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.

[gere7404, BSN, RN]

my old unit was split into a telemetry unit (30 beds) and a step down unit (10 beds)

telemetry ratios was 4:1 during the day, 5:1 at night

step down is 3:1

[martymoose, BSN, RN]

IMC floor, no vents, but stable bipaps( or chronic ones). used to be 1:3-4 on days, 1:4-5 on eves, 1:5-6 on nights. Now add one to all those, and sometimes 2 more. Just the other day nites had 1:10, and days 1:6. Nobody cares. I feel like ripping up my license and handing it in at the door. Just waiting to get sued. Good thing I have insurance.

Oh , and one tech on nites. It's a rarity if we get two. And one usually ends up a 1:1

 

[OUxPhys, BSN, RN]

Unfortunately I've never worked on a true stepdown or PCU. They all had it in their name but we never had the 1:3 ratio. 4 on dayshift was the goal but 5 happened alot. 4 was the goal on nights as well which almost never happened. Usually it was 5 with occasionally having 6....all the while being expected to manage the drips, post-caths with arterial lines while also being on a nitro drip. Both floors did not take vents.

It sounds like your hospital is using that reasoning as a way out of having to pay more staff. It happens at alot of hospitals unless that hospital has a strong union. Most "stepdowns" or "PCUs" are glorified M/S tele floors. 

[FlameHeart, CNA]

On 1/10/2013 at 7:56 PM, kaylasmommy said:

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.

Dang I need to work there.

haha...seriously though

I just applied to ICU and Progressive Care Unit at a Hospital within reasonable driving distance

and I'm a CNA.

I did Home Health Care for 2 years before I got my CNA then went into a LTC and quit my first full day when they gave me 9 Patients and I just barely got through the day with the help of 4 other staff members. It just wasn't safe for me to continue working there.

 

Ironically I've found out that 9 Patients for a CNA is "low", not for me: I went from 1 Patient to 9 in 1 Day, it wasn't pretty and it was AM shift.

 

Hoping ICU or PCU will be better fit for me.

 

Believe me, I know what's it like to encounter a lazy-good-for-nothing-but-firing CNA.

 

I actually had 8 patients that day, but I noticed a patient who needed help but his CNA abandoned him because "he was yelling at me and being mean" or some nonsense like that, it turned out to be just an excuse to not want to change him as he screamed in pain from how hard his BM was and she ended up giving out trays to Patients but I didn't see her doing much changing, just being overall "looking busy".

 

Meanwhile I got 4 patients + HER'S to change diapers and I never got to them all on my own and I had 8 hours +1-2 hours over my shift.

 

Report these lazy CNAs sucking up money they could use to hire real workers.

 

Every place I was a CNA or CNA in training there was ALWAYS something to do, people just need to get off their phones, shut their gossiping mouths, and start answering call lights or learning from the RNs or LVNs at least. I wasn't perfect of course, but I tried my best.