Nurse to patient ratios

Specialties Cardiac

Published

I am interested in knowing how units like mine staff the assignments. I am in a 26 bed cardiac interventional unit. Our main patient population consists of post PTCA/Stent patients, with and without femoral arterial lines. We pull our own lines on the floor when their ACT's are less than 150. The majority of our patients come back with closure devices or are radial procedures who come back with hemobands on. Up until now, if a patient with lines was on reopro or integrilin, they went to CCU (due to the increased chance for bleeding), but now they want to put these patients on our floor. We also take stable MI's, chest pain R/O MI, and any other tele patient they don't have a bed for (there are two other tele units where I work). We use heparin, Nitro (titrating), dopamine (rarely titrate, but has happened), dobutamine, amniodarone, lidocaine, pronestyl, cardizem, adenocard, covert and most other gtts. No nipride. At present, an assignment starts with 4-5 patients per nurse, and then one nurse occassionally gets 6 patients. Our patients are admitted on a day surgery floor, go to the cath lab, and then come to us. We recover them and they stay overnight and are discharged the next morning, and then we start all over with a new group of post procedures. We have a charge nurse without patients, who is bed control and usually is very busy making beds for the patients coming out of the 3 cath labs. If your unit is like this, can you tell me your ratios, as I am this units' manager and my boss says I have to staff it as other like units do and I think my nurses are already overworked. Thank you

I worked on a 20 bed interventional unit (PTCA, Cath, ICD?PM, TEE, Cardioversion). We did the admission assessment, pre labs, sent for procedure, rec'd. post procedure with reopro, integrillen, aggrestat, dopamine, ntg.,dobutamine, lido, cardizem, milrinone, any drip except nipride and levophed. 99% of plastys and caths returned with sheaths, which we pulled and used c-clamp. There were hard wire monitors at each bedside. There was one aide who for the most part was useless. When meal trays came, she went to break. When I started on that unit the ratio was 3:1. Charge nurse had no patients but was available to accompany you for sheath pulls she also had to constantly juggle beds. The work was busy but we worked well together and helped each other and got everything done. Did I mention that we did all our own phlebotomy. Well administration felt that we could domore and increased our ratio to 4:1 and then to 5:1. That was a totally impossible work load. Pulling sheaths require your undivided attention until you get the clamp off. Well needless to say, I don't work there anymore, just too scary.

Up Vote Up Vote ×

Our unit is similiar, we are a 33 bed unit that is postinterventional. However, we also see MIs, CHF, and tele. We check the ACTs, and pull the sheaths on the floor. We also get post-op day 1 open hearts on occassion. Our policy is to have 7 nurses on the floor, and one charge nurse. However, that can change because 5 of those beds need to be kept open at all times for emergency PTCI(except when full with PTCI). I t equals out to about 4-5 and sometimes 6 pt apiece. We run integrilin, tridil, heparin, dopamine and dobutamine(titrating both), reopro, lidocaine, cardizem, and procanimide on a daily basis for most.

Up Vote Up Vote ×

We have 6 pts per RN on our tele floor, most days I literally never sit down and often skip lunch. Any more than that would be insane. I am considering transferring to another unit because I think its unsafe. But I like tele ... not sure what to do.

Up Vote Up Vote ×
Specializes in PACU/Cardiac/Nrsg. Mgmt./M/S.

Stella,

it sounds like your unit is a CCU, with the exception of not having the advanced technology close at hand, nor having the privledge of having 1-2 pts per nurse.

Your unit sounds complicated and would make me very nervous working it with 4-6 pts!:eek:

Up Vote Up Vote ×
Specializes in Cardiac/Vascular & Healing Touch.

our tele unit outside of my CCU takes between 5-7 each. One or two RN's the rest LPN's. I really feel for them because it is at time unsafe. I try to keep an open line of communicaiton with them & walk out to check on the patients if they are going bad, make room for those crashing, even where we are so busy. I applaude the telemetry nurses!:D

Up Vote Up Vote ×

Our telemetry floor has 36 beds and we get patients back after sheaths are pulled with sytec dsgs in place. We hang drips and we also have chemical rapid detox patients on telemetry (usual stay 48 hours). Our ratios with CNA is usually 8:1 - no CNA 5-6:1. The detox patients are usually 4:1. I hate direct admits from the Dr's office, they haven't been assessed, nothing initiated - you start from scratch, which can eat up all your time.

