I work on a 36-bed medical-surgical/oncology floor that dabbles in a little bit of everything (telemetry and such). We do team nursing. On a typical day we will have 3 RNs, 3 LPNs, and 3 CNAs, 12 patients for each team of RN-LPN-CNA. RNs are the "team leader" and do shift assessments, troubleshooting, admissions, etc. LPNs pass medications and do discharges. CNAs do vital signs and patient care (baths, feeding, etc). Obviously we are not static in our roles and help each other out when and where possible. We do not have a charge nurse; each RN "charges" their own set of patients. We are the busiest floor in the hospital, and that is not me being biased; every person, regardless of title, who gets floated to our floor to help out always ends up saying that breathlessly at some point during the day.
Yesterday, our house supervisor/staffing coordinator floated all three of our aides to a different floor. So we had 3 RNs and 4 LPNs left to do what we normally do, plus total patient care on our patients. I did not get to eat lunch until 4 pm (I work 7a-7p) and that was literally the first time I got to sit down all day. All of us on the floor were exhausted, frustrated, and pretty much at our wits' end by the end of the day; we knew we were not providing good care and attention to our patients because we just couldn't. We complained to the evening house supervisor who told us, "Its like this at every hospital." I KNOW that's a lie. But just for the sake of my sanity (and the sake of comparison), I'd like to ask:
What is staffing like at your hospital? What is the typical nurse to patient ratio? Do you do team nursing or primary nursing?
OMG I'm sooooo spoiled. I'm precepting on a stepdown/tele unit- 4:1 RN and 8-10:1 CNA. Night RNs always start with 3, sometimes they end up with 4. I thought my assignment was bad yesterday with 4 turners, constantly asking for bedpans, changes in condition, calling Drs nonstop and a code to top it off. Kudos to those of you who manage with far more patients- no idea how you do that!
Wondering if Flames works on my unit! To the OP, a total of 9 people to care for 12 patients sounds like paradise to me. We seem to be the catch-all unit: cva, mi, response fail, overdoses, you name it we get it. On nights we take 5 to 6 each (RNs, we don't have LPNs) with one tech to 12-15 pts if we are lucky. Most of our pts are total care. It makes for crazy shifts most of the times shoveling dinner in my face in front I'd the computer trying to chart at 3am. I'd love your unit!
was your unit full? Where were the CNA's floated? As a house supervisor i also have to make the decisions as to where to float my staff. Often times because of 1:1 sitter demands i end up having to pull all the CNA's from the floors. It's not an easy decision to make, but i also can't leave a patient that has an order for a 1:1 uncovered. And yes, thete have been times in my small community hospital that i've had 6-7 1:1 assignments... and that's WITH cohabitating as many as I could.
We usually have an independant charge nurse, 6 RN who get 4 pts each and 2 PCA's who each get 12 pts. On nights the only thing that changes is no independant charge. I work on a Neuro floor and we rarely have any open beds, sometimes we will get some med patients but usually its all Neurology or Neurosurgery patients.
Specializes in Cardiac Telemetry, Emergency, SAFE.
At my hospital, the charge RN gets to ultimately decide whether or not to send our aides to float after the Nursing supervisor requests it. Theyve never taken our aides to leave us with none, and if they had tried, it wouldnt have happened, regardless of 1:1 orders. I cant tell you how many nights we've done our own sitting with minimal staffing on the floor. We end up charting in the room or something. Our ratio is usually 5:1 - RN and 1 CNA with 18-20 pts.
I work on a 28-bed Med/Surg unit. We typically have 5 patient per nurse, whether RN or LPN. The charge nurse never takes patients. We have a CNA that works at the desk and handles the orders, but doesn't leave the desk. We usually have 1-2 CNAs on the floor, but they're always so busy with baths and vital signs, the nurses are pretty much pushing meds and taking patients to the bathroom all day.. I always feel like we're under-staffed.
Any time I have to work a shift short, I always write a notice to management that the staffing was not what it should be to ensure patient safety and that I am taking my assignment on protest and that they need to ensure that staffing is safer in the future. I send this email before I even start working (I always come in 15-20 minutes early and look at staffing first before I clock in, so this is done before I start work) I work my shoes off to protect my patients and give them the best possible care, even when the unit is severely short staffed. It doesn't help with the staffing that day, but it may help down the road. I also make sure that if any incidents do happen (like falls) that I make sure to point out if the staffing is short.
jelly221,RN, MSN
311 Posts
OMG I'm sooooo spoiled. I'm precepting on a stepdown/tele unit- 4:1 RN and 8-10:1 CNA. Night RNs always start with 3, sometimes they end up with 4. I thought my assignment was bad yesterday with 4 turners, constantly asking for bedpans, changes in condition, calling Drs nonstop and a code to top it off. Kudos to those of you who manage with far more patients- no idea how you do that!