Safe Pt Ratios for Med Surg

ttiebooRN · Feb 7, 2006

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.

irishnurse67 · Feb 26, 2006

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?

thumperRN · Feb 26, 2006

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:

ljds · Feb 27, 2006

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.?

thumperRN · Feb 27, 2006

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 · Mar 2, 2006

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)

warcode · Mar 16, 2006

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 · Mar 16, 2006

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.

ljds · Mar 16, 2006

I'm IV certified, so that is very helpful, though I can't do anything with central lines or ports. We don't do care plan updates on noc shift anymore, further lessening the work the covering RN must do for me.

Maybe you can get your IV certification? Maybe the hospital would pay for it, or offer it as a continuing ed class? I think it would be helpful in a couple of situations--if you are going to be an LPN for any amount of time--it just makes the burden of the covering RN that much less. Also, if you do choose to go back to school, there is that much that you already know and have experience with.

Anyway, I think that IV certification is technically required for LPNs at our hospital, though I know of one that doesn't have it. But she's not long out of LPN school. I found it more beneficial to do several months after graduation--I was becoming more comfortable in my LPN role, not so much the deer in the headlight look about me anymore. I'd recommend NOT doing it right out of school, and if you are in an RN program or will be within the next couple of months, it would be a waste as well. But if you have the opportunity otherwise, I'd really recommend it for most LPNs.

hoppermom3 · Mar 17, 2006

LPN certification was integrated into our nursing program at school. We still can't do pushes or hang blood though. But I am only 8 weeks away from graduating from RN school (counting down now!!!), so I won't have to worry about it anymore.

JeanettePNP, MSN, RN, NP · Mar 17, 2006

This is something I don't understand. For schools and daycare, there are laws about the adult/child ratio - something like 1 adult per 6 children. Why aren't there similar laws for nursing? Is it because daycare workers come cheaper than nurses?

johnson0424 · Mar 18, 2006

what about having 6 patients and no LPN? this hospital i was looking into does primary nursing. THe nurse does EVERYTHING>>>>meds,iv's etc. that makes it hard don't ya think? never mind whatever admissions come in? I heard someone mention self staffing. is this effective?