I was wondering what your patient loads are like in the States, I work in an orthopaedic Ward in New Zealand where we have acute and elective surgery. Tonight I had six patients 3 of whom where post op. I will describe a bit about them so you can see what loads we have and compare with your own.
1, Knee joint replacment, post op dropped BP, stat gelofusin, PCA could not start that as Systolic BP below 90had to get IV tramadol started...lots of trouble controling pain. IV antibiotics Post op today my duty
2, Non union, fractur tibial plateau, bed to chair for six weeks, needing to be taken to toilet etc.
3, Spinal Bifida lady with cellulitis, total cares cannot roll herself. on airbed. IV antibiotics. refuses to do alot for herself despite nothing wrong with hands having to constantly irrigate IDC.
4, Day 2 Revision THJR, IV antibiotics.
5, police Officer dog handler injured while apprehending suspect. repair of Patella tendon, post op, unable to mobalise at this stage. reg S/cut Morphine. Post op today my duty
6, long term patient with infected thigh wound and septicemia, post op washout and application of vac dressing. requires to be taken to toilet on commode chair also had heparin infusion running. IV antibiotics via PICC line. Post ob today my duty
these were my patients tonight 3 required total washes. We make up all our antibiotics and have to have all narcotics and any injectible drugs checked by 2 nurses and signed by two also. This takes time and we spend time looking for another nurse to sign and check drugs.
So I was just wondering what its like for others.
We also go down to PACU and pick up our patients and have a handover from the nurse there.
Jul 25, '02
I work ER, and we usually have 4 pts each. At night we drop to only 3 MAYBE 4 nurses, and we have to handle however many pts come through the door! I have worked a few agency shifts on med surg and had 9 pts!!! I will NEVER work the floor!
Jul 25, '02
At night we have only 2 nurses for 27 patients, sometimes there are 2 RN's sometimes and EN, I don't know what its like there but here the EN'c ant give any medications except Panadol (Tylenol)...so any narcotics, antibiots etc have to be given by a RN
Jul 25, '02
I work critical care and we have approx. 4 patients on days (more on eves and nights) but the accuity is HIGH. Trach, vent, NG,PEG, PCA, all on continous monitoring.
Jul 25, '02
Team of 10 for one RN/LPN (EN) team. LPN's here can give all PO meds , and can give many IVs, antibiotic etc. but not through central lines. They can start IVs and draw labs. They do not give blood transfusions but can monitor a patient with one.
How on earth do they expect you to leave your patients and go to PACU? To pick up one you leave FIVE? Nope they come to ME and deliver, report is telephoned BEFORE delivery.
OUr mix of patients seems about the same as yours. Most post ops have either a continuous epidural of fentanyl/marcaine with a PCA mode added OR intravenous PCA morphine or hydromorphone. Hardly any injections. Hospital stay is VERY short. 3 days for a total joint, then HOME or 2 days and a week in rehab facility......not the majority though.
The team will also have either their own aide or (3 for the unit) or share one with half of another team (2 for the unit.) They do the bathing and bedpans etc.
HOWEVER the last night I worked it was 15 patients (one RN out sick so only 2 RNs for 30 patients) but there were 3 LPNs and 2 aides.
In my opinion 10 for 2 is better than 5-6 for one, because you have some backup and a relief who already knows your patients.
Jul 25, '02
Reading the responses thus far and all I can say is....
Now, when I worked LTC I was responsible for assessments, medications and treatments for upwards of 30 patients on Swing (3-11) Shift... I also had a couple of CNA's who I assisted with turns, changes, etc....
Where I work now on dayshift... Med-Surg... I can have up to 7 patient's with a CNA for the combined total of 13... the other RN taking the other 6. Our ICU/CIC Units never take more than 2 patient's...(ok 3 when understaffed)... and CNA's are available to help with turns, changes, etc....
I totally understand the frustrations many of you share here... but I'm sure your patient's thank the Lord you're there to care for them.
Jul 26, '02
I know what you're dealing with, I've just moved on after 4 years wroking in orthopaedics in Adelide, the last year of that as a CN. the accuity of the patients you describe was pretty standardm, lots of joint replacements, and just about always a ration of 1:6. I was getting totally burnt out, as the team leader, which i nearly always was, i would be responsible for all meds for 16 patients, plus doctors rounds, discharge planning and would have total care of up to 4 patients also - WAY TOO MUCH
I have now moved onto PICU, where all ventilated patients are 1:1 and non ventilated 1:2 - a much less tiring and back breaking ratio that's for sure
Jul 27, '02
Thanks everybody for their replies, you guys are lucky to have so many aids, we have 27 patients and anywhere from 4-6 nurses maximun, usually only 4 and we have only 1 aid for the whole ward. This is an afternoon shift as that is all I word 2.30-11pm.
we do team nursing, the ward is split into 2 and we work 2 nurses each end and the aid helps down both ends. Both nurses work together, but if were needed we work with
the other down the other ends as well especially if we are turning a patient, we also do most of the washes etc in the afternoon. If the other nurse I am working with is a enrolled Nurse then I have to do all of her medications as they are not allowed to do them....this can be a real pain especially if the ward is really busy which Orto tends to be........
Aug 15, '02
Hello. I am new here and just finding my way around the board.
In answer to your question, I have 15 patients. I work on a 30 bed ward and there is (usually) myself and one other RN. We usually have 4 health care assistant on a morning shift and two on an afternoon shift.
2 more RNs have just left giving us 6 RN vacancies. Anyone fancy coming to West Yorkshire?
Sep 7, '03
I worked on a 34 bed orthopedic unit and on good days we would have 9 a piece, RN's and LPN's were the same, we did all medication regardless of IV or central line meds. On bad nights we would get 12 a piece or even more, this in on the 7-3 and 3-11 shift. It was not fun on Monday nights with all those fresh post ops either.
Sep 7, '03
I work in a 48 bed unit mostly trauma with some elective joint and spinal surgery. We work either 2 rns or 1en 1rn to 10 patients morning and evening. and 1 rn or en to 10 overnight.
We work together and the only thing the ens cannot do is ivabs and DDs . I like working in a team, it means we can have a break and there is cover. Communication is generally great.
I dream of the day of 1:4. Maybe one day.......
Sep 8, '03
I work on a 28 bed ortho floor, including tele, neuro, stroke patients, and long-term epilepsy monitoring. Ideal staffing is a RN, LPN, and CNA for every 8 patients (RN and CNA for 8 to 12 on nights depending on staffing). CNA's- are responsible for patient care and checking vital signs also allowed to do dressing changes, glucose checks, and removing peripheral IV's. LPN's are responsible for all meds x IV, also allowed to do all of above plus call doctors and do some charting. It's a very heavy floor to work on, a lot of the patients require total care, and almost all require more than one staff member and lots of time to move around. But the good thing is that all the nurses are commited to team work and helping everyone else out with getting assignments completed. We do not have to mix our own medications and the PACU has it's own transporters, so that is a plus.
Oct 22, '03
Gosh, I do not know how you guys do it. Our staffing on med/surg is 4:1. They only give you two surgicals if they HAVE to. If I have a CNA with me, we can have up to six patients. If I have a lpn we have 7 or 8. I should consider myself lucky.