I've spent more shifts than I'd like to remember on a tele floor - and it was common to have a ratio of 1:6, and occasionally 7.
I work in the ED now and still continue to have those numbers there - it is extremely unsafe - IMHO. Then again, we don't have techs/CNAs in the ED, so 100% of the care is from the nurses. :frustrated:
you know what?? in malta in a normal medical ward the ratio is 15:1 during the night and 10:1 during the day. there are times where due to sick leave night ratios go up to 22:1 !!!!!!
Wow- the facilities where I did clinicals..ratios were 1:4 during hte day, and 1:6 at night. One of the facilities tried to enforce 1:6 and the nurses came VERY close to strike. And with that....they had LPN's to help but the RN was responsible for full assessments on their 6 patients.
For those of you with those ratios..do you have nursing assitants? LPN's? How does the staffing work?
our ratios vary a great deal in L&D and postpartum/gyn. The ideal active L&D would be 1:1 but it's often 1:2,3 or 4 if it's the 1:4 that's usually not labor it's "think they are in labor" so revolving door paperwork.
GYN postpartum we have 18 beds and depending on the day of the week it could be 18 patients with 1 RN and 1 LPN. Since we cross train if there are no labor patients it could be 3 RN's and 1 LPN.
If we are full in L&D and PP we could have 25 patients (counting one in OR or recovery which is 1:1) then for the other 24 we'd have 3-4 RN's and an LPN.
We've had days where we are turning away elective c-sections and elective inductions (which a big % of deliveries are) and the docs don't care if we're full or near full if it's their call day they'll want somebody else put in even if they wouldn't get the best care that day.
I work in a step down unit. Currantly, we are 4:1 day and noc. PCA/LVN is 6-8:1 We will go down to 3:1 in september, but will lose PCAs at that time. It's all a trade-off, anyway you look at it.
AprilRN wrote:Wow- the facilities where I did clinicals..ratios were 1:4 during hte day, and 1:6 at night. One of the facilities tried to enforce 1:6 and the nurses came VERY close to strike. And with that....they had LPN's to help but the RN was responsible for full assessments on their 6 patients.
For those of you with those ratios..do you have nursing assitants? LPN's? How does the staffing work?
Our floor actually does have Techs/CNA's. Usually on days we'll try to have about 4-5 techs (doesn't always happen that way) and on nights about the same number. Our techs are in charge of giving pt baths, blood draws (unless the pt has a central line), helping patients eat, turning them every 2 hours if necessary. So it's always a huge help when we have enough techs to do these tasks. It still takes plenty of time to input all the assessments and notes on 6 patients (7-8 on nights). I don't think our hospital hires LPN's, maybe just on our TCU.
It's so unfortunate being understaffed though b/c then you get away from actual patient care and become strictly task-oriented...and that's not nursing.:39:
Level 3 critical care beds 1:1 (ITU + the vent beds on burns)
level 2 critical care beds /NIV beds / coronary care 1:2 or 1:3
Assessment units 1:7 generally although on 2 of the sites some ofthe assignments are 1:8 due to the layout of beds
general beds depends on the layout of the unit but often 3:22- 28 depending on unit layout days and 2:22- 28 nights (+ HCAs) some units are better staffed based on acuity
A+E is the incredible elastic department
kudos the Clinical site managers, some ofthe chest pain assessment nurses and the critical care outreach nurses for supporting under pressure areas and we've even had our (lay)service manager making beds ....
general beds depends on the layout of the unit but often 3:22- 28 depending on unit layout days and 2:22- 28 nights (+ HCAs) some units are better staffed based on acuity
QUOTE]
I used to do that 15 patients at night thing it's crazy.
I am currently working on a tele unit, ratio 1:5. In the past I have worked on units tele and ms 1:10, 1:6 and 1:8. These have been with and without assistants. The unit I currently work on has a pretty good ratio and the patient get a little more TLC. I did an assignment on a stepdown unit once and the ratio was 1:5, that was a dangerous situation! Too many critical patients per nurse, it wasn't the least bit of fun!!:hung:
Hello, I work as a med-surg nurse in california and our ratio is 1:5 day or evening. We have no charge nurse so we do all the admits, discharges, and calls to the doctors. The lvn's usually have their own patient load 1:5. They can do just about everything except iv meds and hang iv solutions with potassium.The rns pass all meds on their patients and will usually cover 1 or 2 of the lvns patients. Our med surg floor is small. It can hold up to 26 patients. What are the ratios like in other states?
