Jump to content

Safe Pt Ratios for Med Surg

Specializes in Med/Surg, ICU, educator.

I have tried to find a thread on this, and nothing addressed it quite adequately for Med/Surg pts, ESPECIALLY surgical pts.

Our new Clinical Manager for our surgical care unit wanted to know what we consider safe ratios with our population: fresh surgeries from PACU, outpatient surgeries, and 1-3 day recoveries, and swing bed patients. Right now we usually have 1 RN and 1 or 2 LPN and 1 or 2 CNAs for 16-35 patients, avg is about 21 pts. I think 4-6 pts to a team of 1 RN and 1 LPN and 2 teams sharing a CNA sounds about right-the fresher the surgeries, the less pts should be in a group though, just for safety, and orthos I think should lower ratios also.....what are your opinions, just for sake of info gathering?

BTW, our hosp is trying to get Magnet status, but yet our staffing is awful, some shifts, it goes beyond pt safety issues....They have juggled numbers to make it look good on paper. Do these Magnet folks read between the lines?:confused: Any thoughts on the staffing question are much appreciated.

Thunderwolf, MSN, RN

Specializes in Med-Surg, Geriatric, Behavioral Health. Has 32 years experience.

I work on an Ortho-Neuro Med Surg with total census being 24, which it is most of the time. As you guess, our patients don't move very well and require a lot of hands on. Our staff for 24 patients is 3 RNs, 3 LPNs, and 2 Aides. PT gets them up initially if they can on POD #1. This mix is doable. I've worked at another hospital in the past where staffing was much less and it was horrid. Hope this helps.

HappyJaxRN

Specializes in Transplant, homecare, hospice. Has 9 years experience.

I am so spoiled. The most patients I get is 4. Usually only 3, but last night I had 1. Not a med-surg floor...but transplant....but after a certain number of days out from the surgery, they are considered med-surg patients. We usually have 17 patients on the floor. We range from having 1 patient to as many as 4. The usual number is 3. Most of the time we have 2 PCT's.

I would be lost working somewhere that I would have more than 5 patients. When I float, I have 5....on CV and on the med-surg floor....I don't know how ya'll do it...:chair:

my assignment ranges from 5-8 pt's. we are fighting hard for more staff and more coverage. i feel like i am running an assembly line. 25 beds. 3-4 nurse. 1 LNA (god bless her)

cdmadere

Specializes in peds, medsurg. Has 4 years experience.

Ok, you guys. Here is Louisiana at the hospital I work at we range from 5-8 patients per nurse. :bluecry1: I am getting burnt out quickly and looking for a career change within nursing. I go home so stressed out and tired...

I usually work OB but when I float to medsurg their usual staffing for max of 28 pts is 2 RNs 2 LPNs and 1 Tech. They average 20-24 pts, with anything from ortho to surg to swingbed pts. They even have peds pts as our hosp doesnt have a ped unit.

I work on a med-surg unit in Canada..work straight nights.That seems to be when people go sour or things happen. There's no knitting going on(as some people think of N shift) There are 36 pts with 3 RNs,2 LPNs. We also run the Code cart to other units. It can be busy. I go through burn out spells.

kristi-lpn2

Has 10 years experience.

I work on med-surg floor we can have up to 26 patients on my floor. The staffing we usually get is 1RN,3LPN,1CNA; sometimes we get 2RN,2LPN,1CNA. Every now and then we get 2 CNA but not very often. I work doubles on the weeken 7a-11p. We get very busy and stay busy we used to be staffed better than this and when we have 36pts according to our pt/staff ratio we are working 2nurses short and 1 aide short the majority of the time.

I work on a GI med/surg (mostly surgical) floor. We have 16 patients on the unit. Rarely an empty bed. On days and evenings, we have 4 nurses and 2 PCAs (Personal Care Assistances). On nights, it's 3 nurses and 1 PCA. I feel like we are WAY understaff...Pt wants so much from you...many times, I feel like I'm stretched in all direction. So stressed-out!!!

I work on a 28 bed ortho, neuro, med-surg, trauma unit. We have split the floor so it works like this: staffing for the floor total. 2 charge 6 nurses on the floor and 2 pca. Each side has a charge and 3 nurses and 1 pca for 14 pts. now don't get me wrong people still complain but the majority of our pts are hips and knees so we get alot of postops. maybe 7-8 on one side and 4-5 on the other most of the time. this is in addition to giving blood and new admits and stuff like that. We run most of the time but very rarely does one nurse have more than 5 pts a piece.

twinmomoftwins

Specializes in ortho, pedi. Has 11 years experience.

