Hospital Nurses ? - What is your patient/nurse ratio?

[princesspumpkin]

After reading an article on nosocomial infections, I thought about the nurse/patient ratio at hospitals. I usually am assigned 4-5 moms and their babies on any given night. When I started twenty years ago, the average was to have 7-8 moms and their babies per nurse. We practice mom/baby care at my hospital, so I am responsible for both of them (vs, feedings, meds, etc.) I work at a major urban hospital in Pennsylvania. A friend working in California says that there are regulations there stating that the nurses can't be assigned more than three mom/baby patients. Just wondering what the guidelines are (if any) at different hospitals around the country - and world. Thanks.

 

[MickeyMouth]

I work on a medical/oncology floor in a hospital. We usually have 5 patients per nurse. However, there are a few times when I have to take 6 patients if we are short staffed. I personally feel that a 1 to 4 ratio is the ideal. I'm not sure what the ratio is on or L&D floor. I'll find out and post back later.

 

[Blondie]

Where I work for M/B it's 3-4 couplets. On L&D, 2 laboring patients max unless they are antepartum (PIH/PTL/PROM) long term patients, then it's up to 6.

 

[yeartolate]

We have nurse patient ratios in California written into law. Essentially 5:1 in general med/surg.

The decreased ratio is a double edged sword. In order to financially achieve these ratios, many hospitals reduced many ancillary services. In order to get all the extra nurses required to get the ratios "legal" (there has been a nursing shortage here for well over a decade) --they end up hiring and keeping many motivationaly and educationally impared nurses. Because it has turned into quantity over quality, we are battling nosocomial rates more than ever.

 

[shy little mouse]

I work on two IMC units and our ratio at night is 1:4-5. We have union negotiated staffing grids in our hospital based on the unit. Med Surg could have 1:4-6 with LPN covers (we have no LPNs in IMC). Our ICU has ratios of 1:2-3 depending on acutity level. My only friend in OB works at another hospital that is non-unionized. She works on a postpartum floor for high risk OB and usually has 1:5-6 mother baby couplets. For my floor, five patients is borderline. We run alot of drips and we usually only have one PCA at night for 20-30 patients, so we don't have the tech support. I would rather we had no tech and were limited to 4 patients. There are nights where I know I have someone who is septic and could go down the tubes quick, or when the ICU is full and they are using us as overflow (like the last night I worked). Keeping patients going until we can ship them out to ICU is a handful, and I would rather not have to juggle a group of five when I know one is having ekg changes and looking like he could code. Then there are other nights where five could be a breeze. Our acuity level varies, but our staffing does not, so that is where things are tricky.

Mandatory staffing ratios may or may not be the answer, but I don't even want to discuss our rates of VRE, MRSA, and c-diff right now. We are cracking down on the little things (like masking, gloving, gowning, and hand washing). I think that stuff makes more of a difference with nosocomial infections. I have read a lot about California's implementation of staffing laws and I think there are many bugs to work out. I think our hospital (and the ones in the area) are beginning to prepare for shortages and possible legislation by importing Phillipinos. Our first batch arrives in May. I am going to hold off on judgement until I see how that works out, though I would be interested in other people's experiences with foreign nurses.

 

[roseprincess]

I work on two IMC units and our ratio at night is 1:4-5. We have union negotiated staffing grids in our hospital based on the unit. Med Surg could have 1:4-6 with LPN covers (we have no LPNs in IMC). Our ICU has ratios of 1:2-3 depending on acutity level. My only friend in OB works at another hospital that is non-unionized. She works on a postpartum floor for high risk OB and usually has 1:5-6 mother baby couplets. For my floor, five patients is borderline. We run alot of drips and we usually only have one PCA at night for 20-30 patients, so we don't have the tech support. I would rather we had no tech and were limited to 4 patients. There are nights where I know I have someone who is septic and could go down the tubes quick, or when the ICU is full and they are using us as overflow (like the last night I worked). Keeping patients going until we can ship them out to ICU is a handful, and I would rather not have to juggle a group of five when I know one is having ekg changes and looking like he could code. Then there are other nights where five could be a breeze. Our acuity level varies, but our staffing does not, so that is where things are tricky.

