Nurse/Patient Ratios

[justmanda]

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.

[SheriLynnRN]

Here's how it works on my unit (ortho/neuro/med-surg):

I work nights 7-7. I have 6-8 pts. At least two aides for 20-25 pts, 3 if we are full which is 40. Aides do vitals, turns, toileting, bathing, water pitchers, hs snacks, empty trash etc. I assess, do admits, give meds, change dressings, do iv's etc. Charge nurse has no pts unless we are really short. She does 24 hour chart checks, monitors labs, calls doc and generally coordiantes stuff. Unit secretary enters orders and stuff charts, she also answers call lights and then pages the appropriate person using our beepers.

I feel like i run my butt off all night, but some of you have situations that sound truly scary. btw, our lpn's take their own assignments, and function basically like we do, they are lpn II's so they can do ivs. They can't start care plans, take verbal or telephone orders or note off orders, but they don't seem to have problems. They usually have the charge nurses, or one of us do that stuff.

[WindyWhiteCloud]

I want to know if there are any guidlines for staff/patient ratios on nursing homes

county run? I work in a 100 bed LTC facility. They say we are fully staffed with

3 LPNs, and 5 NAs @ third shift. We have at the moment 92 patients in house, 11

being Alzheimers/ dementia patients in a lock unit. Last night the little NA was in

tears because 3 patients, ambulatory, had either scratched, spit or otherwise threatened to hurt her. We, who had our own busy floors, took turns staying

with her on that floor. The nurse in charge of the floor was expected to 'float' on

the alzheimers unit and another hall at the other end of the building, that has 15

patients. Several of those pt's are end stage CA.

There are no other staff in the building on third shift, untill house-keeping, and cook

comes in at 5 am. You might not think those other staff would be much help,

but they are. Even if to just get 'help' when some one has fallen, or is attacking

another staff person.

This is my first time posting. This is the closest thread I have found, on ratios.

We have very few 'walky talkys'. Most are bed patients, alot are frequent fallers.

Only one feeding tube (J T), and 15 to 16 foleys. Another facility in the area has

closed it's doors ... the problem patients are coming to us. We are getting 2 to 4

admitts a day. We are getting a lot of hospice cases. When I was hired I was

told we'd always have an RN, and that each floor would have a nurse (5) total.

The RNs have retired, and not been replaced ...in the last yr and 1/2.

This weekend will have 3 nurses and have 3 NAs scheduled. They say they are

trying to get more, but the NAs scheduled, don't believe it. I'm afraid to volunteer !! Add, there are 18 skilled patients, some with IVs, on the

"skilled" hall, and our most experienced LPN gets that lucky hall.,plus

her one alloted NA.

[gary jader]

Ratio legislation is being considered in over 20 states last time I checked. I'm curious to know how California nurses and nurse managers are doing with their mandated ratios.

Gary

[tlsweet]

I have also had my share of scary experiences with way to many places. One place I worked at I was responsible for 39-40 patients, out of which 5 were diabetic, 1 had a trach and bolus tube feedings, the other had a continuous and luckily I had only 2 major wound tx. I had to do my morning med pass, but luckily I had a QMA come in to help out with some of my other tx and afternoon med passes. However after she left I was on my own. The other nurse had 34, so needless to say she wasn't available much to help out. I worked a 12 hour shift. So, the 5pm med pass I was on my own, and heaven help me that nothing happend during this time. Which ofter it did. At one time I had a CHF male going into failure with rapidly dropping o2 sats and while waiting on the ambulance to arrive another guy at the end of the opposite hall fell. I left that place and found another facility where I was only responsible for 25......that ended after they closed and went into a sister facility......and once again the patient load climbed. It was only 29, but the acuity was very high. I had 9 diabetics plus 2 major wound changes and a lot of very needy people. I ended up quitting. Then was going to go work PRN until I get my RN. I knew this place was going to add more residents, but also heard one hall had a QMA. Well, during my first day of orientation I learn I would have been responsible for 38 patients and no Q. I didn't go back.

This is really scary. There is no way we can provide safe care. Accidents are going to happen. And as I try to cover my hind end in my charting, sometimes that's not even possible to chart on everything accurately.

How do you find out which states are considering adopting the ratio legislation.

I went into nursing to help people. I've been on the opposite side of the bed in a hospital setting and needed comfort and support. They way they have us running around this is impossible to do.

So glad I found this thread..........as bad as it is, it still is comforting to find out this is widespread.

I sure hope someone does something about it. No wonder there is a nursing shortage.

Thanks for listening to my venting,

Teena

Ratio legislation is being considered in over 20 states last time I checked. I'm curious to know how California nurses and nurse managers are doing with their mandated ratios.

Gary

[moosemnurse]

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.

A good Nurse Manager should be an advocate for her staff and their needs as well as those of the patients. The Manager is in a hard place between staff who need more (and you can be sure (S)HE knows it) and senior hospital management who are accountable for the bottom line. There are no easy answers. What I want to understand is if there are mandated ratios and there are not enough nurses to meet the ratio...who takes care of the lest over patients? You don't want mandatory overtime so what IS the answer? I don't believe that mandated ratio is the answer. Sometimes 7-8 patients is okay and other times only 4. A caring administration that puts patients first is the ideal. I hope my staffs would have said that I supported them in what they needed and supported them when I couldn't find a nurse by adding the CNA or secretary.