Well...first of all, I need to tell that I am doing the research about the Registered Nurse to Patient Ratio for each department in the hospitals in the US. And it's necessary to refer to the hospitals in the US since I think the hospital system there is standardized and can be used as a good source of reference.
I tried searching before but found many about the theory, the abstract, the blah blah blah but no exact number of the required ratio I'm looking for.
That's why I need to ask you guys a favor on this. Please share the Registered Nurse to Patient Ratio. You may tell your department and the ratio. Telling your hospital name too would be excellent but I understand if some of you find it uncomfortable. You can even PM me or leave me a message to PM you for your privacy.
I can guarantee I won't take the information I get to do anything else but for my project only. I'm from a country in South East Asia and just need the reliable data.
NICU in Ontario, Canada. We don't have the best staffing, although we just hired 30 people. Talking to nurses in other NICUs in the area they are shocked at our ratios.
Level IV sick kids, intubated/HFO/NO/drips etc. usually 1:2
sickest of the sick level IV kids 1:1 (rare)
intermediate CPAP/min resp support 1:3
level II feeder/grower/chronics 1:3 or 1:4 if we are short (often)
comparable NICUs in the area have a 1:2 strict ratio for CPAP kids...intubated or anything like that 1:1......we laugh at that dream
I think the NA to patient ratio is just as important as the RN to patient ratio, as well as what type of support staff is available.
I recently left a second job (med-surg/med-surge tele float pool) where the NAs routinely had 12 or more patients each while nurses had 5 or 6 med-surg or med-surg tele. There were no other support personnel at night (respiratory, transport, phlebotomy). I often felt that it was unsafe, not because I had too many patients, but because the NAs did (and I didn't really have time to be doing breathing treatments, occasional transport and blood draws because I was helping out with a lot of other tasks that could have been delegated to NAs if they weren't so busy). Day shift had respiratory and transport, but there were no phlebotomists in this hospital, the NAs were the main phlebotomists day and night. Charge nurses usually took 4 patients who were walkie-talkie.
My other job is in a stepdown/progressive care cardiac unit at a different hospital. Our NAs usually have 7 patients (and sometimes have only 6, sometimes 8) while nurses usually have 4 patients (rarely 3 and rarely 5). At night the charge nurse gets 3 walkie-talkies and on days, the charge nurse takes no patients. We often have an ANM that works 1500 to 2300, overlapping part of the day shift and part of nights. All night (and day), we have respiratory, ECG techs, transport and phlebotomists. (We also have an excellent support system of on-site PAs/NPs who can provide new orders within a very short time frame for all admissions and for any emergencies - minor or major. At the other hospital, new admissions can arrive with almost no orders for the floor, even for patients who have been in active pain, nausea and vomiting in the ER, they arrive with no orders for meds to treat pain or nausea and have to wait for the attending to return my page.) My patients are very well cared for by both the NAs and the nurses, really the entire medical team, at this hospital.
In the same hospital where I work the cardiac stepdown unit, I have also worked orthopedic med-surg/tele. On that unit, NAs have a similar, but slightly higher ratio, 6-7:1 and RNs have 5-6 patients (typically starting with 5 and sometimes an admission during the night). On this unit, the charge from 3-11p has 4 lower accuity patients with the possibility of night charge taking an admission after the ANM arrives at 11p). During day and night, there is an ANM from 7a-3p and from 11p to 7a who has no patients. During the day, there's also a treatments and admissions nurse who has no patients and does dressing changes, IV starts, and admissions as well as other "helping out" tasks. Same support staff that the progressive care unit has.
Nursing ratios mean nothing if you don't also specify other support staff. I believe that if my hospital was mandated to have 3:1 for stepdown/progressive care, then we would lose at least one NAs per shift, causing each NA to have 9-10 patients (versus 6-7), and maybe even as many as 14 patients per NA because RNs would be expected to do primary care and do all nursing and NA roles at 3:1. I could also see them cutting other support staff (hospital-wide ECG tech pool, respiratory therapists for nights, phlebotomy techs) if it was mandated 3:1 for stepdown and 4:1 or 5:1 for med-surg.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
Inpatient psych. No set ratios but lowest number of pts I've ever had is 7, normal would be 9. Highest would be 11. Charge nurse takes no load or a very small load. On Inpatient child psych I have had up to 14. That's not okay. This is all day shift.
