comfort a crying patient or giving special attention to a confused, elderly patient? No time to actually TALK to your patient, other than to say "I need to start an IV on you" Do they have water in their pitcher? I don't know. Would they like an evening snack? Who cares. I have to go take a set of q2 vitals on my guy on the cardiziem drip who's heart rate is in the 130s. God forbid anyone goes bad during a shift...that's when your six other patients have to fend for themselves --that's when your license is blowing in the wind. I understand there is a nursing shortage, but that excuse won't fly when I'm in front of the nursing board! If there is such a nursing shortage, then give us 7 or 8 patients, but hire more CNA's...hire a phlebotomist to do our labs, hire a file clerk to file all the paperwork. Anything that doesn't require a nursing license needs to be done by ancillary staff. The fact that the management in my hospital hasn't taken these steps to allow the nurse to really know her/his patients and take care of them properly re-enforces my belief that it is all about the numbers. Whheeww...glad I got that off my chest. Tell me about your hospital.

I'm curious if you can tell me which hospital you are at? I'm in Central Florida also but at the Florida Hospital location that I am at on the PCU/Telemetry/Step-Down our ratio is 1:4 or 1:5 depending on our census. We either have no tech or 1 tech to anywhere between 15-25 patients.

pickledpepperRN · Aug 2, 2005

Bluespruce:

A sample letter would be something like:

"As patient advocates in accordance with the Nursing Practice act this letter is to inform you that in our opinion the staffing on August 1, 2005 puts our patients at risk. While objecting to the unsafe staffing we will care for our patients to the best of our ability.

We have one patient who is at extreme risk for a fall. We recommended that someone sit with this patient to prevent falling, however our aide was floated.

We have 7 patients each with only one aide. It is not possible to provice safe, effective, nursing care. We are informing you that the facility not the nursing staff is responsible for any harm caused by this unsafe staffing. Medications and treatments may be missed or late, documentation may be incomplete.

Signed (all who agree) " An incident report must also be filled out for this shift even if everything goes OK.

This is not good to do alone unless you have union protection. If the entire unit signs letters like this, or for an especially dangerous shift all staff on the offgoing and oncoming shift usually gets additional staffing, management actually doing patient care, or a meeting. Once we got a nice apology with explanation.

FAIRYTALES · Aug 2, 2005

right now I only pass meds as a cmt (starting lpn in oct)and all of my nurses talk very strongly about CYA(COVER YOUR ***)and it's scary but very true document document document good luck

elthia · Aug 2, 2005

Wow! I can't believe these ratios...I was hoping that was more or less a thing of the past, but I guess not. In the metro area where I live I haven't heard of more than 7 pts per nurse other than at the VA hospital. Was this at a more rural hospital? Being a new RN & having just done aide work for a while though, let me tell you doing vitals on 32 pts is virtually impossible.(especially if it's q4 & your're supposed to answer all the lights - it can't be done really) They'll be asked for several different things & not just the vitals upon visits to each pt room to do the vitals. Anyways, I don't think their job is necessarily easier (but of course I'm not there). To me it sounds like you're all working your xxsses off & risking your licenses at the same time. Of course the aide gets paid substantially less too...I don't think I could ever be an aide long-term (for more than a few years). They really work hard, don't get the respect they deserve by many & have a super physical & important job.

It can be done, I've done it before. I used to work at this same facility as an unlicensed aide, and I've had that assignment many a time. This is a VA hospital, and trust me, the aide has worked there long enough they get paid more than some of the LVN's.

I've also had to do charge, RN responsibilities, IV"s, Chemo, patient care for 6 patients, and had 2 patients getting blood at the same time, and that same aide told me, while I'm taking care of a patient that broke out in a rash while recieving blood, that "Mr. So and so was incontinent, his family wants him cleaned up now, he's your patient, and I'm going to go pick up lunch". Needless to say, me and that aide don't really get along.

pink2blue1 · Aug 2, 2005

I'm a CNA and nursing student. I am in California and in the hospital I work in the a Nurse can take up to 5 patients on all med-surg floors (In our hospital even telemetry& oncology gets regular med-surg patients. the DOU has a 3 to 1 ratio and ICU/CCU is 2 to 1 I believe. Not sure what L&D and Post partum are. The CNA's get 10 patients each for bed baths and linen changes and any other thing they might need within our scope. We do ALL the vitals though and chart them. My floor has 31 patients and we sometimes have 2 CNA's, but mostly 1. The night shift gets no CNA's.

