This poll is directed to the Med/Surg staff nurse.

[Cheyenne RN,BSHS]

Med/Surg patients are defined for this poll as surgical care patients, telemetry patients, dialysis patients, and the other typical acute care patients that are now placed on the floor.

I am trying to obtain information on the nurse to patient ratio problem as it applies to the shortage of nurses at the bedside.

I believe that the reason many hospitals end up on diversion and the reason that there is a "nursing shortage" is actually one and the same.

Nurses are having to take care of too many patients and the patient acuity levels have increased. The results are such that patients need more "hours" of bedside nursing care than ever.

Quanity care has replaced quality care. Patients that were once placed only in ICU are now put on the floor with their multiple IV lines, drips, tubes, and potential for complications.

Nurse's care.... they care enough to want only the very best for their patients. Thanks in advance for all who participate.

[grinnurse, RN]

I have just started at a new hospital and from what I have seen so far is that the nurses only start with 6 and so far, have only ever had 6 even with d/cs and admits. Up until 3 weeks ago, I was at a hospital where you almost always started with 7 and wouldn't be out of the realm of possibility that you ended up with 8-9 by the end of shift.

And being that this is a small rural hospital, the majority of these pts where in the geriatric population and required much more care than one nurse, who usually worked with out an aid, could handle. Hence alot of the basic care that should be performed on these patients wasn't able to be done and the major reason that I left that facility. Some days it was all I could do to keep my head above water.

I agree this is one of the many reasons why nurses are leaving the profession and the nursing shortage only stands to get worse and that it is all about quantity rather than quality care.

[canoehead, BSN, RN]

For poll purposes, is this with an aide? and days or nights?

[SharonH, RN]

When I first started out in 1991, I routinely had 15 patients; on a good night I "only" had 12. When I left that job and switched to med-surg I worked at a hospital where I only had 10 patients and there was an IV team which did all things IV. I thought I was working at the Hilton. Somehow those 10 patients ended up being just as much work. Over the years, I have seen the ratio whittled down to 4-6 patients on day shift and yet there was more and more work to do. By the time I left the floor in '03, I was at my wit's end because I couldn't spend the time I wanted to providing the care to my patients. Nurse-to-patient ratios is very important but as you pointed out, so is acuity and the overall patient care environment which contributes to the shortage.

[Spidey's mom, ADN, BSN, RN]

I'm in California so obviously we have state-mandated nurse/pt ratios.

I work mostly med/surg and we have 5:1 with an aide. We only have two nurses working at a time so can only take 10 patients. So, two nurses (this can be an LVN and RN combo btw) and one aide with at most 10 patients.

Today, 1 RN, 1 LVN, 1 CNA and 1 swing pt, 2 acute patients and one post-partum mom/babe.

steph

[RN4NICU, LPN, LVN]

Disclaimer: I am not now, nor have I ever been a Med/Surg staff nurse.

However, I have worked in nursing quite a while and I have to say that sometimes the reasoning behind high ratios has less to do with there truly not being enough nurses than with hospital money grubbing.

In an ICU I used to work, a usual assignment was 2 patients. Only in a DIRE emergency would anyone ever have 3. If someone did have 3 patients, the charge nurse was there helping out and everyone else pitched in to help as well. It didn't happen often, but it did happen. Since I left there, I ran into a former co-worker who told me that the nurses now routinely get 3 patients apiece - with no one to help out. OF COURSE they have a hard time finding and keeping staff! I would suspect that this sort of things happens on the M/S floors as well.

You can't always blame short staffing on a shortage of nurses. Once a facility finds out that a nurse *CAN* care for X number of patients without a "sentinel event" (at least for that shift), it is quite common to see that number of patients becoming a common nursing assignment thereafter.

Hospitals are notorious for shooting themselves in the foot while trying to save a buck. They will have plenty of nurses, but will staff the units inappropriately. Nurses get frustrated and quit. The hospital gets a bad reputation, and then they really CAN'T recruit an adequate number of nurses and those they do recruit, they can't keep because the staffing problems don't get addressed. Yet it isn't because of a true nursing shortage, but rather their own greed.

[Tweety, BSN, RN]

We're "supposed" to be 4 to 6 on day shift, but with the latest budge crunch where we have to be "110 productive" it's up to 7 to 8. Don't get me started. I floated to another floor today and have 4 and am having the time of my life, with time to surf the net and play. :)

[Cheyenne RN,BSHS]

for poll purposes, is this with an aide? and days or nights?

i should have clarified. thank you. i specifically work 7 am to 7 pm so i tend to be egocentric and look at day shift; however, i really do need input as to the shift that is worked.

my reasoning is that days is usually staffed better than nights, so that if there is a 1:6 ratio days then the night shift will often end up 1:8/9.

please do include the shift as i am collecting the data for a presentation.

also, the best that i have seen or heard in relation to an aide's presence is one or two aides that are assigned to the entire unit or hallway.

in my experience thus far, there is not an "assigned" nursing assistant to work one on one with the nurse. the aide is basically shared by every nurse so that there is no way to say "i have an aide and 10 patients."

the poll is limited in what one can ask in a single question, so please do include if there is an aide assigned specifically with a group of patients. there is a difference if the fte becomes 1.5 "bodies" assigned to "x" number of patients, and that is important information.

rn4nicu wrote: you can't always blame short staffing on a shortage of nurses. once a facility finds out that a nurse *can* care for x number of patients without a "sentinel event" (at least for that shift), it is quite common to see that number of patients becoming a common nursing assignment thereafter.hospitals are notorious for shooting themselves in the foot while trying to save a buck.

all i can say is amen to that! i do not believe that the single problem exists that there is actually a "shortage" of nurses per se, but a shortage of their "presence" at the bedside. nurse's have chosen other fields in which to practice, or have decided not to work as a nurse at all.

any input or clarification is welcome. thank you.

[Spidey's mom, ADN, BSN, RN]

The staffing I posted is the same whether it is night or day shift.

We work 3-3 btw.

steph

[loridoo]

On our medical floor census can change dramatically from when I leave at 0615 and when I come back at 2215. I could have 11 patients when I leave, and come back to 7. They routinely schedule 3 RNs and then either over-staff one of us or float us to another unit. If we are lucky we each have a tech to work with us, but sometimes there is only 1 tech.

Previously I worked on the surgical floor of another hospital in the same town and could have anywhere from 7-13 patients on the 2300 to 0700 shift.

I would love to be able to spend more time with my patients, but as it stands now we usually only have time to do a quick assessment, pass meds, chart and do 24 hour chart checks.

:penguin:

[KristiePDX]

Telemetry-step down unit

59 bed unit dedicated to cardiac nursing (some MOF)

high acuity, multiple drips, post heart surgery, MI, CHF, arrythmias, ect.

1:4 on days (2 CNA per 30 pt and telemetry tech)

1:5 on nights (1 CNA per 30 pt and a telemetry tech)

[overlyrn]

I work days on a med/surg floor where we typically have 6-7 pts per nurse, and the CNA's typically have 8-10. It can be very stressful at times but not as bad as it was before our staffing ratios were raised. Use to be that we always had 8 pts, I was very close to leaving the job because I never felt I gave adequate pt care. The best days are when I only have 4-5 pts, very rare but I treasure those days...