Survey: Has your facility implemented nurse to patient ratios?

fedupnurse · Jan 20, 2004

8:43G-9.7 Critical care staff time and availability

(a) Nurse staffing shall be determined by the acuity of illness of the patients on the critical care unit.

(b) There shall always be at least one registered professional nurse for every three patients.

There shall be the capability to increase nurse staffing to one nurse for every two patients or one nurse per patient based on acuity levels.

These are the regs for my specific unit. this is how the nursing supervisors and administrators interpret the entire above statement:

(b) There shall always be at least one registered professional nurse for every three patients.

Myself and colleagues have repeatedly contacted the DOH giving specific examples of how the facility is NOT in compliance and yet they never seem to find anything wrong. Couldn't be because we have an exec on the advisory board of the DOH?????? The DOH also doesn't mandate how acuity is done. My facility does it once a day in the morning. We are staffed and budgeted based on average daily census rather than number of licensed beds. All the while our innumerable execs (both at the facility and health system level) are laughing all the way to the bank with their hefty salaries and benefit packages!

We continue to leave a paper trail to cover our butts. Sad thing is we are unionized and it still persists!

Thanks for the info Lee1!

InfoNeeded · Jan 21, 2004

Hi. For all you Oncology RNs out there. What is your RN to patient ratios at your facility? We are currently trying to put together a Cancer Care Center where I work and need to know what other facilities are doing.

I would appreciate any help you can give me.

Thanks!

LuvbabiesRN · Jan 22, 2004

On my unit... cv surg.. its 3/1 days.. 4/1 3-11 and 5/1 for nights...sounds good compared to alot of places... and sometimes thats crazy... assessments and vitals q 4 hrs.. all done by RN

sassynurse78 · Jan 22, 2004

Originally posted by lakelady45
I had the question of what the state regs. are for aides to patient ratio and no one either knows or hasn't answered me yet. I am a CNA at a Mo. veterans home and 99% of the time we are trying to care for 12 to13 residents who are all on the total care unit, plus trying to do 5to6 baths on our side of the hall. Can someone please find out what the ratio is suppose to be acording to state and let me know? Thank-You

According to our state board (IND) the nursing facility only has to staff with as much staff to provide the care required. I wish there was a ratio! You can prob call your state board and ask.

Burnt Out, ASN, RN · Jan 22, 2004

I work on a pulmonary unit. Most days I will have 4-5 patients. I have had up to 7 patients on 7a-7p. Our night shift has anywhere from 6-9 patients per RN or LPN.

We do have nursing assistants to help with VS, FSBS, etc. On a very good day, we will have 4 assistants for 38 patients (if we are full). But on most days, it is 3 assistants...sometimes 2 on the weekends...

lee1 · Jan 22, 2004

Does anyone know where this 1:3 ratio came from in ICUS???? In NJ I am thinking that someone changed the state laws approx. 10 years ago. This is the problem----I have been a critical care nurse for more than 30 years, have worked at over 8 different hospitals and only recently have seen this 1:3 ratio implemented in critical care units in NJ. My own hospital which is high acuity abides by the AACN guidelines which is 1:2 and is adjusted by acuity. Very RARELY does a nurse have 3 patients and that is only for emergencies and a very short length of time, or if you are holding 3 tele patients and are trying to move them out to tele beds.

The problem is at the state level and those laws need to be changed.

RN-PA, RN · Jan 22, 2004

HEY fedupnurse -- Good to "see' you again-- Been missing your posts here!

Our hospital was having serious financial problems 2002-2003-- bond rating issues, skyrocketing malpractice insurance in PA, etc.-- and were required to bring consultants in to find ways to save money. "Grids" for every unit were instituted by the "consultants'' and mandated, and that's when our med-surg floor went up to 1:6 ratios on every shift. Many times we have 1:7 and 11-7 can go up to 1:9 if there are holes in staffing (sick calls or whatever). We are supposed to have a PCT (aide) for at least 1:12 patients (there are 29 beds on our oncology-emphasis unit), but if census is down, they may have one PCT for maybe 18 patients since they can't justify PCT's having only 9 patients apiece, but then we get slammed with admissions and the PCT is caring for maybe 24 patients. They get burned out and eventually leave if this happens too often, naturally, and then we're short PCT's again. :stone

The only true nurse-to-patient ratio is for the LPN's since RN's must do the following for the LPN's patients in addition to their own assignment since they aren't in the LPN's scope of practice at our hospital: all admissions, call for and sign off doctor's orders, hang blood products, take any patients with PCA's or continuous Epidurals, initiate Heparin drips, hang TPN, and give IV push meds.