Mandatory staffing ratios may or may not be the answer, but I don't even want to discuss our rates of VRE, MRSA, and c-diff right now. We are cracking down on the little things (like masking, gloving, gowning, and hand washing). I think that stuff makes more of a difference with nosocomial infections. I have read a lot about California's implementation of staffing laws and I think there are many bugs to work out. I think our hospital (and the ones in the area) are beginning to prepare for shortages and possible legislation by importing Phillipinos. Our first batch arrives in May. I am going to hold off on judgement until I see how that works out, though I would be interested in other people's experiences with foreign nurses.

Sorry, a little OT.
I worked in nursing homes-rehab facilities(PT,OT,speech rehab) in the early and mid '90s as a staff RN. As of Phillopino nurses at nursing homes, I remember one nursing home I worked at for 2 yrs in a very wealthy suburb, the nursing home shipped in the Phillopino nurses in 1994. Some of them ,they couldn't speak English. I also worked at another nursing home after I quit the previous one, and that was about 90 percent Philopino staff! I don't have a problem working with Philopinos staff if they speak somewhat fluent english and they are nice to me. I'm guessing the hospitals in our area had the same situation with the Philopino nurses, due to huge nursing shortage in Illinois, esp. the Chicago area.
I really don't know how things are now with staffing because I have been a SAHM since 1997 and no longer work in nursing, tho I keep my RN liscence active.

 

[MouseWorshipin]

Of course it depends on the department and the day. But I'll say about 5:1, med-surg.

Course, this doesn't count the addition of 5 more if SOMEONE is in the break room all day every day. Grrrrrr. Gee, that felt good!

 

[Disney Doll]

32 bed medical unit. "Ideal" staffing on the day shift is 7 nurses, 2 nurses aides. Reality is usually 6 nurses, 3 nurses aides, sometimes 5 nurses, 4 aides. The evening and night shifts have fewer nurses, since the administrators seem to think those shifts are not as busy.

Worked last on Tuesday and had 6 patients on the day shift. Too many to handle well.

Thge nursing shortage is a HUGE looming issue that I am surprised that the American public is not more concerned about. In about 10-15 years, just when all of us who are currently in our late 30's and early 40's may start needing some hospital care, there are going to be very few nurses to take care of us.

Scary....

 

[lsyorke]

Med surg, no less than 6... sometimes 7-8 depending on admissions.

 

[MScott1851]

It depends on where I work. When I am in the ER, I have 4-5, but usually pick up another room or a hallway stretcher. In the chest pain/stroke emergency center (which is separate and where I mostly work), we have 9 rooms, and after 11 at night, only two nurses, which I think is absurd! Especially since our ICU and tele floors have been basically full for two months, we're holding ICU patients in one or two of those rooms, tele holds in two or three more, and then the patients that aren't so sick are usually the most demanding (go figure.) When an acute MI or stroke or full arrest comes in...we're also responsible for those patients...and they will end up being held, too. I have literally lost weight over the past two months because I don't get to eat at night. We've been calling in agency nurses and putting patients in unused sections of the hospital for overflow, or in outpatient specials, or in the GI lab at night.

It's even worse on the medsurg/tele floors...Last week I spoke to one nurse who had 5 really sick (just downgraded from ICU) on a tele floor. They were running her ragged. Our ICU is pretty good with ratios, though..they have 2 at the most in the CVICU stepdown, sometimes only one if the patient is a open heart recovery or on a balloon pump. The other sections of ICU will usually carry three patients apiece.

 

[shy little mouse]

Some of them ,they couldn't speak English. I also worked at another nursing home after I quit the previous one, and that was about 90 percent Philopino staff! I don't have a problem working with Philopinos staff if they speak somewhat fluent english and they are nice to me.

Well, that is good to hear. Other RNs I have spoken to from other hospitals that have them have said there are huge cultural differences. Our administration is promising us that they are going to be fluent in English, so I am hoping communication is not an issue. Like I said, I am hoping they will be a good fit for our hospital. I do feel bad for the Philippinos who are going to be left without competent RNs and Docs when they all come here as RNs.

 

[shy little mouse]

and then the patients that aren't so sick are usually the most demanding (go figure.).

Isn't that the truth! I was so miffed by the end of my shift on Friday morning with one of my patients who was treating me as her personal waitress and drug dealer in between her escapes of the unit to go out smoking and to the vending machines. She got so po'ed because she wanted MORE drugs and had mommy call one of the renal docs at 0030. If you are well enough to go out smoking and to the vending machines, do you really need phenergan, benedryl, norco, ambien, and dilaudid!?!?! She got all five and was not even close to snowed. All while I had a new admit who was an acute cva and a septic man going down the tubes, was charge, and another nurse was shipping a patient off to ICU to be vented with a pH of 7.12. I think we need a thread for nurses to vent on, lol.