Bluespruce · Aug 2, 2005

It can be done, I've done it before. I used to work at this same facility as an unlicensed aide, and I've had that assignment many a time. This is a VA hospital, and trust me, the aide has worked there long enough they get paid more than some of the LVN's.
I've also had to do charge, RN responsibilities, IV"s, Chemo, patient care for 6 patients, and had 2 patients getting blood at the same time, and that same aide told me, while I'm taking care of a patient that broke out in a rash while recieving blood, that "Mr. So and so was incontinent, his family wants him cleaned up now, he's your patient, and I'm going to go pick up lunch". Needless to say, me and that aide don't really get along.

Yeah it sounds like the aide wasn't empathetic to you at all - that doesn't help the pts any.

Bluespruce · Aug 2, 2005

I'm a CNA and nursing student. I am in California and in the hospital I work in the a Nurse can take up to 5 patients on all med-surg floors (In our hospital even telemetry& oncology gets regular med-surg patients. the DOU has a 3 to 1 ratio and ICU/CCU is 2 to 1 I believe. Not sure what L&D and Post partum are. The CNA's get 10 patients each for bed baths and linen changes and any other thing they might need within our scope. We do ALL the vitals though and chart them. My floor has 31 patients and we sometimes have 2 CNA's, but mostly 1. The night shift gets no CNA's.

Yeah, that sounds sort of similar to where I was as an aide. I did vitals at times on all 30 pts, but during that time I really couldn't be answering lights as well.(when I was only aide) Sort of a tough balancing act. Those sound like decent ratios though for the nurses so that they aren't stretched as thin as some with say 8-14 pts.

SarasotaRN2b · Aug 2, 2005

The ratio for the med/surg respiratory unit I work on is 4:1, maybe 5:1 and the charge nurse rarely gets patients unless we are short a nurse. They are busy enough with the 4 to 5 patients that they have that anything more will definitely compromise patient safety.

lee1 · Aug 3, 2005

justmanda
Registered User
Join Date: Jul 2003
Posts: 21 Nurse/Patient Ratios
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I'm curious to know about the nurse/patient ratios in other hospitals. I am in central Florida on a Cardiac/Telemetry/Med-Surg floor. We take all kinds of cardiac drips, BP drips, Insulin drips, Heparin drips and we are now taking 7 patients each. I work 7p-7a and we have to file all our labs from the previous shift, stuff our charts and draw our morning labs. We have a charge nurse (me sometimes) and she takes six patients.

I think that you should go to your local library and look up your state regs. In NJ they state that the maximum is 6 patient/nurse for telemtry floors. Then do not allow your hospital to overstep this----call the board of labor if need be. Nurses are their own worst enemies because they have not learned the proper ways to complain. Fill out protests of assignment, incident forms, pass the responsiblity, hold staffing rallies, push your legislators, push your hospital leadership. Your charge nurse should have the lightest assignments, they are there to be in charge, mentor, help manage, relieve for breaks/meals, etc. Where is your HN??? Maybe it is time to go public???

Haunted · Aug 3, 2005

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!

I assume you are also in California based on your reference to CNA. I remember the days when there were no mandatory ratios and I look back and wonder how I ever got anything done with 11 or 12 patients.

Now, I never have more than 5 patients on a med surg floor and unfortunately am often primary for them. I find that taking vitals, changing linens, emptying bed pans, feeding patients, delivering trays and answering call lites takes up the majority of my day and providing medications, assessments, dressing changes and charting tend to take a back seat.

This is getting to be frustrating and unfortunately many facilities are reducing our nurses aids and blaming this bogus "shortage" on the inability to adequately staff. I work registry and also notice that the acuity of the patients I am caring for is getting higher and higher.

It seems to make more sense that we base our staffing on acuities, not ratios. I think if we were all honest, we could easily provide for 10 "walky talky's " that did not require such intensive care, and ratios be damned!!!

I also do not believe the hype about the "nursing shortage". I believe there is a shortage of good nursing jobs. Give me back my CNA!!!