I work on an ortho med-surg unit. Lately, staffing is sub-par. The other day, with 22 patients and an RN call-out, they were going to staff us as 2 RN's, 1 LPN (float) and 2 PCA's. When I objected, they replaced the LPN with an RN (pulled from another unit) but then left us with 1 PCA. As charge nurse, I had an 8 pt. assignment to start the shift!! I would dream of a 5 pt. assignment. Hasn't happened in a long time!!! To add insult to injury, the LPN compained to the VP that I refused her! Heck, I was refusing an 8 pt. assignment, I was hoping to keep her plus get another RN, Am I dreaming or what?! Luckily, I have a D/C by 10:30 am. Guess what, they want to send the first post-op of the day at 11:00!! By the end of my very long 12 hour shift, with D/C's and post-ops, I've charted on 11 patients, ugh!!

applesRN

Has 13 years experience.

I work as a resource team nurse. My job is to float to any med- surg or rehab unit that needs me, between 2 hospitals. I would say the average is 6 patients on day shift, with a low of 3 on telemetry ( on a good day) to a high of 11 on a 30 day rehad unit. The tough part is when you have 7 patients on day shift on a fresh surgical floor- complete with TPN, PCAs, chest tubes, etc, and the manager says # 8 is on the way. If there were more CNAs, or maybe make the ones who just sit around actually do their work (some); maybe that would relieve some stress. But when i can't do assessments or give meds because I'm constantly being paged for drinks or bathroom lights- that really makes me mad. Our hospitals just got Magnet status- and then our DON left within 2 months, we started a new computer system which drove us mad for several months and lost nurses on the way, and I would quit if I could. It just keeps getting worse. I would say that staffing is unique to each unit; but patients are coming to the floor when the should be in the unit, and we are having to rush people out the door for insurance, and the ER is holding people because there are no beds, we are poorly staffed on most units, the managers are yelling "save money, move them out quicker, work more efficiently! Just do it". Yet our motto is "Excellent Care.... Every time." Every time? I can't remember the last shift I was able to have a meal. No breaks either. If we barely get a chance to see our patients, how are they getting excellent care? The hospital jsut announced it is cutting 60 FTE. Not nurses, but if you cut out custodians- who's gonna clean the rooms? oh, let the nurse do that. etc. Thanks for letting me vent a little. :nurse:

At the med/surg unit I worked on each RN had 5-7 pts. LVNs had their own pts. Each PCT had about 10 pts. It was extremely chaotic. We had people working 3-11 and 7-7. it seemed like shifts were changing constantly. You were either picking up pts from someone leaving, getting a post op or sending someone home... unfortunately, I let it push me over the edge one day and I quit... Having trouble getting a job now. Oh well. Just glad I'm not there anymore. I wasn't doing anyone any good by being stressed out.:o

The reason why we deal w/unsafe staffing is b/c we put up w/it. If we as a group refused to take the flr before we punched in, this crap would stop in a very short amount of time. Then all the "paper nurses" in the bldg would have to pick up an assignment and we all know how long administration would put up w/all the paper jobs not being done--that would interfere w/reinbursement! The problem w/nurses (myself included) is we do a good job of complaining, but admit it, do we ever do anything drastic?

We have jsut had a mass exodus on our floor in the past couple of months because of the short staffing that goes on. And all the LPNs who have moved on have not been replaced - there are many RN's who have moved to other facililties, LTC, etc. It's an everyday occurance for me to have 12 paients with 1 LPN or just me and an aide. I work with surgery and dialysis pt's so most are on bedrest with NG's, epidurals, foleys, CBI's, the list goes on and on. It is an absolute picnic to have just 8 patients - I can't hardly imagine it, and doesn't happen very often. My contract is up in June and I'm thinking of going elsewhere. It's a shame because I love everyone I work with, but the bigwigs are gonna wear us all out. They are going to end up losing all the great nurses they have right now, and get the ones only looking for a paycheck. z Such a shame, it's the patients who lose out in the end.

:sniff: :sniff: :crying2: :banghead: :banghead:

I work on a 45 bed med unit, our staffing ranges typically between high 20s to high 30s.

Day shift usually has 5-6 pts per nurse + aide team. TPCs (total pt care; where a nurse does everything for her pts, no aide assistance) usually run at 3 pts per nurse. So basically there are approximately 3 pts per staff member(if you count all RNs, LPNs, and aides together as "staff").