Lol, and I have inadvertently (not by trying, but being too busy to eat) lost 30 pounds in the last year and a half of this job, which is a good thing. Changing and positioning 300-500 pound people has probably also helped out with that.

 

[susan1]

We have nurse patient ratios in California written into law. Essentially 5:1 in general med/surg.

The decreased ratio is a double edged sword. In order to financially achieve these ratios, many hospitals reduced many ancillary services. In order to get all the extra nurses required to get the ratios "legal" (there has been a nursing shortage here for well over a decade) --they end up hiring and keeping many motivationaly and educationally impared nurses. Because it has turned into quantity over quality, we are battling nosocomial rates more than ever.

sounds just like the u.k. except on an acute medical ward there are usually 2 trained staff and a health care assistant for 28 patients! i agree with the whole quote entirely it could just be transplanted over the pond!

 

[Judy from Boise]

At our acute rehab hospital we have a team of a liscensed nurse (RN or LPN) with a CNA for 6 patients. On top of this we have a charge with no pts, and an admissions RN that does all of the admit work, and a PCC for each team that does education and DC planning. Beleive it or not I can't convince the staff that they have VERY good staffing!

 

[lsyorke]

At our acute rehab hospital we have a team of a liscensed nurse (RN or LPN) with a CNA for 6 patients. On top of this we have a charge with no pts, and an admissions RN that does all of the admit work, and a PCC for each team that does education and DC planning. Beleive it or not I can't convince the staff that they have VERY good staffing!

That's it, I'm moving to Idaho!!!

 

[Disney Doll]

At our acute rehab hospital we have a team of a liscensed nurse (RN or LPN) with a CNA for 6 patients. On top of this we have a charge with no pts, and an admissions RN that does all of the admit work, and a PCC for each team that does education and DC planning. Beleive it or not I can't convince the staff that they have VERY good staffing!

I'll say!!!! Holy cow!!!!!

That's beautiful staffing. We'd kill for staffing like that at our place!!!!!

 

[cdrn1]

We have a 29 bed Med/Surg/Ped floor and we staff at 1:5-7 with CNA's, usually one per nurse team, and a float nurse. The float helps with admits, hanging blood, starting IV's, dressings etc. That is the day shift. The night shift has 1:5-8 and only two CNA's on at night. We actually are allowed to have better staffing than that but can't find enough nurses to fill the spots.

 

[Puffy2]

Haven't worked in a number of years, but in Georgia we used to get 6 0r 7 for Med Surg with an assistant for day shift. I worked at another hospital that would give up to 10 per nurse. That was crazy and I quit.

The thing is, number one - patients who are in the hospital these days are REALLY SICK and need a lot more care than they did 20 years ago. For that reason, I don't think nurses should get anymore than 5 and they should also have an assitant to help with baths/feeding, etc....

Number two, I worked for one hospital where I was friends with the weekend relief house supervisor. She told me that she was instucted to do the numbers on how many patients to nurses the floors should get AND THEN SHORT THEM BY TWO on purpose!

For regular people who are reading this thread just for info, I suggest if you have a loved one in the hospital who is unable to care for themselves, DON'T leave them there by themselves - either stay with them or hire a private nurse.

For those nurses wondering where to work - avoid the floors and go into a specialty area - you might have more challenging work but you'll have fewer patients and more resources and back up when you need it.

 

[MinnieNurse]

I work in Texas and we have 4:1 mother baby care, 4:1 pediatric patients, and 6:1 medical surgical on days and at nights they take 8:1 medical surgical. The pediatric ratio is the only one I think is appropriate.

 

[Dizkneenurse]

Our hospital is very understaffed ! When I worked on med-surg we had a verybusy unit of 33 patients and 3 nurses ( yep, 11 a piece..sometimes charge had only 9 and the others had 12)

Then I transfered to the uber busy ICU and it is not uncommon for us to have 3 (or 4 on occassion) I am talking vents, balloon pumps, swans..really busy. sad to say that care is basic..horrible feeling for us nurses who care.

Pretty much every Buffalo hospital is in this boat....nowhere to go! Yikes!

heidi