Patients per shift, how many is too many?

Mags4711, RN · Feb 15, 2007

If you are a Patient Care Associate (or Patient Care Tech or CNA)how many patients are you assigned per shift?
I work in at a children's hospital on a med/surg, infectious disease, neurology unit and the PCA's went from an assignment of 7 children to take care of per shift to 10-14. I think that it is a bit much to give full care, vital signs, beds and baths, feedings, blood work (and other routine lab) on up to 14 kids (including some babies that don't have parents staying with them). All of this while the nurses who don't help out have 3-4 patients (which is considerably light load because we do most of the hands on care) I am not saying that all of the nurses are lazy but do they really need full coverage if they only have 3 patients? I am in nursing school now and I hope that I will never be the type of nurse that feel that it is not "my job" to do vitals or bed/baths for my patients, even if I do have an assistant working with me.

I'm flabbergasted! I've never had a PCA/Tech who did, or was expected to do all of my feedings, baths, vitals, labs, etc. That's crazy! When I worked on a peds floor, our tech had the entire floor (26 patients), but she was only expected to get the vitals (and many of us would tell her we'd get our own so we could assess our patient at the same time) and then help us out with answering call lights, and what we asked her to do (chemsticks, feeds, etc.) on a first come-first served basis unless there was a need for something to take priority.

I'm kind of lost on one thing you said, that you give "full care" to the patients. What is the nurse doing? Just passing meds? I am amazed and saddened by how your unit is run if the PCA's do all of the daily care and the nurse only passes meds. It is unfair to the PCA and to the patient.

missgigius, RN · Feb 15, 2007

Yes, we are expected to do all of the care for the patients that we are assigned to. If a nurse is "kind" enough to do a set of vitals or feed a baby, trust me the entire unit would know about it. We have a handful of nurses on our unit that feel that this "expectation" of the PCA's is ridiculous and help out, but this is very rare. I work midnights and sometimes it takes an hour and a half to two hours to do vitals on all of my patients because if you wake a baby you have to get them back to sleep or if a bed is dirty you have to clean it. I have been there for almost 7 years and this is the new protocol for the last 4-5 months and I am burnt out. If I wasn't in school with an end in sight to this nonsense, I would leave. I don't feel as if I am or able to take good care of the kids I am assigned to because I am spread so thinly.

jb2u, ASN, RN · Feb 15, 2007

IMHO, any more than 8 patients is too many for a pca to handle if they are expected to perform all basic care plus vital signs. Now, it does depend on the acuity level of each patient. I know many charge nurses that will not consider this when they make out the cna assignment. They go down the list counting and then draw a line; every pca gets 12 patients. This is the easiest way to do it, but not easy for the cna. Let's say cna #1 has 8 self-care patients and 4 assist while cna #2 has 6 total-care patients, 5 assist, and 1 self-care. This is NOT a fair assignment. I know it is difficult enough for the charge nurse to decide which nurses are going to get which patients, and that worrying about the cna's would only add to that; however, an overloaded cna means the patient ultimately suffers!

Also, consider the fact that oral care is the most overlooked part of care. Now, I normally have 12 patients. It is NICE, but impossible to come in, get report on 12 patients, and then go around and wash their faces and brush their teeth all before breakfast trays arrive on the floor. I would LOVE it if I had that kind of time! I once had a patient's family member ask me, "you're not going to wash her face? You wash your face in the morning don't you?" Again, I would love to wash each and every one of my patients' faces; however, it just is not realistic. Normally, before I even finish receiving report, I already have call lights going off for patients wanting to go to the restroom, family members who just got there and are furious that there mom is in a wet bed, family members wanting to know if dad is going to get a bath "sometime TODAY!" (it's only 7am!!), bed alarm is going off because the patient will not stay in bed and we can't use restraints, but hey we don't need restraints because we have bed alarms; it doesn't matter that we may be understaffed and not have the staff to run to the room as soon as the alarm goes off, but that's ok because we can just blame the staff if the patient falls for not responding in a timely manner.....I think you see what I am getting at. CNA work is tough. I enjoy helping others, but sometimes all I can do is just NOT enough. More than 8 patients is WAY too many, but hospitals do not care because they can always point a finger while collecting a bigger check by running floors short staffed. All of this is just my take on things though.

Sincerely,

Jay

followyourbliss · Feb 16, 2007

Hello All,I work in a complex care facility doing all three shifts because I am casual so I get the birds eye view of it all!So during the day we are responsible for 15 ressies with two C.NA's on per "house"...however one of us has to do meds so one person has to end up doing more cares.On one floor a L.P.N works alongside a cna and during dayshift there are R.N's on.During NIGHT shift which I have done a bunch of because the shift is hard to fill we have 30 people,there are two floors 30 on each floor and the night nurse floats between the two.Some nights are quiete and some nights are...like I am racing around sweating trying to get it all done for day shift arriving for 7am.Hmmm in answer to how many are to much I think it is when your level of care starts to decline,when you are not having the time for mouth care,doing all the little things that are important but are not life and death,but that bug us when we go home and go over our day in our minds.to be honestI am trying to find the balance still and be true to ME.Some people are all about getting ressies "DONE".To me it is not life altering if someone has breakie in their P.J's if they like that,or something similiar..this is their HOME and I always try to remember that.Anyways hope all is going smoothly for you all?

My boyfriend is on "overshare" right now.Take care.