No acuity is taken into consideration in our ratios, either. I had two patients out of six last weekend that probably should have been on monitored units due to their multiple problems and acuity, but there wasn't a bed available on PCU, IVU or ICU.

kimmicoobug · Jan 22, 2004

I think our hospitals ratios are fairly decent for the most part (med-surg), 4-5:1 on days and eves, and 6-8 on nights. I work nights and if our loads are too busy or patients are crashing, our NAC will either re-route the new admits to another unit or turn them away. Honestly, our house sups are great in that respect.

I do think that on nights 8 is WAY too many. I actually like to provide care, not babysit my patients. I know that days and eves are busy, so I like to get IV's, consents, central line changes done before the day shift starts. The other night, we were understaffed d/t no one able to come in (and a hole in the schedule that our unit director laughs off) and the three of us had 8, 8, and 9. I felt that all I did that entire shift was charting and I thank God that all my patients were stable.

VIRGO NURSE · Jan 22, 2004

:eek:

I am a LPN and I work in LTC. I have 40-42 residents to take care with g-tubes, foleys, IV's and major wounds. There has been times I Have had 1 cna!!!!!!!!

So the two of us are turning and positioning, changing bed linens and answering call bells. This is outrageous!

I've lost more good cna's becuase of this.

There should be a ratio of nurses to patients. Not only for my liscense but for the care and well being of the ill.

unikuelady, RN · Jan 23, 2004

We just started using the new CA law requiring nurse/pt ratios. So far-for me it has worked to my advantage as a bedside RN. Just a few weeks ago...management would tell us to take more pts, unable to get staffing for the increased workload...etc. Guess what? Since JAN 1st when the law took effect...The nurses now have the strength and backing to refuse to take more patients than the ratio requires. It seems this is working for the bedside nurse. It has made the Charge nurses job much more difficult. Now that the "charge nurse" is out of ratio (having no direct pt load). She is required to relieve all of her RN's for breaks and lunches (being responsible for the patients). Do all the next shifts staffing, assigning pts to nurses, handling any/all problems that occur during the shift with pts, families, md's and other nurses. This would be ok if you worked on a small unit with only 3-4 nurses. But when the charge RN is responsible for 9-10 nurses.....you can do the math. relieve each one for two 15 min breaks and one 30min lunch during a 12 hours shift + everything else!:imbar It doesn't quite work. There has been talk about going to total pt care without any LVN's, CNA's or Ward Clerks due to the increased cost of having to hire more RNs-which IMO defeats the purpose of better pt care. (Can't be sitting at the desk answering phones, call lights without taking away from pt care:( ) Oh well.....We will see what happens. Not many people that I know take change with ease. Time will tell.

:kiss

Dayannight · Jan 25, 2004

The new CA law has made for better nurse/pt ratios. On our med and surg floors the ratio is now 5:1 days and 6:1 nights, and the charge nurses do take pt assignments. The down side to this is now it's required to have the same number of nurses on the floor at all times even during lunch breaks. Now they have someone (whoever they can get) come in for 4 hrs just to cover lunch breaks, but that person is just another "body". Most of the time it isn't even a nurse from the same floor. The nurses that are already there working do a better job covering for each other during breaks. Also, the number of CNA's we are allowed has been decreased. Our hospital is also supposed to take aquity into consideration, but when it comes down to it, numbers are the determining factor.

ROMIRN · Jan 26, 2004

Have had enough of trying to get a nurse to patient ratio in the hospital where I am. On the tele floor, sometimes we can have up to 9 patients. It is getting tiresome and I am getting burnt out. I will be starting home care again, just so that I have some say in the amount of patients I have!!!!