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Staffing Sucks

Nurses   (4,300 Views 19 Comments)

JustEnuff2BDangerous has 2 years experience as a BSN, RN and specializes in Med-Surg/Oncology.

1 Article; 4,234 Visitors; 137 Posts

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Its been a very trying two weeks at work.

For some backstory:

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?

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demylenated has 18 years experience and specializes in Addiction, Psych, Geri, Hospice, MedSurg.

7,253 Visitors; 261 Posts

Holy CRAP!! That sounds pretty dern ideal to me!!! We usually have a pt to staff ration of 7-10 PER NURSE, and the CNA's have up to 12 patients PER CNA! When I worked at the hosp, though, I was responsible for my 7-10 pts and the RN was responsible for hers. The only role difference was she made the schedule for the day... and if I needed her to push a med. If we needed blood, we both had to be present. We'd split an admit.

When I worked in a LTC facility, I had 30 patients. I was the charge nurse (only 1 RN for the entire home on 2nd shift). I did all meds/wound care/feedings/assessments/Dr. Calls

I think you have it pretty good... but that is just me.

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Orange Tree specializes in Medical Surgical Orthopedic.

13,469 Visitors; 728 Posts

We used to have 12 patients for each RN/LVN/CNA team...the catch being that each CNA belonged to at least a few teams. Now, they're pushing us to 14-16 patients for each team. I mean, they will actually send a nurse home when we each (nurses) have 6-7 patients and give us her patients knowing that we will each have 7-8. The "team" thing is a joke because we never have time to communicate with each other. Sooo, it might not be like that everywhere, but I don't think it's uncommon either. I would love to have six patients!

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dragonfly55 specializes in neonatal intensive care,paed,paed oncol.

3,602 Visitors; 68 Posts

I work in an intensive care setting- therefore it is primary nursing. I haven't done floor nursing (team) since I trained. I didn't like it then and based on what you have said, I certainly wouldn't like it now.

I like doing everything for my patients, being totally responsible for their entire care for my shift. I'm not saying it's a walk in the park, but it you might want to

consider switching to a different type of nursing- ICU, CCU, ER, NICU, day surgery, OR- just a suggestion.

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Boog'sCRRN246 has 9 years experience as a RN and specializes in IPR, Utilization Management.

12,930 Visitors; 778 Posts

I work on a 18-bed Rehab unit. We do somewhat primary nursing and our staffing varies greatly from shift to shift. We have anywhere from 2-4 RNs and 1-3 CNAs per shift. We don't have LPNs. The unit was paradise today - We had 4 RNs (4-5:1), 3 CNAs (6:1) and 2 sitters for the patients on behavior management plans.

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JustEnuff2BDangerous has 2 years experience as a BSN, RN and specializes in Med-Surg/Oncology.

1 Article; 4,234 Visitors; 137 Posts

The unit was paradise today - We had 4 RNs (4-5:1)' date=' 3 CNAs (6:1) and 2 sitters for the patients on behavior management plans.[/quote']

"Behavior management plans"... I love that euphemism! :D I love it when days feel like walks in the park... Yesterday was horrendous, but today we had 4 RNs, 4 LPNs, and 3 CNAs, so my LPN and I had 9 patients to care for, plus I had a CNA to help answer lights... My assessments on my 12 patients yesterday took me until noon to complete, and today I was done by 8:30. WOOHOO!

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Flames9_RN has 10 years experience as a BSN, RN, EMT-B.

23,788 Visitors; 1,854 Posts

tele unit (PCU) nights --normally 5 or 6 pts each. 2 techs to help with 34 pts. Quite often only had 1 tech. For some strange reason, people hated getting floated to our floor. Some down right refused, or all of a sudden got sick!!!

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Boog'sCRRN246 has 9 years experience as a RN and specializes in IPR, Utilization Management.

12,930 Visitors; 778 Posts

"Behavior management plans"... I love that euphemism! :D I love it when days feel like walks in the park... Yesterday was horrendous, but today we had 4 RNs, 4 LPNs, and 3 CNAs, so my LPN and I had 9 patients to care for, plus I had a CNA to help answer lights... My assessments on my 12 patients yesterday took me until noon to complete, and today I was done by 8:30. WOOHOO!

Lol I guess you could call it a euphemism...for us, it's a plan put in place for patients who have no safety awareness, act impulsively, and become overstimulated easily - typically brain injury patients and those with strokes affecting certain areas of the brain. Let me tell you, when staffing doesn't send us sitters for these patients, 12 hours can seem like 1200 hours :uhoh3:

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evolvingrn is a BSN, RN and specializes in Hospice.

8,222 Visitors; 1,035 Posts

wow....i feel like i have it great now. night shift. usually 6 to 7 pts for an rn or lpn and each rn has a cna that 'teams' with them. usually not to bad.

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Love_2_Learn has 21 years experience and specializes in Level II & III NICU, Mother-Baby Unit.

5,892 Visitors; 223 Posts

I've not worked on a med-surg floor for almost 20 years but remember how hectic it was. I have nothing to offer to help you but simply want to say how much I admire all of you and will be sure to send extra prayers and good wishes your way. It takes my breath away to see how busy you all can be!!!!!

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Do-over specializes in CICU.

15,378 Visitors; 1,085 Posts

Nights on step-down - 4-5:1, all RNs. On a good night we'll have 3 aides for the unit (30+ beds).

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NewTexasRN specializes in Ortho and Tele med/surg.

10,060 Visitors; 331 Posts

Ortho/ Med/surg: 5-6 pts. RN's and LVN's have their own pt's. Most of the time. 1 CNA to 23 pts. I used to work at hospital where if you they didn't have a CNA each nurse would have 3 pts each.

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