skay

looking for avg staffing ratios for nurses in CICU in a rural hospital setting. This Hospital does vents, heart caths no intrevention these are shipped to bigger hosp. Our CICU and PCU combined will take a max of 13 patients. We have acute MI, Resp., Drug overdose, post-op. the unit is staffe with RN and total of 2 LPN. No CNA. A ws on day shift and sometimes on afternoon shift. Never all night. Tell me what the usual pt to staff ratio would be. Thanks

sorry for the caps lock. I am not yelling at anyone just stating my opinion as you are yours. I do know how to use punctuation but I am posting on the internet not writing a paper. I was a "lowly" staff nurse long before I went into management and I resent the fact that you imply that staff nurses are "lowly" . I have the deepest respect for staff nurses who are the hub of any nursing facility. I am sorry if I offended you. But I stand behind my post.

SEE POST #113

ALL THE MANAGERS IN MY FACILITY ARE EXPECTED TO FIND COVERAGE FOR THEIR OWN UNITS OR FILL IN THE HOLES THEMSELVES. I RECENTLY WORKED A 12 HOUR SHIFT DOING PT CARE. FORTUNATELY MOST OF THE STAFF WILL WORK OT. ALL THE MANAGERS IN MY FACILITY WORK ON THEIR UNITS. THEY DO NOT HAVE OFFICES OFF THE UNIT. WE ALL SEE OUR EMPLOYEES ON A FREQUENT BASIS INCLUDING OUR NOC SHIFT. I KNOW MY STAFF FAIRLY WELL.SOME MORE THAN OTHERS. YES I HAVE STAFF THAT FEEL I TARGET THEM MORE THAN OTHERS. WELL SORRY DO YOUR JOB AS YOU SHOULD FOLLOW ALL THE RULES AND YOU WON'T BE A TARGET. NEVER HAVE I BEEN TOLD BY UPPER MANAGEMENT TO TERMINATE SOMEONE JUST BECAUSE----- THEY MAKE MORE MONEY THAN A NEW GRAD ETC. I HAVE HAD IT SUGGESTED TO ME TO WATCH CLOSELY AN EMPLOYEE WHO HAS POOR JOB PERFORMANCE AND NOT TO OVERLOOK INCIDENTS TO DISICPLINE SO A PAPER TRAIL CAN BE CREATED. AS A CO-WORKER TO THESE INDIVIDUALS I WOULD THINK YOU WOULD BE GRATEFUL THAT MANAGEMENT WANTS TO ELIMINATE THE POOR PERFORMER. I FIND THE PEOPLE THAT YELL THE LOUDEST THAT MANAGEMENT IS OUT TO ELIMANTE OR STICK IT TO THE EMPLOYEES ARE THE PEOPLE THAT ARE HAVING DIFFICULTY IN THEIR JOB PERFORMANCE, ARE NOT FITTING IN AS A TEAM PLAYER, AND ARE GENERALLY NEGATIVE PEOPLE. AS FAR AS KNOWING EVERY EMPLOYEES COMPLAINT/COMMENT/ ISSUE THAT IS UP TO THE EMPLOYEES IF YOU WANT TO AIR YOUR DIRTY LAUNDRY THAT IS YOUR RIGHT BUT DON'T BLAME MANAGEMENT BECAUSE THE ISSUES ARE BEING AIRED AMONGST THE STAFF. IF YOUR ON THE RECIEVING END I HOPE YOU WOULD LISTEN WITH AN OPEN MIND AS USUALLY YOU ARE GETTING ONLY WHAT THE PERSON WANTS YOU TO HEAR AND USUALLY FOR THE SYMPATHY FACTOR. I HAVE EMPLOYEES THAT DO THIS AND IT IS DIFFICULY NOT TO SPEAK OUT AND CORRECT WHAT IS BEING SAID BUT AS A MANAGER WE CAN NOT ALWAYS DO THAT AS THE INFORMATION BEING DISCUSSED IS CONFIDENTIAL BETWEEN A MANAGER AND THE PROBLEM EMPLOYEE. KEY WORD: PERCEPTION

Oops. My Reponse Post #112 Was In Response To Post#109. Sorry.

Amen!!!!!! There Is Usually More To The Story. Preception Plays A Big Part.

you need to cooperate wholly with your place of employment this will probally require frequent drug testing, documentation of substance counseling. As long as you prove you are seeking assistance to stop whatever substance abuse you are doing the licensing board will consider this and will not immediately pull your license. Your place of employment may limit your access to drugs if that is the problem. Be very honset with your manager/employer they will be discreet handling the issue with your co-workers. There is no reason anyone else you work with should know anything re. the issues you are having. I have personally handled instance of one employee who was abusing and currently know of another that is currently in treatment and still working. My prayers are with you. You can do this.

