Patient Nurse Ratio

[ambobam]

The large patient to nurse ratio is giving us a bad rap.

Patients and their families do not feel well cared for (and on some occasions are actually not well cared for) when we are running in and out of their rooms trying to get to our next patient.

When I was a student, I believed that the patient to nurse ratio should be limited to 5 patients:1 nurse (or less.) I remember that people would chuckle or roll their eyes at the idea.

Now that I am a nurse, I still FIRMLY believe that the patient/nurse ratio should be 5:1 or less.

It's a quality issue.

It's a care issue.

It's a safety issue.

As far as I know, CA is the only state with a limit. This needs to change in the other 49.

[SN2014]

I work med/surg/tele nights. I usually have 7 patients.

Acuity doesn't matter: I can have 1 person on a Cardizem drip, 1 on a heparin drip, 1 paraplegic total care on isolation, 1 prepping for a colonoscopy pooping every 3 seconds, 2 confused as hell trying to get OOB (1 of which is getting blood and trying to rip out his IV and foley), and 1 ETOH'r on his call light every 3 seconds asking for narcotics..

Acuity never matters

The CNA/techs often have 15-20pts so they are rarely available (they usually are only there to take vitals)

[justmovingon]

Have you ever actually sat down and figured out what you make an hour per patient. It's appalling! It's less than minimum wage per patient lol

[Nurse SMS, MSN, RN]

No, but I sat down and worked out what the time requirements were for five patients and mandated hourly rounding. It came out to more hours than were available in a shift and that was without figuring in time to chart.

[justmovingon]

Do hospitals realize the crap they load on nurses? They keep adding more duplicate and dumb paperwork. Sometimes I would sit there about to chart, and realize I don't know enough about them cause I couldn't do a proper assessment. I work psych so it takes more 1:1 time. What the heck am I supposed to chart when I have not had time too even talk to them?

[Ambiguphobia]

Working at a 1:8 patient load here. It becomes pretty hectic because we get a lot of transfers/discharges/admits during the overnight shifts. So a 1:8 patient load can quickly double, and this is in a hospital. Oh boy, the charting when this happens....

[db2xs]

1:3 - oncology here. Occasionally 1:4, but only when acuities are low. I feel safe and supported! Can't imagine taking on more with the types of patients we have.

I bet we work in the same hospital. 1:3 in oncology as well here with occasional 1:4. I was told by an oncology mentor that I should never take more than 1:4, as that is super unsafe.

[chrabi417]

$$$$ is the reason things aren't changing. It is a numbers game and the hospitals want to make the most money so they make us deal with all of these crazy conditions and they promise the patient the moon and the stars all the while making nurses work short. As more and more people get sick and medicaid implements more laws in regards to reimbursement...nurses will suffer and suffer. Hospitals no that they are kicking patients out of the bed to soon. They know they will be re-admitted. Being readmitted allows for the hospital to profit more. We don't have a voice. Who speaks for us???

I totally agree that the nurse to patient ratios are absurd and something needs to change soon!

However, I don't think that the hospitals profit more from re-admissions.

Because of the ACA there are now penalties for Medicare readmissions especially those involving chronic conditions such as CHF, COPD, etc.

March 2015-

[SassyTachyRN]

I bet we work in the same hospital. 1:3 in oncology as well here with occasional 1:4. I was told by an oncology mentor that I should never take more than 1:4, as that is super unsafe.

When I worked inpatient onc, we were 1:4-5 if we were properly staffed and 1:6-7 if we weren't. It was really unsafe. Those patients are so unstable, especially the ones who are septic but have an ANC of 0, which was always at least one patient out of your group. Seems like we had a rapid response all the time. I always felt like we were more of a step down unit. Patients getting chemo,

Blood/platelets like crazy, abx due to neutropenia, kidney failure and liver failure due to chemo.... Not even mentioning the family dynamic involved with oncology patients.

[ambles]

You're right , just wondering what is holding everyone from doing the right thing.

[Galendria]

I work at a level 1 trauma/regional referral teaching hospital on a very busy med surg/telemetry floor. Our matrix calls for us to have a 1:5 nurse patient ratio, with the occasional nurse able to only take 4 patients. The charge RN typically has 1-2 patients. *If we had the staff* the nursing assistants would have 9-11 patients each. What's been killing us lately is that all our assistants are graduating and moving on, so we have less help. I feel like PCAs/techs/whatever your facility calls them are the unsung heroes that help make current nurse:patient ratios bearable. Stellar techs make days SO much better.

In the past I've also worked in another hospital as a new grad on a post-op floor with epidurals, trachs, tubes coming out of every bodily orifice and a patient ratio of 6:1. That sucked big time. I also worked on a pediatric surgical floor for 7 years with a patient ratio of 1:4-5 unless we had call offs that couldn't be covered. I really enjoyed that position, and felt like we were typically adequately staffed.

Now with 4 years at my current job (and often functioning as charge RN so I see the "big picture" of how each nurse on my 39 bed unit is coping with the ratios) I have a few thoughts on the 1:5 ratio that seems to be here to stay at my hospital. First, I feel bad complaining b/c so many other hospitals make their nurses manage with higher ratios. That being said, when the patients are *stable* (key word) 5 patients isn't so bad. Unfortunately, patients usually get referred here from other hospitals because they need a higher level of care which means they are pretty time intensive by med-surg standards. Insulin drips and other interventions that require RN action every hour are very unsafe with 1:5 ratio in my opinion. It's not unheard of to have 2 or even 3 rapid responses called during a 12 hour shift, and that takes up a significant amount of time for not just the primary RN, but also the charge RN and anyone else playing "gopher" or helping to cover the floor. Then if there isn't a progressive care bed available to transfer the patient to right way that also becomes an issue.

I guess my point is that when managers/administrators create matrixes they seem to have an ideal work environment in mind where all the patients are "typical", and all the ancillary staff will always be available. The real world is not like that, and so we have discussions like this

[ponymom]

Do hospitals realize the crap they load on nurses? They keep adding more duplicate and dumb paperwork. Sometimes I would sit there about to chart, and realize I don't know enough about them cause I couldn't do a proper assessment. I work psych so it takes more 1:1 time. What the heck am I supposed to chart when I have not had time too even talk to them?

Absolutely they do and it doesn't matter because they know they can get away with it. Because nurses, as a general group, are the most kicked-in and meek-minded group of employees (professionals? Haha) when it comes to advocating for themselves (and ultimately for their patients/residents). All talk and complain amongst themselves and on message boards, but when it comes in right down to it, they just bend over and close their eyes.The doormat mentality is what the suits have come to expect, and they have been continually affirmed.

[downsouthlaff, LPN]

Nursing Home LPN here , ratio 1-42. This is 3rd/graveyard shift which is not that bad actually