foxyb621 wrote:Hello, I work as a med-surg nurse in california and our ratio is 1:5 day or evening. We have no charge nurse so we do all the admits, discharges, and calls to the doctors. The lvn's usually have their own patient load 1:5. They can do just about everything except iv meds and hang iv solutions with potassium.The rns pass all meds on their patients and will usually cover 1 or 2 of the lvns patients. Our med surg floor is small. It can hold up to 26 patients. What are the ratios like in other states?
we don't have any required ratios in KY or IN. There are staffing grids and acuity systems but that doesn't mean they are followed...our postpartum/gyn floor might have 1 or 20 patients and that's covered by 1RN and 1 LPN no matter how many patients (sometimes 2&1 during the day) our charge nurse is only there to give report the admits and d/c's a whoever gets them...we play by the team (or gang up) approach everyone just pretty much works together which works most of the time... L&D is another story see above :)
So far, it averages 7:1 & 8:1 in the ED, acuity doesn't matter. Just last week I had what turned out to be 5 ICU holds (in addition to 3 other patients) by the end of my shift (12p-12A). I did get a little help from floats now and then; but, the techs are useless, and except for a couple of them, they might as well stay home. I was told it is because nurses aren't union and the techs are. It was no use complaining that the max in our ICU is 2:1 because of patient safety issues-I was told that the ED is different. This is a relatively new job (hospital) and I think it is time to start looking elsewhere. Funny thing, the NM doesn't seem to recall telling me that the max would be 5:1 during my interview, (after I told her I was looking for a new position because the patient ratios were going to soon be increasing to 7:1):lies: . Nobody wants to hear about the ENAs (Emergency Nursing Association) recommendation that the ratios be no greater the 4:1:frustrated: . Does anybody have that ratio in their ED and are they looking for additional nurses?
I see you're from NYC. I couldn't start to imagine to working an ER there or in LA, Chicago etc...you see all of the things on the news about the big ER's and people that show up to use the ER for everything (like they do ours but not on the same scale) and waiting all day for minor things and holding patients for ever waiting for beds I think that would drive me nuts. I think we might have 1 gunshot a month (that I hear about)...maybe I've watched to much Trauma live in the ER on TV.
Hey y'all, I'm new, help!! We're having a press conference tomorrow morning in front of a hospital in the Dallas,Tx area that terminated 3 ICU nurses for refusing unsafe patient assignment. No union in Texas, that's taboo you know, but I can't see how we can avoid it at this point. We have been sent to classes so that we will give the "right" answer to JAHCO during their visit, in other words, we're lying!!
Our ER, it is 4:1.
ICU, 2:1
Medical, 5:1
Surgery, 4:1
I don't know how it works out on OB, etc..
TJRN wrote:So far, it averages 7:1 & 8:1 in the ED, acuity doesn't matter. Just last week I had what turned out to be 5 ICU holds (in addition to 3 other patients) by the end of my shift (12p-12A). I did get a little help from floats now and then; but, the techs are useless, and except for a couple of them, they might as well stay home. I was told it is because nurses aren't union and the techs are. It was no use complaining that the max in our ICU is 2:1 because of patient safety issues-I was told that the ED is different. This is a relatively new job (hospital) and I think it is time to start looking elsewhere. Funny thing, the NM doesn't seem to recall telling me that the max would be 5:1 during my interview, (after I told her I was looking for a new position because the patient ratios were going to soon be increasing to 7:1):lies: . Nobody wants to hear about the ENAs (Emergency Nursing Association) recommendation that the ratios be no greater the 4:1:frustrated: . Does anybody have that ratio in their ED and are they looking for additional nurses?
I work at a community hospital in Missouri (40 west of Saint Louis ). I work on a 43 bed MS unit. Our ratio is usually 7:1 and sometimes 8:1. However, I have had as many as 13 patients total, in 12 hours taking into account discharges and admissions. We do have PCTs to assist with bathes, feeders V/S (thank God!). I refused to do relief charge the other day AND have an 8 patient assignment. I cannot give the kind of care patient's deserve AND be an effective CRN. Matter of fact, having 8 patients, discharges and admissions, barely allows for mediocare care in my opinion.
I have been at this hospital for 6 years, for some reason I thought maybe it would get better. In fact, it has only gotten worse! We are admonished if we "vent" ( we are not being "team players" ) and if we bring up our concerns at staff meetings, it is likely to prevent us from getting any kind of raise( that happened to a couple of my peers this year).
I am looking to head west the 1st of the year.....travel to CA or AZ. Prob go back to peds ( where I was for 13 years before moving here - staffing ratios were doable, my back didn't hurt, and I never dealt with "drug seekers" ). If I am going to retire as a bedside nurse , I want to make as much money as I can for putting up with what bedside nursing has become......a business.