Night shift the numbers are a bit higher, with 6-8 pts per nurse + aide team and usually 4 pts per TPC. NIghts runs more at 4 pts per staff member. I work nights. I don't feel like we are understaffed at all. Usually four is about right (I'm an LPN, and we almost always take TPCs). Rarely I will have five pts for whom I am completely responsible, and that stretches me, especially when they need to be turned, have attends changed, etc, plus trying to get all the MAR checks done. But five is doable. Six would make me feel very unsafe.

I don't know how anyone can function with ratios like 7 pts or more per nurse. When you say that, are you responsible for EVERYTHING? Baths, bedchanges, vitalsigns, everything? Or does the floor have aides who help with those activities.?

I work on a 45 bed med unit, our staffing ranges typically between high 20s to high 30s.

Day shift usually has 5-6 pts per nurse + aide team. TPCs (total pt care; where a nurse does everything for her pts, no aide assistance) usually run at 3 pts per nurse. So basically there are approximately 3 pts per staff member(if you count all RNs, LPNs, and aides together as "staff").

Night shift the numbers are a bit higher, with 6-8 pts per nurse + aide team and usually 4 pts per TPC. NIghts runs more at 4 pts per staff member. I work nights. I don't feel like we are understaffed at all. Usually four is about right (I'm an LPN, and we almost always take TPCs). Rarely I will have five pts for whom I am completely responsible, and that stretches me, especially when they need to be turned, have attends changed, etc, plus trying to get all the MAR checks done. But five is doable. Six would make me feel very unsafe.

I don't know how anyone can function with ratios like 7 pts or more per nurse. When you say that, are you responsible for EVERYTHING? Baths, bedchanges, vitalsigns, everything? Or does the floor have aides who help with those activities.?

Yeah, sometimes I don't know how we do it either . Sometimes, I have an aide, but that still is 12 pt's to bath, turn, change, walk, vitals, etc. Sometimes I do get lucky and get an LPN and aide. In that case, the LPN does most of the med pass while I assess and do orders. We all try to help with lights, baths, and everything else and then the LPN and I split up the charting. It can be a stressful zoo. I would LOOOOVE to have only 5-7 pts. I'm not saying that you have it easy by any means, but it would be nice to feel like you really made a difference and/or taught somebody something that day instead of feeling like you're just the maintenance crew. :uhoh3:

McGyverRN

Specializes in ACHPN. Has 18 years experience.

I work on a 27 bed medical unit, with an average census of 21. We are allowed 4 rn's 1 lpn and 2 aids on 7-3 shift for 21 pts. Our LPN's have a full pt assignment, just like the RN's. Each RN is assigned one or two of the LPN's pts to "cover" (assessment, iv pushes, etc). 21 is an excellent census for our numbers. With 15 patients we are allowed 3 rns and 1 aid. So we average about 4-5 pts per nurse at the start of the shift. This is nice when there is a mix of fairly independant and complete care pts, but recently the majority have been total care, making a 4-5:1 ratio difficult. We don't staff for acuity, strictly numbers. (we tried the acuity staffing once, and we were allowed as much as 7 rns for one shift....management didn't like that, so it didn't last long)

i work in a 48 bed med-surg unit, night shift. 7-730. We generally have a max of only 5 patients. Regardless if 2 or 3 are total care or if all 5 are fresh post-ops. Gone are the days when the census dips in the 20's. There are usually 7 RNs, 1 LVN, and 3 CNA's on most nights. Or we can have a mix of 5 RNs, 3 LVNs, and 2 aids... We are allowed self-scheduling so the nights are varied.

The nights where there are alot of LVNs (licensed vocational nurse - i live in california), are tough. Our LVNs are responsible for their own patients, but of course we have to cover them too. I really hate it when their patients have alot of IV meds and piggybacks. But thank goodness our LVNs are seasoned nurses.. it's just the Registry nurses i'm venting about...

Nways, when i started about a year ago, we had a 6:1 patient ratio. I'm really happy about this 5:1 thing, although some nights I feel like I have 20 patients...

THEY NEVER SLEEP!!!!

hoppermom3

Specializes in OB, House Sup, ER, Med Surg. Has 5 years experience.

My hospital is 25 beds..usually have 4-6 pts per nurse, sometimes up to 8, and I have been told that 10 is acceptable at night. We have 1 or 2 aids for the whole hospital.

When I get over 6 pts, I start to feel spread way thin. I am an LPN, and have to go find an RN to do my IV pushes and hang blood for me. We have a wide variety of pts, from peds to elderly, post-op, acute, tele, and swing bed, as well as monitor beds.

Guest
This topic is now closed to further replies.
×

By using the site you agree to our Privacy, Cookies, and Terms of Service Policies.

OK