Question about staff ratios?

[lag413]

I work on a telemetry unit primarily dedicated to post-op cardiothoracic surgery patients (hearts can come out to the floor as soon as POD #1, and lungs get recovered and then come to the floor a few hours after OR). If we have beds available, we can get surgical tele or regular tele admits. Most of our patients have chest tubes and pacing wires, and frequently have JP drains,epidurals and foleys. We are often giving blood, and can have cardizem gtts and renal dose dopa. We also have the highest rate of falls in the hospital and the highest acuity of all tele units. The generally accepted ratio has been 1:7 max on days and 1:8 max on nights.

Even with ratios as they are, we are stretched to the bone, dealing with all the complications and trying to get our general nursing obligations completed. Lately staffing has been worse (many days we have 2-3 nurses scheduled for our 26 bed unit). We were told today by our manager "You don't know what short-staffing is until you've had 14 patients".

I realize my generation can be a tad entitled at times. Having only been a nurse 2 years, I don't know if this is the standard elsewhere or if this is unacceptable. To me it seems highly unsafe, considering the acuity of our patients. But I am wondering if my manager is right and we are just spoiled, or if the higher acuity of many patients, combined with the added liability nurses have now as opposed to 20 years ago makes our frustration justified. Any advice please?? Thanks!

[missbutton]

The telemetry/ stepdown unit at my hospital is 1:3, sometimes 1:2 depending on acuity. I'm on med/surg and my staffing ratio is 1:5 max. I'm in Ca. Whenever I hear about the staffing ratios in other states, all I can say is thank goodness for the California Nurses Association. I don't know you do it!

[imintrouble, BSN, RN]

:eek::eek:

That is the most insane, unsafe thing I've ever heard of. They'd have to make a bed for me by the end of the night. No wonder you're short staffed. Nobody wants to work there.

[Flo., BSN, RN]

wow! On my ortho/ neurosurgical floor we are 1:5 days 1:6 nights and we are fighting for lower ratios. I can not imagine 1:7 on your floor, that just does not sound safe.

[HamsterRN, ADN, RN]

That's extremely unsafe, we can't all be as spoiled as Cali nurses but that's excessive. Normal tele units should not be higher than 1:6, your description of your floors falls somewhere within a step-down unit and progressive care, depending how you define each, but either way it should be closer to 1:4.

Are you saying it's possible to have 8 post hearts? That is insane. Has your manager ever actually worked your floor, or even on any floor in a modern hospital for that matter?

My advice would be to speak with your Department of Health.

[meandragonbrett]

Um. That's not a tele floor. A floor with POD1 Hearts is a STEP-DOWN unit. 1:4 at the max! You guys shouldn't be taking lungs from PACU either. They should go to the unit. Your staffing ratios don't allow you to safely take care of fresh post-op transplants.

I'd be looking for a new job tonight.

[Crux1024]

I ditto what was said. Unsafe!

There is a similar unit to yours in the hosp i work for. They do 1:4 for days and 1:5 for nights. And they dont get post ops until AT LEAST the next day (at the extreme earliest) and that includes lungs.

Run.

[sunnycalifRN]

I agree with the other posters. 1:7 or 1:8 for POD#1 hearts is crazy. Haven't there been many "adverse events" that are caused by the staffing? I work in ICU, 1:2 ratio, and we still have delirious "pump-head" patients who pull out their chest tubes, swans, art lines, etc. I would think that the CT surgeons would be your allies in trying to improve the staffing. Some of our CT surgeons won't transfer their patients out of ICU because of staffing in the stepdown unit (1:3).

Just because staffing back in the day was even worse, it doesn't justify your staffing ratios.

[casper1]

I would not want one of my family members to be on your unit. The staffing is unfair not only to the patients,but also to the nurses. You could easily have multiple patients experiencing complication simultaneously. With every Nurse spread thin you would have no one who could help.It's No wonder you have the highest fall levels:uhoh3:

[sunnycalifRN]

Um. That's not a tele floor. A floor with POD1 Hearts is a STEP-DOWN unit. 1:4 at the max! You guys shouldn't be taking lungs from PACU either. They should go to the unit. Your staffing ratios don't allow you to safely take care of fresh post-op transplants.

I'd be looking for a new job tonight.

Agreed! OP, by accepting those crazy assignments, you're putting your license in jeopardy. If a sentinel event occurs, you can be sued and the hospital will not back you up. They will say that, if you knew the assignment was unsafe, you should have refused to accept it.

[njdrn1]

1:8 on nights? Thats crazy! It sounds like my hospital. I work on a Observation/Tele/Peds/overflow or what ever come sin the door. I work nights and I've been working nights for 12 yrs now. It's not getting any better. In fact it's getting worse. At night it's basically 1:7 our ratio. there is no unit clerk or aide.we have tele monitors but they are monitored on another floor. We have this little red hotline phone that rings if something is wrong. Most of the times, yu can't answer that floor becuase you are stuck in aroom giving patient care. we also have computer charting which sucks. It freezes alot and it always goes down at 3:30am then goes back up in 10 minutes. They crab about overtime but I can neer getout of there at 7:30a. Your floor needs more nurses. Especailly wiht the cardizem gtts. You got to monitor their VS frequently wiht that. Everything ios about cutting corners now. You know who pays for it? The patients and the nurses. And thats sad.

[merlee]

Your staffing is horrific - - no more than 4 pts on days, probably 3 would be even better.

No wonder there are so many falls. Where are your risk management people?!!