Hi, I work in the OR now, but on the med/surg/tele. floor I worked on prev., an Rn on days would have 4 pts. usually, occ. 5 if they were a little more self sufficient, the RPN's would have 4-5. The RPN's are great, they do alot, the only thing the RN has to worry about with the RPN's load is IV meds, or if something changes and you need dr. orders. On eves, the RN would have 6 and on nights it jumps to 8 per RN. I found the load was usually satisfactory, but on days it could get quite hectic if your pt. had to go for CT or radiology as we had to transport our own pts. there. But that's another story....
TeleNurse4986 wrote:Just out of curiosity, would anyone like to offer the floor they work on and the maximum Patient : Nurse ratio (day and night shifts)?
I'm just curious to see what ratios others are working.
I work on a Tele floor our day ratio is 6:1 and nights is 7-8:1
Hi - I work in a acute psych facility- my unit routinely has 16-17 patients with 1 rn, 1 lvn and two floor staff.
The RN (me) performs and documents all the asessments, The LVN passes the meds and transcribes orders, the floor staff are with patients all day helping with the patients basic needs and keeping patient behavior from getting out of control. IMHO this is very unsafe but there are no legally established ratio for free standing psych facilities in California. Three weeks ago I was punched in the face by a patient - another staff member (A case mnager had her nose broken recently) Why do I stay? The hours and pay are great and it's not just a job - it's and adventure!
Today on my PP/GYN/Everything else floor it was me and LPN and 2 students (I was clinical instructor also as the instructor was sick) we had 11 patients 4 of them fresh post ops from previous day, 2 deliveries from today admitted, 1 OB/GYN's wife who he wanted on our floor for non GYN problem, 2 discharges, isolation post c/s, 2 more 2 day c/s and a bunch of babies just busy busy busy...
but they had a nurses day thing and I won a gift basket with a beach towel, margarita mix, $20 gift card to cheesburger in paradise, 2 bottles of suntan lotion, sombrero, swizzle sticks, bottled water, empty tequilla bottle (I wonder if it was full when the basket was turned in and somebody dumped it there was maybe a tsp in it), disposable camera and flip flops...I think that's all but I couldn't have won a better basket ICU made that one.
I left a job about ten years ago because of inability to maintain a safe nurse/patient ratio. It was a med-surg unit in a small community hospital. I worked nights and often had upwards of ten patients and there were always fresh post ops. We didn't have clerical staff so we did all of our orders, admissions, answered the phones and so on. Furthermore, we did the phlebotomy and bedside respiratory therapy as well. We had one severely overworked LNA for twenty-five or thirty patients who could barely keep up with blood sugars, forget about vitals. It was ridiculous.
After about six months of a steady diet of that, I gave my notice. The last night I worked, I had four admissions on top of the seven patients I started with, had one go bad that I had to send to the unit, and just ran like an idiot for twelve hours. I stayed more than two hours over my shift so that I could do the admission charts, all of the routine orders and all of my documentation as if I could remember anything... Admin didn't believe that this was a problem, not only for the nurse but also the hospital. Guess why I left.
That experience let me to the following conclusions: Voice concerns over unsafe staffing conditions. If the problem persists, leave. If enough nurses gave their notice, it would eventually force the necessary changes in the institution. Nurses continuing to work under such circumstances put unknowing patients at risk, impose unreasonable liability not only on themselves but ALL licensed staff. Finally, I firmly believe that continuing to work this way perpetuates the problem. Healthcare institutions get away with understaffing because they can. I experienced chronic understaffing in only one place but wouldn't hesitate to leave any facility that practiced that way. We don't need unions to handle this problem, just enough backbone to stand up to it. Good, experienced nurses have no trouble getting positions so don't hesitate to leave a bad one.
Hi well i just got of my night duty as well and it was hell the first night i had 17 patients including two post ops mind you i work in a paediatric unit.I worked alone excpet for the enrolled nursing assistant.We had admission after admission which i had to handle as well not to mention all the medication to give the report to be done and then the clean up after the doctor finishes with the admissions.Basically the two other shifts were well handled because of the nurse patient ratio.I work in a general hospital in Trinidad and have been in paeds since i graduated 3yrs ago......I enjoy what i do but i guess it overwhealms me when its so much patients to one nurse and unlike you i cant leave cause there is the same problen in the other two hospitals of the country.It Sucks!
Wow! That's truly overwhealming. Thankfully there are more options here in the US. What can be done there to get some basic help? Are you restricted to only credentialed staff helping with patient care. A physician colleague that I have who came from the Phillipines tells about patient's family members providing care in the hospital. Good luck
