nurse/pt ratio

PathFinder · Jan 22, 2000

I don't think you'll find a "cap" in long term care, or anywhere else for that matter. So let me ask you about your workplace & residents:

1. Who else works with you (nursing assistants, LPNs, others?).

2. On what shift are you responsible for 30 patients -- Days (when 250 activities need supervision) or Nights (when most of these people are asleep)?

3. What are the patient care activities that are YOURS to perform for these 30 patients?

4. What is the likelihood that you have patients who's condition is highly unstable and likely to deteriorate unpredictably?

5. What back-up systems are in place to assist you (nurses on a near-by unit, house supervisor, someone on-call)?

6. How complex and frequent are the assessments you are expected to make of these 30 patients over the course of your shift?

7. Are your patients in any danger or are you just feeling alone and overwhelmed by this responsibility? (this may be a reasonable fear!)

Just curious. Your situation is probably very common.

tremmi · Jan 24, 2000

Pathfinder: You have "management" written all over you. How could you ask such questions of this person? Feeling overwhelmed? You betcha!!! It is a nationwide thing to understaff the ICU's and the floors. We have nurses leaving all the time for other careers, because they are tired of the backbreaking work, heart wrenching work and disrespect and nonsupport from their managers. The doctors don't help and they are tired of patients and families treatimg them like waitresses and maids. I work a CCU unit and have been there for 10 years. When I first came the ratio was 2 patients to 1 nurse. Now there are 3 to 1, and sometimes you have your 3 patients and 2 of them are vents. I have even done 3 patients, 2 vents and one of the vents was on a balloon pump. I refer to that day as "black saturday". Do the managers care? Hell no. They are so worried about keeping their "numbers" under the limit. There is no worry about safety of patients care or safety of the staff. That's just the way it is.

Joanne D · Feb 12, 2000

Originally posted by tremmi:
Pathfinder: You have "management" written all over you. How could you ask such questions of this person? Feeling overwhelmed? You betcha!!! It is a nationwide thing to understaff the ICU's and the floors. We have nurses leaving all the time for other careers, because they are tired of the backbreaking work, heart wrenching work and disrespect and nonsupport from their managers. The doctors don't help and they are tired of patients and families treatimg them like waitresses and maids. I work a CCU unit and have been there for 10 years. When I first came the ratio was 2 patients to 1 nurse. Now there are 3 to 1, and sometimes you have your 3 patients and 2 of them are vents. I have even done 3 patients, 2 vents and one of the vents was on a balloon pump. I refer to that day as "black saturday". Do the managers care? Hell no. They are so worried about keeping their "numbers" under the limit. There is no worry about safety of patients care or safety of the staff. That's just the way it is.

OUCH !!! I am a manager and care very much about staffing. WE STILL are staffed 2:1 with 1:1 for IABP patients. Yes, budgets are something we need to look at and be careful with, however, not at the expense of patient care. Our CEO is adamant about patient care being the reason we exist. Northwestern NJ. Joanne

Suzanne · Apr 17, 2000

I read the messages here and learned.

first that the initial seeker is scared and wanted some facts to help her.

Second that while the second was management I felt she did give something to start with.She taught us how management thinks. Now we can use that to talk with our management.

To get results and help you must be able to give reasons that management can't argue down.

If you think the staffing levels are sh** but have no idea of the legal safety levels then management will wipe you fast.

I am not management but have had to handle such situations.

Knowing how to approach management is truly half the battle.

Always ensure if you feel unsafe, you say so. If you have told your management then they are legally liable for any problems arising from your shift, you have asked for support and not got it, hence done your utmost to alleviate the situation.

You must always keep a diary of such instances for your own safety and lodge incident reports each time, making sure to photocopy the original so it can't get lost.

Sophie · Apr 18, 2000

Well everyone,

I was disappointed to be told by the Dept. of Health (Calif.), that they could not agree with me that a violation of state regulations had occured in the hospital where I work after reporting the violations. They had rec'd numerous complaints about our short staffing. Despite extensive data keeping on the part of many staff members, showing the consistent shortages of staff, the inspector from DHS said she had been given proof from administration that they 'had tried' to get staff to come in (extra nurses, registry nurses).They also showed how they'd advertised for positions in the paper, which reflected their "sincere effort" to obtain nurses.

The jist was that because the hospital hadn't maliciously short staffed us, they couldn't be fined. Now the hospital knows that as long as they keep those ads, and document the phone calls they've made to get staff in to work extra, they don't have to be worried about DHS fining them for violations relating to short staffing. When I read the Barclay's Rules and Regs for Healthcare in Calif, is didn't state or imply anything about hospitals being excluded form adhering to regs, despite their "sincerity" or "good intentions". It seems that these regulations haven't any 'teeth' with which to really put the 'bite' on the hospitals. It was very disappointing to me to have tried so hard to go through the appropriate channels to get action, and then that is what I was told.

Shadog · Jul 3, 2000

Originally posted by tremmi:
Pathfinder: You have "management" written all over you. How could you ask such questions of this person? Feeling overwhelmed? You betcha!!! It is a nationwide thing to understaff the ICU's and the floors. We have nurses leaving all the time for other careers, because they are tired of the backbreaking work, heart wrenching work and disrespect and nonsupport from their managers. The doctors don't help and they are tired of patients and families treatimg them like waitresses and maids. I work a CCU unit and have been there for 10 years. When I first came the ratio was 2 patients to 1 nurse. Now there are 3 to 1, and sometimes you have your 3 patients and 2 of them are vents. I have even done 3 patients, 2 vents and one of the vents was on a balloon pump. I refer to that day as "black saturday". Do the managers care? Hell no. They are so worried about keeping their "numbers" under the limit. There is no worry about safety of patients care or safety of the staff. That's just the way it is.

Regarding the above: Interesting that you perceive "management" as not caring. Let me assure you I do care- enough that I am kept up nights thinking about the decisions I make, the resonsibilities I have to keep my depts running well, with patients and staff alike feeling that the system is meeting their needs AND yes keeping on budget. The questions the "manager" was asking the nurse about her assignment in a sub-acute floor were astute and were meant to focus the nurse on what the problems were, what her resources were, and what she/he should be doing about the situation. Without focus, he or she will have a difficult time making change happen, or documenting conerns.

Nancy1 · Jul 3, 2000

I wonder when did management become a 4-letter word? So many of the postings seem to think that because one is in management one does not care about anything but the numbers. I recommend that some of you start participating actively in your professional organizations and start getting the feds to let loose with the payment systems that the budget is controlling.

I trust that your mamnagers woulsd listen if you could come up with some way to solve the problems, not just complain.

Though I do want to say everyone has the right to complain, but with that right comes a responsibility to help solve the problems. And who better to solve the problems than those faced with them on a daily basis.

NA