Up Vote Up Vote ×

Our telemetry floor has 36 beds and we get patients back after sheaths are pulled with sytec dsgs in place. We hang drips and we also have chemical rapid detox patients on telemetry (usual stay 48 hours). Our ratios with CNA is usually 8:1 - no CNA 5-6:1. The detox patients are usually 4:1. I hate direct admits from the Dr's office, they haven't been assessed, nothing initiated - you start from scratch, which can eat up all your time.

Up Vote Up Vote ×

I don't work on tele but have a very close friend who does. Nights has 10-12 patients each, usually 1 moniter tech and 1 aide. No pressor drips are allowed outside the icu in our hospital.

Keep in mind we are the largest cardiac hospital in the area, yet the in no cath lab after noon saturday till mondya morning. We have the highest death rate in the country for post cardiac surgeries, we are about 5-10 years behind the rest of the country. Gee I wonder why soo many patients die. Nowhere in the hospital does accuity mean anything, not on the floor, not in the ICU's, nowhere. They just look at bodies.

Up Vote Up Vote ×

I don't work on tele but have a very close friend who does. Nights has 10-12 patients each, usually 1 moniter tech and 1 aide. No pressor drips are allowed outside the icu in our hospital.

Keep in mind we are the largest cardiac hospital in the area, yet the in no cath lab after noon saturday till mondya morning. We have the highest death rate in the country for post cardiac surgeries, we are about 5-10 years behind the rest of the country. Gee I wonder why soo many patients die. Nowhere in the hospital does accuity mean anything, not on the floor, not in the ICU's, nowhere. They just look at bodies.

Up Vote Up Vote ×
Specializes in Hospice and palliative care.

Having worked on several tele/stepdown floors, I'll chip in my $.02 worth. One hospital where I was staff for about 6 years, our tele floors were 34 beds. The one floor which took the post-interventional patients with lines (about 8-10 beds designated for this purpose) the nurses usually only had 2-3 patients (maybe 4 on nites but not 100% sure of this). The rest of the floor, which got all variety of cardiac patients (CP R/O MI, post MI, post pacer, post EP, post cath, etc, drug washouts, cardioversions) the ratios were 1-4 or 5 on days, 1-5 on evenings, and 1-6 or 7 on nites

As an agency nurse, I worked at one suburban hospital's Interventional unit on nites and had 4 patients (but days had 5! Go figure!). However, the one nite was sheer hell b/c I had one patient acutely stroking out (who should have been moved on evening shift :angryfire). Thank goodness for the staff there, they really pitched in and helped me out! :)

I applaud you, Stella, for sticking up for your staff. When are administrators going to understand that you have to staff by acuity and not just straight numbers?!?! :rolleyes: Kewlnurse, I am frightened for your friend's license--10-12 patients at nite! :eek: (Totally unsafe in my opinion).

I hope this info helps all of you that are looking at your ratios. I love cardiac nursing but am looking forward to moving into advanced practice (which of course will have its own headaches) so I don't have to sweat nearly as much about my license being at risk

Laurie

Up Vote Up Vote ×
Specializes in Hospice and palliative care.

Having worked on several tele/stepdown floors, I'll chip in my $.02 worth. One hospital where I was staff for about 6 years, our tele floors were 34 beds. The one floor which took the post-interventional patients with lines (about 8-10 beds designated for this purpose) the nurses usually only had 2-3 patients (maybe 4 on nites but not 100% sure of this). The rest of the floor, which got all variety of cardiac patients (CP R/O MI, post MI, post pacer, post EP, post cath, etc, drug washouts, cardioversions) the ratios were 1-4 or 5 on days, 1-5 on evenings, and 1-6 or 7 on nites

As an agency nurse, I worked at one suburban hospital's Interventional unit on nites and had 4 patients (but days had 5! Go figure!). However, the one nite was sheer hell b/c I had one patient acutely stroking out (who should have been moved on evening shift :angryfire). Thank goodness for the staff there, they really pitched in and helped me out! :)

I applaud you, Stella, for sticking up for your staff. When are administrators going to understand that you have to staff by acuity and not just straight numbers?!?! :rolleyes: Kewlnurse, I am frightened for your friend's license--10-12 patients at nite! :eek: (Totally unsafe in my opinion).

I hope this info helps all of you that are looking at your ratios. I love cardiac nursing but am looking forward to moving into advanced practice (which of course will have its own headaches) so I don't have to sweat nearly as much about my license being at risk

Laurie

Up Vote Up Vote ×

LLD sounds like yor floor was staffed like our ICU, man I gotta get out of here. Poor staffing is the norm not the exception.

Up Vote Up Vote ×
+ Add a Comment