Safe patient ratios

sherryg0 · Aug 21, 2005

I am from Texas and our regs will not allow more than 12 pts per RN with 3 techs for this many patients. Less techs = more nurses. If the clinic were to fall below this and was visited, they would be out of compliance.

jnette, ASN, EMT-I · Aug 22, 2005

KAT.. when you have 15 pts. with 3 PCTs, do you also take patients?

What about when you have 12 pts and three PCTs ? In other words, do the techs take all the patients dividing them up amongst themselves, or do you have a "side" as well?

Nurseinthemaking · Aug 25, 2005

This is another State of Tx thing, but LVN's are not allowed anymore then 4 that they caring for. That meens actually doing the Dialysis.

In our Unit We have 2 Med nurses (RN's) that handle all the meds, both work the same hourse then 2 more RN's that do Charge generally they are both there atleast for 4 of the 15 hours at the same time. Then there is 1 LVN (soon to be me, YAY) (so for now they have the one LVN and Me ,little Ms. GVN :lol2: ) plus umpteen billion techs. We have a fairly busy unit which consists of 3 shifts of 30 patients each. We run 6 days a week.

Does anyone else work 2 fifteens and a 10? :bluecry1:

Nurseinthemaking · Aug 25, 2005

Oh and did I mention, I AM TOTALLY LOVING IT!!!!!!

KAT1994 · Aug 28, 2005

KAT.. when you have 15 pts. with 3 PCTs, do you also take patients?
What about when you have 12 pts and three PCTs ? In other words, do the techs take all the patients dividing them up amongst themselves, or do you have a "side" as well?

I usually put on 3 or 4 of the patients so that we stay on schedule for turnover. I help with rounds while each PCT goes on break ( a total of 90 min). So while I am passing meds and doing dressing changes I am also answering the phone, doing rounds, supervising PCTs, trying to keep pt med lists, and charting current.

During turnover I usually take off 3 pts and put on maybe 3. Turnover 3 machines. do all of the pre/post assements. By turnover, there is another RN which leaves me with 11 pts to take off and 11 to put on with 2 PCT. We have 30 min after a catheter comes off to have another pt in that chair and on the machine. 40 min after a stick to have another pt in that chair and on the machine. When we get down to 7 pt a PCT is to go home. I am exhausted at the end of the day.

Now my CD wants to make me salary since I am frequently still trying to finish my paperwork two-three hours after my shift. I am also the Vascular Access Coordinator for our unit with 75-96 pts.

I am feeling a little abused. My own fault I suppose.

hemo_diva · Sep 15, 2005

Patient load has been an issue in hemodialysis for the 10 years I have been employed in it. I transitioned from tech to RN during that time and have seen both sides of the battle. I have to admit, nurses get the bloodier side of the field when it comes to functionality of the unit. In other words, we can do everyone else's job and they can't do ours. My patient load used to be 16:1 patient/nurse, with 4 techs who do all the put-ons and take-offs. I usually put on 1 to 2 patients or take off the same to ensure a smoother change over (if there is such a thing), assessed all patients pre and post, passed all the meds, reviewed all labs for 3 shifts of patients, rounded with the docs, scheduled declots and venograms, arranged transplant info, do the tech's floor schedule, thin charts,etc...and let's not forget about the accountability. The company's policy states that the ratio should be 12:1 patient/RN. So why do I have 16? Well, the company counted the unit manager (who is an RN), who sits in her office 20 feet away from the unit. Long story short...after I threatened to walk away the regional manager ok'd a second RN when our census when up to 19 each shift. Too little too late in my opinion. Kat...why do we abuse ourselves for the love of a specialty? LOL!

jnette, ASN, EMT-I · Sep 15, 2005

Patient load has been an issue in hemodialysis for the 10 years I have been employed in it. I transitioned from tech to RN during that time and have seen both sides of the battle. I have to admit, nurses get the bloodier side of the field when it comes to functionality of the unit. In other words, we can do everyone else's job and they can't do ours. My patient load used to be 16:1 patient/nurse, with 4 techs who do all the put-ons and take-offs. I usually put on 1 to 2 patients or take off the same to ensure a smoother change over (if there is such a thing), assessed all patients pre and post, passed all the meds, reviewed all labs for 3 shifts of patients, rounded with the docs, scheduled declots and venograms, arranged transplant info, do the tech's floor schedule, thin charts,etc...and let's not forget about the accountability. The company's policy states that the ratio should be 12:1 patient/RN. So why do I have 16? Well, the company counted the unit manager (who is an RN), who sits in her office 20 feet away from the unit. Long story short...after I threatened to walk away the regional manager ok'd a second RN when our census when up to 19 each shift. Too little too late in my opinion. Kat...why do we abuse ourselves for the love of a specialty? LOL!

