Safe Staffing--Can you help me with my paper?

ShayRN · Nov 18, 2008

I think the thing about staffing models is that it doesn't take into account how sick the patients are at the time. I have taken care of 8 patients at a time without any difficulty. They had been admitted for a couple of days and their pain/symptoms were under control. On the flip side I have spent an entire 8 hour shift with one patient who was so wild I was giving him 1mg boluses of Ativan q15 min IV. He finally settled right before I left. While there are absolutely nurses who will take advantage, I think the safest way to staff a unit would be to ask the nurses how many they need for the mix they have at the time. I don't think it will ever happen, however.

HonestRN · Nov 18, 2008

I think any talk about safe ratios should go beyond simple nurse, patient numbers and address the acuity level and assigns patients based on acuity. As ShayRN stated, you can have a lot of easy, low maintenance patients but throw in one or two really acute patients and the dynamics change. Staffing should be based on acuity not simply numbers.

classicdame, MSN, EdD · Nov 18, 2008

Besides acuity, which is MOST important, consider skill mix. I charged in Pedi where all nurses were RN's because we gave most meds IV, needed RN's to assess and change plans of care, etc. One night I had an LVN who floated from post-partum and a new grad. I was the only one who could assess, give meds, do urinary caths, and of course I was responsible for my own patients and the paperwork. I waited for the supervisor to come in next morning so I could vent. We had 10 patients, but they were all MINE.

Vito Andolini · Nov 18, 2008

I think the above responses say it well. Staffing needs to be based on acuity, not on numbers. The complexity of the necessary care is what counts, more than how many patients there are, or how many nurses.

And, yes, it does matter whether the staff is all RN's or whether there are aides, LVN's, sitters, whether you have a secretary to answer the phone and help with orders or run for needed but missing supplies, and so on. One place I worked locked the doors at dark. Well, someone had to answer the doorbell (by remote, located at the nurses' desk) and push the button to buzz in those we wanted to buzz in. This meant that we were having to either hang out at the desk or run up and down the hall for about half of our evening shift. Utterly ridiculous, just maddening. And the secretary, naturally, either went to dinner or got off duty during the time the door was locked.

Another thing, when you don't have a clerk/secretary and the phone is ringing repeatedly, constantly, and you don't have portable phones. I'd be down the hall giving meds or doing dressings, helping someone to the toilet, or whatever and there would go the phone. I got so tired of it that I just usually ignored it. To try to answer it meant to interrupt my focus on meds and caused me to have to leave patients unsafely unattended. Forget it, just let it ring. Enough complaints from families to Administration got us a clerk for at least a few hours on that shift.

so, these are some of the things you need to think about for your paper. I hope this helps.

Let me just add - when I started out more than 30 years ago, the usually staffing on Days was 1 RN to 1 or 2 ICU patients. Adults. On Med-surg, I think an RN took no more than 5 patients. We did baths, beds, meds, charting, VS, feeding, toileting, I&O, hair care, mouth care, nail care, toesies care, and pillow plumping care, LOL, generally total care for them. Plus, we made Rounds with the doctors, helped them get their charts, etc. We had an aide who would help with getting some VS, doing some ambulation, answering some lights, but we primarily did it all beccause the aides were split among 30 patients and could be only 1 place at a time. We did have lab techs to draw blood, transporters to take them to Radiology or wherever, orderlies to help with heavy lifting (often not available and we had to do this, no lifts at that time except our own muscles). Plus, we had to do teaching of new diabetics, dressing changes for post-ops, and so on. We did always have a ward clerk and she took off orders, which we later checked and signed off. Pharmacy did not mix our piggybacks. There were no piggybacks, if I remember right. Everything was IM. We were busy but it was doable, somehow. Oh, we also did the discharge planning, such as it was way back when.