Nurse-pt ratios

GrnHonu99, RN · Oct 2, 2005

I work on an ortho unit in a large hospital, a lot of hips, knees and backs. Our current ratios are 4-1 on days, 5-1 on evenings, 7/8-1 on nights, with CNAs having about 10pts each. Our supervisor has informed us that the ratios are going to change (more pts of course) which actually already happens when we are short staffed. I am wondering what other hospitals have. All the lifting and moving is taking a toll on my back evn though I work out a lot. Thinking of looking for another niche........ Any replies on your ratios would be much appreciated.

My mom works on an ortho floor and their pt./nurse ratio is typically 3-4 on days, same on evenings and 5-6 night shift. I am in clinicals at the moment and have been at two different hospitals. The first hospital I was at I was there day shift on a gen med/surg floor and the pt./nurse ratio was never more than 3-4. The hopsital I am working in now has a pt. ratio of 5:1 on days, it is a post op floor. I am there 7-2.

Cheyenne RN,BSHS · Oct 5, 2005

Our facility has decided that since there are not enough nurses to keep up with the patient loads and they want more $$, they are going to change the staffing ratio's. We are already stretched way too thin and stressed and anyone new who has been hired does not stay for long. Morale has been going down for the past year and we have had 3 nurse managers in 2 years who have come, stayed a little while, caused an uproar of changes, and then quit and left.

((like you would think administration with the big guns would figure out there is a problem right?)) :crying2:

Now the nurse will have 7 or 8 patients a piece instead of 5 or 6. Those patients may be on a single hallway or down any one of three hallways.

We also have large cumbersome medication carts and a computerized medication administration system so that you must take the entire cart every place that you go every single time. The carts and electronic med administration have already slowed us down tremendouly.

I feel like my license is being stretched thinner and thinner, my patients will have even less "nursing" time, I will have less time to assess for changes in a patients condition, and it is because the administration would rather "stick it" to those of us working than deal with their staffing shortage.

I love the work I do and I love the patients, but I also want to be sure that I can deliver quality care and keep my license safe. Everyone is upset but no one will take a stand and I can't fight the system alone.

Any suggestions? Help. :idea:

nursemaa · Oct 5, 2005

When you talk about nurse-patient ratios, do you mean RN's and LPN's? The reason I ask is that I have heard RN's say "I have 8 or 9 patients" when in reality they have 5 primary patients and are a resource (for IV meds and calling docs) to 2 or 3 patients assigned to LPN's. Just wondering.

Our typical ratio is:

Days: RN 4 patients, LPN 5 patients 3 or 4 NA's

Nights: RN 5 patients, LPN 6 patients 2 NA's

That is of course if no one calls off!

BillEDRN · Oct 5, 2005

When you talk about nurse:patient ratios, do you mean RN's and LPN's? The reason I ask is that I have heard RN's say "I have 8 or 9 patients" when in reality they have 5 primary patients and are a resource (for IV meds and calling docs) to 2 or 3 patients assigned to LPN's. Just wondering.
Our typical ratio is:
Days: RN 4 patients, LPN 5 patients 3 or 4 NA's
Nights: RN 5 patients, LPN 6 patients 2 NA's
That is of course if no one calls off!

It really does not matter if the ratio is based on whether or not you have LPN's to help. As a matter of law, RNs are entirely responsible for that patient regardless if the LPN is "assigned" to that patient. Far too many RNs believe that since the LPN has a license they (the LPN) would be held accountable for any mistake or ommission. That's why, IMHO, "sharing" an assignment with an LPN is as difficult and time consuming as if you didn't share. The time spent overseeing their work, charting and other activities is still time spent outside of caring for "your" patients. Same goes for a CNAs. There are many, many cases where the the RN has been held legally responsible for the actions of his/her subordinates, without having actually made a mistake or ommission themselves. It's a litigious society, protect yourself!

maconnurse · Oct 7, 2005

Our facility has decided that since there are not enough nurses to keep up with the patient loads and they want more $$, they are going to change the staffing ratio's. We are already stretched way too thin and stressed and anyone new who has been hired does not stay for long. Morale has been going down for the past year and we have had 3 nurse managers in 2 years who have come, stayed a little while, caused an uproar of changes, and then quit and left.
((like you would think administration with the big guns would figure out there is a problem right?))
Now the nurse will have 7 or 8 patients a piece instead of 5 or 6. Those patients may be on a single hallway or down any one of three hallways.
We also have large cumbersome medication carts and a computerized medication administration system so that you must take the entire cart every place that you go every single time. The carts and electronic med administration have already slowed us down tremendouly.
I feel like my license is being stretched thinner and thinner, my patients will have even less "nursing" time, I will have less time to assess for changes in a patients condition, and it is because the administration would rather "stick it" to those of us working than deal with their staffing shortage.
I love the work I do and I love the patients, but I also want to be sure that I can deliver quality care and keep my license safe. Everyone is upset but no one will take a stand and I can't fight the system alone.
Any suggestions? Help.

Sounds like you work at my hospital. Those carts are so bunglesome. Our staffing numbers have nothing to do with acuity levels just numbers, numbers, numbers. They are weeding out older nurses with higher pay for LPNs.

beckyboo1, BSN, RN · Oct 7, 2005

I'm an LPN on a telemetry unit. We do not share assignments and we do our own IVs, except for IVP's and blood. We generally have pt care techs but our ration is 6 pts to one nurse, on all 3 shifts. IF we're lucky, and this doesn't seem to happen often anymore, we'll have a nurse designated for admissions, discharges and transfers.

