Opinions about staffing please....

stidget99 · Jun 11, 2005

Non-tele Surgical unit, 33 patients. Staffing is 4 RN's, 2 LPN's and a NA on nights. Assignment: each LPN has 6 patients, each RN has 4 primary patients (one will have 5), and be resource to 3 of the LPN's patients (LPNs do assessments, pass meds except IV meds, and do treatments for their patients- RN has to call docs if needed, do IV meds if there are any, check out any big problems). What do you think?

My idea of Utopia. My unit - med/surg (non-tele) ...29 pts--> 4 RNs, 1 CNA. But we do it!!! Teamwork at it's absolute best!!!

live4today, RN · Jun 12, 2005

Eight patients per nurse is too many patients, and very unsafe -- I don't care how many LPNs and CNAs are on duty at the time. :rolleyes:

On a surgical unit.........no....on ANY inpatient ward.........., nurses should have no more than four patients...regardless. I soooooooo want to build a hospital and run it the right way. :uhoh3:

annmariern · Jun 12, 2005

Pretty good. Where I work, also surgical non tele. 35 beds. on days 5-6 nurses usually 2 are Lpns. 6-7 pts a piece, plus the RN also covers LPN pts for IVP meds, and takes off the orders, verify admit assessments. Oh and 2 CNA's on a good day. Nights: 1 CNA, 4 nurses, some nights only 1 of themRN and 1 CNA. It stinks. :angryfire

PamRNC · Jun 12, 2005

Let's see where I work now: overnight on a 32 bed surgical unit is 4 RNs and 2 NAs, and that's a good night. It could be 3 RNs with 2 NAs (or 1), depending on what the census is before the shift begins.

Where I used to work: 43 bed unit med/surg 4 RNs, 3 PCAs, and 1 SCA (provided they weren't pulled to sit a 1:1).

The last time I worked with an LPN who had her own assignment was my very first nsg job - then I think it was a 30 bed med/surg unit: 2 or 3 RNs, 1 LPN, 2 NAs.

nursemaa · Jun 12, 2005

Eight patients per nurse is too many patients, and very unsafe -- I don't care how many LPNs and CNAs are on duty at the time.
On a surgical unit.........no....on ANY inpatient ward.........., nurses should have no more than four patients...regardless. I soooooooo want to build a hospital and run it the right way.

So are you saying that an all-RN staff with 8 RN's would be more appropriate for this situation? When you say 4 patients per nurse, are you considering LPN's to be nurses? Just wondering.....because in the situation I described, the RN doesn't "have" 8 patients, but is available to resource and help with 3 of the LPN's patients in addition to the 4 patients assigned to the RN. I'm just trying to get a feel for what people think is appropriate when you have both RN's and LPN's on board. :)

ZASHAGALKA, RN · Jun 12, 2005

That's wonderful staffing.

The last hospital I worked at starts med/surg with: 2-3 RNs, 3-4 LVNs (for a total of 6 in any shift), 1 CNA for a 40 bed unit, but: staff is cut before the start of each shift so that all nurses start with at least 6 patients (6 and 7 apiece - and by cut, I don't mean 'on call', if census picks up dramatically, then 8 and rarely, more patients along with all that new admit work is your responsibility). If some nurses need to start with 7, it's usually the LVNs cause RNs have to do admission assessment work. RNs have to push meds, etc for LVNs but it's not organized; if you need one of the RNs, go find one. Theoretically, if a patient had an LVN for day shift, then they have an RN for nights and vice versa, that way, there is an "RN assessment" every 24 hrs. But you can see if there were 2 RNs on days and 2 on nights with 40 beds going, that doesn't happen. Oh, and the CNA more often than not is considered 'optional' at night; if another unit complains about staffing, a typical response is, 'I'll send you med/surg's CNA'.

They are trying team nursing but that is even worse: 3 teams of 1RN/1LVN means 12-15 patients per team and lots of stepping all over each other: lots of wasted time trying to figure out what 'teammate' did.

OH, and you got to love the new infrared tracking system to monitor call bell response times because the nurses 'aren't answering thier call buttons fast enough'.

Did I mention this was a 'former' employer?

ZASHAGALKA, RN · Jun 12, 2005

OH, and I didn't mention that in my last post that about 1/3rd of the patients on telemetry monitoring. They do at least have a non-negotiable tele monitor tech for each shift.

nursemaa · Jun 12, 2005

Yikes!! Sounds like trouble to me! At least in my situation, the LPN's patients are assigned to a specific resource RN so everyone is clear on who's responsible for what. Usually for the 30-33 patients, they'll have 5 RN's and 2 LPN's unless there are calloffs or vacations and they couldn't get someone to cover it.

We did team nursing back in the old days: 15 patients with an RN, an LPN, and a NA. The RN and LPN divided up the patients for charting- RN did meds and IV's, made rounds with docs and signed off orders and was the "overseer", the LPN did dressings, soaks, etc, and the NA and LPN divided up the baths. The NA also did vitals, I&O, feeds, turns, etc. The RN and LPN helped with baths and turns as time permitted. It seemed to work very well back then, but somehow it doesn't seem to work so well now. Maybe because patients are sicker and people are more demanding? What do you all think?