Sorry. Yes the nurse was trained as a RN. What I should have said was the nurse has not been oriented as a RN in the hospital he/she works.

If a RN working as an LPN gets sued the court I assume would go after her under her RN license. The problem I have is if the Nurse was never trained in the RN role can the hospital and/or manager be held accountable in any way for the nurses actions providing she was within her scope of practice as a LPN? Why would she be sued against her RN license since she is working as an LPN ? Background info: the nurse graduated as a RN while working as a LPN. The nurse does not want to accept less than a fulltime postion as a RN nor work a night shift and wants to stay on the unit she has been working. Therefore, the nurse maintains a LPN liscence to keep her position. The nurse performs the job duties of a LPN and gets the pay rate of a LPN and is resourced by a RN. She signs orders as a RN. Looking for some legal opinions on this situation. Thanks

I NEED ADVICE AND ANY INPUT YOU CAN GIVE ME. I HAVE BEEN A UNIT MANAGER FOR 7 YEARS ON A 26 BED MED UNIT. I HAVE HAD GOOD TIMES AND A LOT OF ROCKY TIMES. I WAS A STAFF NURSE ON THIS UNIT PRIOR TO BECOMING THE MANAGER. MOST OF MY EMPLOYEES ARE LONG TERM STAFF EXCEPT ON THE DAY SHIFT. AT PRESENT I ONLY HAVE 3 RNS OUT OF 20 PEOPLE WHO HAVE BEEN THERE LONGER THAN 5 YEARS. 2 OUT OF MY 3 LONG TERMERS ARE VERY SET IN THEIR WAYS AND PRACTICE NURSING FROM THE DARK AGES (PAMPERING,ETC), ONE OF THESE 2 IS A BIG THORN IN MY SIDE AND HAS BEEN FOR OVER 20 YEARS. SHE HAS OVER THE LAST YEAR DECIDED TO STIR UP AS MUCH TROUBLE AS SHE CAN BY UNDERMINING ME, CONVINCING NEW HIRES THAT MANAGEMENT DOESN'T CARE, AND CERTAINLY I DON,T CARE AS ALL I DO IS GO TO MEETINGS AND SIT IN MY OFFICE. MY UNIT IS A VERY BUSY UNIT WITH MULTIPLE DISCHARGES AND ADMISSIONS. MY NURSE RATIO CAN BE AS HIGH AS 6 OR 7 PER NURSE IF I AM SHORT STAFFED .WE HAVE 2 AIDES USUALLY WHO THIS NURSE COMPLAINS ABOUT ALL THE TIME THAT THEY NEVER DO ANYTHING THAT THEY DON'T DO IT RIGHT ON AND ON.WE HAVE UNDER WENT MULTIPLE CHANGES OVER THE LAST 3 YEARS.THE FIRST CHANGE WAS SWITCHING TO COMPUTERIZED CHARTING WHICH FOR SOME REASON HAS MADE LIFE HARDER THAN EASIER. THE NURSES TAKE 2 X LONGER TO CHART THE WHEN DOING PAPER CHARTING, WE ALSO BECAME UNIONIZED WHICH THIS NURSE IS VERY PRO UNION. MY NEW NURSES ALSO SEEM TO COME IN WITH AN ATTIDUDE THEY DON'T GET THEIR HANDS DIRTY BECAuse they are rns. I JUST SPENT 2 DAYS WITH MY WITCH NURSES ALL ON THE SAME DAY AND AM SPENDING A HORRIBLE WEEKEND QUESTIONING MYSELF. I DO NOT WANT TO GO TO MY DON AS WE JUST LOST OUR CLINICAL DIRECTOR AND DON EXPECTS THE MANAGERS TO HANDLE THE PROBLEMSTHAT OFTEN THE CLINICAL DIRECTOR HELPED WITH SHE WAS OUR BUFFER THE LIFFER NURSE CAME TO ME YESTERDAY TELLING ME WHY MY CHANGES WERE NOT WORKING I SAID OK WHAT DO YOU THINK WOULD BE BETTER WHAT SOLUTIONS CAN YOU COME UP WITH TO MAKE OUR UNIT HAVE MORE TEAMWORK SHE LOOKS AT ME AND SAYS I DON'T KNOW THATS YOUR JOB. LATER SHE COMES TO MY OFFICE AND TELLS ME THAT EVERYTHING ON THE UNIT IS FALLING APART AS ONE NURSE IS CRYING BECAUSE SHE IS DOING AIDE WORK AND THE AIDES CAN;T BE FOUND I GOT UP TO GO CHECK THINGS OUT AND SHE TELLS ME OH YOU DON'T NEED TO GO NOW I DID ANYWAY SPOKE TO THE CRYING NURSE WHO WENT OFF ON ME GAVE ME THE FINGER AS SHE FLEW OFF THE UNIT I FOLLOWED HER INTO THE ELEVATOR ASK HER WHAT WAS GOING ON AND CALLED HER ON HER GESTURE SHE HANDS ME HER NARC KEYS I ASK HER IF SHE WAS QUITTING AND TOLD ME TO TAKE IT FOR WHAT IT WAS WORTH I ASK AGAIN SHE DID'NT ANSWER ME BUT WAS ON THE VERGE OF TEARS I TOOK HER INTO AN OFFICE WITH A SHIFT COORDINATOR AND WE TALKED. POINT I AM TRYING TO MAKE IS WHAT CAN I DO TO MAKE THESE PEOPLE START WORKING AS A TEAM 1/2 OF MY DAY SHIFT PULLS AGAINST EACH OTHER I HAVE SEVERAL UNORGANIZED NURSES MY GOOD ORGANIZED NURSES DON'T WANT TO HELP THE OTHERS AS THEY GET DUMPED ON. i FEEL THIS ONE NURSE IS THE ROOT OF THE PROBLEM BUT I DO NOT HAVE ENOUGH TO DISCLIPINE HER NOR CAN I TALK WITH HER I HAVE TRIED. HER AND I CAN NOT COMMUNICATE WELL AS NEITHER OF US LIKES THE OTHER I HAVE TRIED TO PUT ASIDE MY FEELINGS ABOUT HER BUT SHE WILL NOT BE RECEPITIVE TO ME.HELP HOW CAN I GET THINGS BACK ON TRACK