Becky

Haunted · Oct 7, 2005

It really does not matter if the ratio is based on whether or not you have LPN's to help. As a matter of law, RNs are entirely responsible for that patient regardless if the LPN is "assigned" to that patient. Far too many RNs believe that since the LPN has a license they (the LPN) would be held accountable for any mistake or ommission. That's why, IMHO, "sharing" an assignment with an LPN is as difficult and time consuming as if you didn't share. The time spent overseeing their work, charting and other activities is still time spent outside of caring for "your" patients. Same goes for a CNAs. There are many, many cases where the the RN has been held legally responsible for the actions of his/her subordinates, without having actually made a mistake or ommission themselves. It's a litigious society, protect yourself!

You are GD RIGHT!!! Here in California we have mandated ratios in place, it's a very nice start but it does not take in to account that an RN is also accoutable for the patients the LVN is assigned. It is a pretty good start in protecting patients and reducing a small amount of burnout.

I say good start because ratios should be in place everywhere and they should also be based on patient ACUITY. Often I am primary for 4 patients before the unit assigns me a CNA (which they are under no legal obligation to provide) and being registry, these patients are the "frequent fliers", non compliants , family members who are intrusive or total care. When meds or procedures are delayed or not done on my shift, guess who gets it up the shaft?

Remember, your hospital administrators and supervisors are not looking out for your best interests and the patent response to any complaint will most likely be "if you don't like it, there's the door!" so don't expect support.

The BRN is also not in any position to hear your complaints, they are put in place to protect the public from you! If this sounds like a grim picture then my point is taken. Speak up, speak out in any and every venue that you can to get your concerns heard. Only collectively can we effect change.

lsyorke, RN · Oct 8, 2005

We're I work it's 6-7 med/surg/tele/ortho regardless. That's PER RN. I didn't think that was bad until I see that some nurses only have 4??? I would kill for that.

meownsmile, BSN, RN · Oct 8, 2005

It really does not matter if the ratio is based on whether or not you have LPN's to help. As a matter of law, RNs are entirely responsible for that patient regardless if the LPN is "assigned" to that patient. Far too many RNs believe that since the LPN has a license they (the LPN) would be held accountable for any mistake or ommission. That's why, IMHO, "sharing" an assignment with an LPN is as difficult and time consuming as if you didn't share. The time spent overseeing their work, charting and other activities is still time spent outside of caring for "your" patients. Same goes for a CNAs. There are many, many cases where the the RN has been held legally responsible for the actions of his/her subordinates, without having actually made a mistake or ommission themselves. It's a litigious society, protect yourself!

I fall in line behind this one too. We work with LPN's and CNA's on teams but (for instance) as the RN i have 8-10 patients on a busy day that i have to assess, chart on, call docs on, sort labs, handle emergencies etc etc etc. The LPN will pass oral and IVPB meds, dressings etc. but when it comes to having to juggle that many patients it doesnt matter how many other staff are on your team, you (the RN) are ultimately responsible for the entirity of the assignment.

Wow, to only have 4-5 patients!!!!! Wouldnt that be a lovely day.

Haunted · Oct 8, 2005

I fall in line behind this one too. We work with LPN's and CNA's on teams but (for instance) as the RN i have 8-10 patients on a busy day that i have to assess, chart on, call docs on, sort labs, handle emergencies etc etc etc. The LPN will pass oral and IVPB meds, dressings etc. but when it comes to having to juggle that many patients it doesnt matter how many other staff are on your team, you (the RN) are ultimately responsible for the entirity of the assignment.
Wow, to only have 4-5 patients!!!!! Wouldnt that be a lovely day.

It is lovely! screech....BAM! I just crashed and burned. It all depends on your patient acuity. I bet there have been days when you had those 8-10 patients, a CNA and possible an LVN to assist you and things went smoother than doody from a goose. Question, your LPN's give IVPB???

Cheyenne RN,BSHS · Oct 8, 2005

When you talk about nurse-patient ratios, do you mean RN's and LPN's? The reason I ask is that I have heard RN's say "I have 8 or 9 patients" when in reality they have 5 primary patients and are a resource (for IV meds and calling docs) to 2 or 3 patients assigned to LPN's. Just wondering.
Our typical ratio is:
Days: RN 4 patients, LPN 5 patients 3 or 4 NA's
Nights: RN 5 patients, LPN 6 patients 2 NA's
That is of course if no one calls off!

AMEN to the call off issue.

I should have clarified, but when I wrote "nurse" I meant RN and LPN for our facility. Each one, including the "charge" nurse is expected to take a full load of 7 to 8 patients.

The nusing assistants are assigned to the floor to help us with vital signs and baths, but each nurse is totally responsible for her/his assigned patients and every aspect of their care.

That is 1 RN/LPN for 7-8 patients and the one nursing aide will be shared between two to three of the nurses. Without the nursing assistants the nurses honestly could not function and the aides have my utmost respect.

The worst downside on the staffing is that if you are busy with one patient that is unstable and heading to transfer to ICU, or assisting to put in a chest tube, triple lumen cath, etc, that task can take you off the floor to your other assigned patients and put you literally one on one with a single patient.

No one is there to fill the gap and if you are in the middle of passing medications, or giving blood, or God Forbid, have two patients going sour, then your license literally walks a tightrope.

It drives me crazy and scares me to death sometimes. :sniff: