Staffing ratios

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Specializes in Med/Surg, Neuro, ICU, travel RN, Psych.

I'm just wondering for those of you that work in hospitals that use aids, do they frequently take away your aide when there are less patients on the floor? Do you work without a unit clerk frequently?

It's getting quite frusturating with my job. I work in a small community ICU. If we only have 4 patients in the unit we do not get an aide at all. If we have 5 patients, we get one from 7-11. If we go up to 6 patients we get one from 7-3. This is during a 12 hour shift. We never have a unit clerk either, so we are responsible for our own orders at all times.

It just makes no sense to us. Just because we have less patients on the unit, we as the nurse still have the same number of patients if we have 4 or have 10 on the unit. Yes we have slower days, but we have days where we have very sick patients, and we have no help. We have to answer phones, call lights, bed pans, baths, everything our self. As well as all the orders. Thats a lot when you have vent patients, and drips, and people who are not stable.

Sorry this turned into a little vent. Anyways, what do you guys work with?

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Specializes in multispecialty ICU, SICU including CV.

Agree with you. My ICU is 8 beds. We are supposed to staff one NA every shift, but we only have 3 FT NAs, so that means every shift, 2 of the 5 days aren't covered. In addition, the nursing supervisors think that our NAs belong to the float pool because our nursing ratio is higher (uh, yeah, it's because our patients are way sicker and we spend that much more time taking care of them -- so how does that mean we can get by without an NA?) We have had 3-4 days go at a time where either our NAs aren't scheduled or are floated off.

We have a M-F day and PM clerk. On weekends and evenings we share a clerk that carries a pager for a bunch of the units in the hospital. So, usually, the weekends are the worst with call lights, the phone, no turning help, no drawers stocked, etc.

This economic downturn sucks.

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Specializes in icu/er.

its not all the economic turn down..many ceo's and bean counters are using the excuse of poor economic to reduce or limit staff in order to fatten their bonuses at the end of fisical yrs. we have just as bad economic issues in my state and area but it hasnt kept folks from crowding my hospital..we have literally been busting at the seems for about 9 months straight, but no new hires, many units beg and borrow staff and have bare bone shifts. dont believe all the hype.

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And it's not like they pay the aides that much anyway.

I'd like to see administration send some of their staff home when they're slow. Like that'd ever happen. They might have to do some actual work instead of going to perpetual meetings.

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Specializes in ICU.

Where I work our 24-bed ICU never has a unit clerk, and their aides always, always, always get pulled first. They do have 2 core staff aides on 7a-7p, and one core staff aide on 7p-7a, but almost every shift they're needed on the med/surg floors. We have 2 floating charge nurses that help with entering orders when they can and getting new patients "settled."

I usually spend my "down time" in ICU and help turn and enter orders and run lab down/blood up and help with postmortem care. The nurses teach me things and appreciate the help, and I love being in the ICU. :)

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Specializes in Med/Surg, Neuro, ICU, travel RN, Psych.
Agree with you. My ICU is 8 beds. We are supposed to staff one NA every shift, but we only have 3 FT NAs, so that means every shift, 2 of the 5 days aren't covered. In addition, the nursing supervisors think that our NAs belong to the float pool because our nursing ratio is higher (uh, yeah, it's because our patients are way sicker and we spend that much more time taking care of them -- so how does that mean we can get by without an NA?) We have had 3-4 days go at a time where either our NAs aren't scheduled or are floated off.

We have a M-F day and PM clerk. On weekends and evenings we share a clerk that carries a pager for a bunch of the units in the hospital. So, usually, the weekends are the worst with call lights, the phone, no turning help, no drawers stocked, etc.

This economic downturn sucks.

You're lucky you atleast have someone to help occasionally with the orders. It really sucks, because we will have days where they need an admission to the unit, so they will make us call doctors to see if someone can transfer. Then we have to transfer, and take an admission.. with no one to help with all those orders. They staff us as if we are a M/S unit it seems. They'd rather do that, than give us an extra nurse to take the additional patients.

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Specializes in Med/Surg, Neuro, ICU, travel RN, Psych.
And it's not like they pay the aides that much anyway.

I'd like to see administration send some of their staff home when they're slow. Like that'd ever happen. They might have to do some actual work instead of going to perpetual meetings.

I hear ya there. They are cutting 11 nursing positions in our hospital. Yet we have TWO managers for each unit. Makes no sense to me. Remember this is a small community hospital, that was almost shut down. I've worked at big hospitals that only have 1 manager per unit.

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At my hospital, there are no aides in ICU or CCU period, the exception being when a safety attendant is needed. The ICU/CCU nurses are responsible for total nursing care of their patients. Whenever they float to other units it's a pleasant surprise for the aids because having nurses who are willing to help with turns, bathing, and everything else when they have the time is wonderful.

I am curious what your pt/nurse ratio ratio is though--I'm in CA so the patient/nurse ratio is pretty awesome and I'm not sure if that's why it seems to be so much of a non-issue at my work.

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I do not work in the ICU, but I've seen the US pulled from the floor when the census is down to 4. I work in CA, so with ICU considered a specialty, RNs have a ratio, although I can't recall at the moment. I also, have never seen an aide in the ICU where I work and I don't think I can recall seeing an aide at the other facilities I've worked in. In my experience, the RN has done total care for all patients, but again, we have a ratio.

At my facility, and the facilities I have been in, the Charge Nurse does not take any patients. The Charge Nurse is the support to the staff, so their responsibilities are resource, orders and bed control. I have seen the Charge Nurse work as the patient advocate, communicating with the department manager or director for the need for another staff member, or at least a US. ICU RNs are also responsible for assisting in a rapid response, so in that event, that thins their patient care staff as well. Your situation sounds unacceptable, especially if one of your staff is called to work on a code or rapid response.

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As an aide, here's my experience:

- 5 patients or less = 1 nurse, 1 aide, 1 secretary

- 6-7 patients= 2 nurses, either aide or secretary sent home on call or floated, nurses do primary care

- 8-12 patients= 2 nurses, 1 aide, 1 secretary.

All aides/secretaries are in the process of becoming UT's on our floor, though. So I would hope that won't increase the risk of cutting our staff (but I have a feeling it will).

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I work tele and we lose nurses before we lose aides for low staffing. Our units used to have aides but haven't had them for years, nursing there is total care. They are generally staffed well though with a ratio of 1: 1 or 2, sometimes 3 if they have stable patients that can't be transferred out due to floor census.

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I do not work in the ICU, but I've seen the US pulled from the floor when the census is down to 4. I work in CA, so with ICU considered a specialty, RNs have a ratio, although I can't recall at the moment.

I'm pretty sure the ratio is 1:2 here in CA--at least that's how it is in our ICU/CCU and I'm pretty sure the higher ups would make the nurses take more if they could. If the patient is stable enough to transfer and is just waiting for a bed to become available I wouldn't be surprised to see them go up to 3 on certain days though--we have days where the units have a mass emptying to tele and in those cases I'm sure they have enough of those patients for one nurse to have 3-4 or four of them just waiting for beds.

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