Level 1 trauma center, Neurosurgery PCU: 1:3 with 3 patients as an absolute max. I have been dropped down once to 1:2 when every ICU bed (in the hospital) was full and they had to have a bed for a patient who should've been in ICU, but wasn't going to require any drips that we couldn't do in PCU.
I do know how lucky I am. The state is NOT California.
Specializes in Case manager, float pool, and more.
I work float pool but most floors the ratio is 4 to 5 pts per RN, we use LPNs so 1 LPN will work with 2 RNs and then we have 2-3 CNAs on the units. ICU, ER and L&D are different. ICU is 2 RNs to 1 pt and depending on acuity I have had 2 pts with a LPN in ICU. We have some really good ratios where I am.
Night shift on most floors will be 5-6 pts per RN and we drop to 1-2 CNAs on the floor.
I work at a 120 bed hospital in Weston Wi on a Stepdown unit (IMC). Our nurse to patient staff ratio just increased from 1:3 to 1:4 on days and from 1:4 to 1:5 nocs. This is a unit that is a stepdown from ICU but not a med/surgical unit. Although, med/surg also went up to 1:5 days and 1:7 nocs. Mind you this apparently based on acuity and can increase or decrease. I have yet to see a decrease for any nurse with high acuity. I am a charge nurse and have no say in the increased ratio on my unit, believe me I've voiced my opinion. It has been 2 weeks since the change, nurse's and cna's attitudes have changed dramatically.
I remember reading that some people argue against mandated ratios, like they have in CA. They say it will risk patient care, which is crazy since you have a certain amount of patients and you can't take more, but what are some of the nurses that work in places that have no staffing laws about mandated ratios?
Normally, nurses get 1:4 patients, both days and nights. 1:3 if you're managing drips.
However, on nights, we've been juggling 1:5 ratios quite often compared to day shift. New grads included. We also have a med-surg area. It's 1:6 in that spot.
One of us is chosen to be the charge nurse, and often, that person gets 4 patients, 3 if they are lucky (though rare). It's usually a nurse that's been around for awhile, but one of my residency classmates has been assigned as charge nurse over and over again.
As for NAs, they are very rarely fully staffed. 2-3 is the norm. 46-47 patients, give or take, so each NA can get 23 patients to tend to, I believe.
Oh, there is no transport at night. So, usually the assistants, or nurses act as transport. We do have respiratory and phelbotomists, too.
On my previous med/surg unit it was 8-9 patients per RN. Lately there has been days where the nurses get 10-11 patients. In the ICU, it can go up to 3:1. They usually try to give you 2 ICU patients and 1 patient who's been downgraded but doesn't have a bed, but the other night I had 3 ICU patients.
Most of us are not happy with taking 5 patients. It would not be so bad if it was every so often, but it has been constant over the past few months. Our hospital is centered in the downtown area, where the majority of the population is below poverty or homeless. A good portion of our patients are high acuity because they are not able to afford healthcare. We get ALOT of sepsis, MI, COPD/CHF exacerbation patients. A plethora of patients.
I'm not gonna sit here and say it is undoable. I've handled 5 patient loads for a few months now as a new grad. But do I feel safe doing it? No. Just the other day, I had to manage a blood transfusion while tending to four other patients. Luckily, everyone was stable, including the one receiving the blood.
But, what if he wasn't? That's the scary part. Many of the other nurses on the floor are relatively new, too. I honestly don't think we have anyone over 3 years (nursing experience) on nights.
As for pay, I am getting 23.50 per hour as a new grad. But I work for every cent.
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der_kerl
10 Posts
1:6 for subsidised wards and healthy manpower, 1:9 to 1:12 for manpower shortages. 1:2 for ICU, 1:4 for high dependency.