Why Is Team Nursing Confusing? It Makes The Staff More Accountable For What They Are Doing Or Should Be Doing Such As Na, Rn Who Never Even Looked At A Lpns Patients When She Resourced Them. Rn Tusted Lpn Knew What Was Going On With The Patients And Would Seek Her Out When She Needed Help. Some Lpns Would Act Like Rns Except For Push Meds .

At My Hospital We Have Been Doing Team Nursing For About 4 Weeks. Is It Working?????? Some Days Are Better Than Others! It Depends On Who Is Working With Who. The Nurses Are Still Confused About Their Role And Most Have A Lot Of Problems Delegating Esp. To Another Rn. The Teams Can Be As Big As 13 Patients To 2 Liscenced People That Could Be 2 Rn Or 1 Rn 1 Lpn. Everyone Thinks The Rn Should Not B3e Responsible For That Many Pts But In Primary Care 1 Rn Could Have 6 To 7 Pts And Resource A Lpn With 6 To 7 Pts. So What Is The Difference Really?

change is difficult. our rooms to not go in a section like 1 to 6 etc etc. mainly because our difficult total care patients are often put in these rooms therefore one team gets the heavy load. actually the geography of the assigned rooms is not a problem the staff prefers this to having all complete care pts. we do not have a charge nurse but our unit manager. our teams could have 13 patients to 1rn 1pn 1 aide but most of the time that team would have 2RN 1LPN 1 NA. the work load has been split diff. ways 1. 1 RN does all assess. 1RN and LPN split meds to orders help aide. 2. both RN split asess. and LPN passes meds. any other ideas? another day there was 2 teams with 3 counting the aide and the x RN took her own pts.

thank you for the input. i plan on sharing it with my peers. today was a better day till late afternoon when the admissions came.generally that is when we get hit with admits. we had 2 teams today. one team with rn/rn/na they had 9 pts. to start. team 2 had 2rn/1lpn/na who had 12 pts. team 1 had 1 discharge took in 2 transfers from cicu and 2 admits. team 2 had no discharges took in 2 admits. team 2 had 1 rn do all assess 1rn pass med on 6 lpn pass on 6. team 1 rn all assess 1 rn meds. any thoughts on this? tommorow same rn/rn/na will have 10 pt. team 2 will be rn/lpn/na and then x rn is going to take 6 pts passing her own meds and doing own assess. the two aides will split her patients along with their team assign. is this workable ? guess we will see.

ERteleRN what are your staffing ratios? do you have aides? thanks for responding.