Patient ratios progressive care units

[kaylasmommy]

I work on a progressive care unit which had a pt:RN ratio of 3:1 when I started 3 years ago and now we are moving to 4:1 ratios now. The facility/mgmt has stated that 4:1 is the national standard for progressive care units now.

They have decided to off-set this increase in patient loads by increasing the number of CNAs on the floor. So now each CNA also only has 4 patients.

The problem I am seeing is that the nurses are way over worked, stressed out, skipping lunch etc. while the CNAs walk around complaining about how bored they are.

On our unit all patients are on cardiac monitoring, (which we monitor ourselves, no tech, and alarms hooked to a pager) we do some titratable gtts (cardizem, nitro, heparin and insulin). We have some respiratory patients including chronic and/or stable ventilators, rescue bipap, and hi flow 02. We also have pre and post cardiac catheterization pts, and also post open heart (usually day 2) when they still have external pacer wires, chest tubes, insulin gtts, etc. Needless to say, the assignments are busy and adding an extra patient seems unmanageable.

The union was of very little assistance with this transition. It seems to me that patient safety and satisfaction are at risk here. I'm just wondering what others find in similar units.

[turnforthenurse, MSN, NP]

not all PCUs are created equal. I work on a PCU and the ratio is 1:4 but for awhile we were going to 1:5-6 because of staffing. A ratio of 1:3-4 seems to be common. I did my preceptorship my senior year on a cardiac stepdown/VICU and the ratio there was 1:3. in the VICU, it was 1:2. And ICU stepdown at that same hospital (where they had patients on ventilators and titratable drips) also had a ratio of 1:3.

My unit does not accept patients on (invasive) ventilators. I realize some PCUs do but as I said, not all PCUs are created equal. We have patients on continuous BiPAP. We have pre/post cardiac cath patients. We have patients with a lot of cardiopulmonary problems (UA/NSTEMI, chest pain, CHF exacerbation, PE, pneumonia, COPD exacerbation, acute respiratory failure) in addition to acute/chronic renal failure patients, DKA/HHNKS (usually once they can come off an insulin gtt, our ratios are too high but once in a great while if our ICU is full, we will get a patient on an insulin gtt), patients with electrolyte imbalances (typically hyponatremia and hyper/hypokalemia), anemia, coagulopathies (we have gotten several patients with critically elevated PT/INR). We get patients with chest tubes and all sorts of drains. We do not get open-hearts because that is not done at my hospital. We also do not get patients with VADs and I have never seen patients with pacer wires.

As for our CNAs, we have 1-3, depending on staffing. With one, they have the whole floor (up to 24 patients). With two, they have 12 patients each and with three, 8 patients each. I find some nights are worse than others...there are certainly nights where we literally hit the floor running and other nights are very uneventful. I find patient SAFETY is at risk because management seems to care more about SATISFACTION thanks to HCAHPS...

[kaylasmommy]

Wow thanks for your input. I guess it does kind of depend on pt acuity. I am really surprised to hear how few CNAs you work with. I think we are going through an adjustment period, 4 patients seems like a lot to me right now especially when they are busy assignments not a lot of walkie-talkies. I guess I probably needed a place to vent but I am interested in how other units operate too. Thanks for your response.

[cardiacsuperstar]

I work on a cardiac pcu and our ratio is 1:4 and they are continually trying to give us 5. It is always a nightmare when we end up getting 5 pts each and usually we end up having an event like a pt fall or a confused pt rips out his introducer line or a pt tries to get up without using sternal precautions and reopens his incision. We only get 1 tech amongst our 19 beds. Everyone preaches pt care first, but we aren't robots. We can only keep so much straight in our heads. I've just flat out started refusing 5 pts. We will never get what we know is safe until we as a profession start demanding it.

[skyandsydneysmom]

The PCU I work on has a 4:1 ratio, but sometimes we have 5:1. My floor sounds exactly like the OP's...drips, post CABG patients, and a mix of other illnesses. We have a max of 3 PCT/CNA's on the floor which means that when we are full, each PCT has 12 patients. The ratios are definitely not ideal but my floor thrives on teamwork...without it we would all sink.

[Vespertinas]

1:3-4 days 1:4-5 nights

we get valve repairs, CABGs, transplants, LVADs, cyromaze

[bowlofsurreal]

At a non-union hospital in the dc area, we have 1:5 on days and 1:6 on nights. It used to be 1 less patient per shift until about a year ago. The difference that addition of an extra patient makes is monumental... half the staff has moved on and the rest are considering it :/

[nursecyndi05]

my unit is an icu stepdown( intermediate critical care unit). Our ratios 1:3-4. We actually have two floors a 16 bed and a 9 bed. If all 16 beds are filled then we usually have 2 techs,4 nurses (ocassionly we have 3 techs and 5 nurses if we lucky). The 9 bed unit only get 1 tech,3 nurses. We have titration gtts ( heparin, cardiazem,nitro), and all of our pts are on cardaic monitors which we monitor. We get stable trach-dependent vents, pre- and post cath, continuous bipap, hemodynamically unstable but not yet ICU criteria patients. We also have bariatric pts. Our acutity can be very high some days and so we suffer from a high nurse turnover rate.

[eatmysoxRN, ASN, RN]

Wow. I'm in shock here. My floor is kind of a catch all but ultimately the icu Stepdown. We get lots of chest pain. Positive troponins. Post lhc. Post ppm. Post chole. Post VAD placement. Bipap. Pneumonia. Copd. A lot of continuous Bipap. Chf. We do biopsies on our floor. Titratable drips (mostly a bunch of heparin, integrillin, nitro, cardene, amiodorone, cardizem). We get fairly unstable patients and if a patient comes in who is deemed more critical we get a still critical level patient from the icu so the new one can have the bed. We are staffed 3 nurses for 24 beds. 1 tech and 1 ward clerk. We do have a monitor tech who watches our tele but many times we spot bad stuff on our monitors at the desk before they do so we are running with the crash cart. I would love to have better ratios but the job is still far preferable to my previous and mostly I feel like my workload is manageable.

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

[SNB1014, RN]

We are strict 3 pts max to a rn

[VidaUrbana]

I currently work on a PCCU floor and I work nights. My max ratio is 5. You guys have it good!

[kalanel5]

Wow I am a cardiac nurse by no means an I work on a neurosciences med-surg floor. We get post heart cath patients on bed rest, titration drips such as heparin, insulin and cardizem. We are usually running with 5-6 patients at night with 2-3 techs for 32 patients. We too can't keep nurses. I am appalled that we take care of similar patients that you guys do but you all are in ICU's and stepdown units. We also get patients post pacemaker placement.