I don't undcerstand how all you nurses get by with having all these techs to do the "put ons, take offs".

Heck, where I work, the nurses each have their own set of four patients, because we only have two techs... so we're doing their assessments and meds, plus our OWN ... plus four patients apiece.

I'd LOVE to just "float" and help techs on the floor... do assessments and meds. But we do that PLUS having to handle our own patientload. :stone

And yes... they count OUR unit mgr. (clinincal mgr./DON) in our staffing module as well.. count her as a floor person. (How DARE they!!!???)

But yes, she spends as much time on the floor helping US as she does in her office where she NEEDS to be ! So it's not fair to HER, (she's not able to get HER work done) and not fair to US (we get shorted when she has to take all the important phone calls or conference calls, or catch up on her piles of work on her desk that was supposed to be done last MONTH).

You couldn't PAY me ENOUGH to do her job !!! It's absurd what is expected of her.

They screw us anyway they can. :angryfire

hemo_diva · Sep 20, 2005

Our techs do all the put-ons and take-offs entirely by their choice...a unit vote, if you will. And really we (the nurses) are not getting away with much at all because we still put a few on and take a few off.

I don't undcerstand how all you nurses get by with having all these techs to do the "put ons, take offs".
I can relate...the last unit I was at was like this...those patients really suffered. The nurses were too busy trying to keep up with their own pod to effectively and timely assess the remainder of the patients according to policy. Heck, where I work, the nurses each have their own set of four patients, because we only have two techs... so we're doing their assessments and meds, plus our OWN ... plus four patients apiece.
I'd LOVE to just have an assignment and not run helter-skelter through the unit. There is much to be desired when it comes to the floating concept...but actually in reality my assignment is the whole unit.I'd LOVE to just "float" and help techs on the floor... do assessments and meds. But we do that PLUS having to handle our own patientload. :stone
Don't get me wrong...I want my manager off the floor too and thoroughly enjoy for her to get the payroll in on time instead of having to cover the floor. But when I have 16 patients to deal with and such high acuities, ultimately it is the patients who suffer the lack of care with just one licensed person on the floor. Study after study has proven higher rates of mortality with insufficient amounts of RN's present in direct nursing care.And yes... they count OUR unit mgr. (clinincal mgr./DON) in our staffing module as well.. count her as a floor person. (How DARE they!!!???)
But yes, she spends as much time on the floor helping US as she does in her office where she NEEDS to be ! So it's not fair to HER, (she's not able to get HER work done) and not fair to US (we get shorted when she has to take all the important phone calls or conference calls, or catch up on her piles of work on her desk that was supposed to be done last MONTH).
You couldn't PAY me ENOUGH to do her job !!! It's absurd what is expected of her.
You couldn't have said this any better...keep up the good fight.
They screw us anyway they can. :angryfire

nosonew, BSN, RN · Oct 8, 2005

I have a question... how can WE, RN's, SAFELY care for patients with short staffing?

Check out this scenario:

1 RN, 1 Tech. 9 patients (4 wheelchair, 1 cath). From 5:45a-8:30 a only 2 employees in the unit.

And if there was a fire? Tornado? Other emergency? See where I am going with this?

No reuse tech, no water person, no secretary, NO one but those 2 employees.

I recently had this happen to me. I told my Director I refused to initiate treatment to the patients without at least a 3rd person (tech or RN). Amazingly she found another to work.

I call my state board of nursing and dept of health and environment. They both backed up my decision. So did 3 nephrologists.

As the only RN there, it is my responsibility to put patient safety first. Not the budget.

Trvln Nurse, RN · Oct 13, 2005

What is the penalty for being out of compliance? Does anyone know?

nosonew, BSN, RN · Oct 16, 2005

Honestly, from what I have found out... the penalty is the RN losing his or her license IF ANYTHING goes wrong.

That is why I refused to work with inadequate staffing...

that is also one of the reasons after SEVEN years with Davita I am no longer with them! It is NOT the company...but the administration of my unit.

Don't think Davita isn't a great company to work for.. but when you get stuck with a sucky admin... you are screwed.