Nurse to pt ratios

[nursetull]

Hello everyone..I am new to supervising the small med surg floor at my hospital and am looking for some help with staffing issues. My med surg unit is very small (16 bed) and currently census is staying around an average of 5 pts. I have staffed 2 RN's at night without an aide and am wondering if that is unreasonable. Please be honest I am looking for other's perspectives. I come from the ED in this hospital which is also small (10 beds) and is staffed at night with one RN and a tech.
Thank you for your help.

Lisa

[debg73]

I do not see any reason why 2 RN's could not handle 5 patients on their own. I think that is very reasonable. You said you were new to the unit if so did they have 2 RNs and an aide at night before? I can only assume that the nurses are complaining because you came in and changed things. Unfortunately there are many nurses out there that think that they are above the menial patient tasks.

[fuzzie]

8 patients at night...are you kidding! That's not safe!

[NURSEDETROIT]

Sounds unsafe to me. You are staffing without the anticipation that "shit can hit the fan," and when it does; it flies far and wide. . . If I were one of those 2 R.N.'s on a 16 bed unit, no other assistance if someone should head "south" i.e., code or otherwise be circling the drain; I would certainly hope there would be someone else to call. Takes a minimum of 2 people to run a code for God sake! Then, what about bathroom or lunch breaks; you then leave the other nurse alone?!!! That is absurd and unreasonable not only for the nurses, but for the patients affected. You have to anticipate the worst, then hope for the best in all situations. You are placing everyone affected at risk. Yeah, it's easy to handle 5 stable patients when all goes well and smoothly (that's rare these days considering most patients that actually are admitted are all but half dead, then with multiple co-morbidities). Then, if 1 patient tanks, the others you have are left unattended. . . never mind the patient that gets confused at sundown, and are trying to get out of bed, pull out lines, etc. . . It's not all or just about #'s of patients; it's the acuity thereof. Therein lie the potential issues that could ensue and usually do.

The problem with the "staffing programs" that spit out the #'s of staff required; don't necessarily take into account all the extraneous details (explanations to patients, assessments, getting things that are missing from the unit such as meds, etc.) that make up the course followed on any given shift. It's the information, or lack thereof that's front loaded into these programs that provide inadequate information as to the #'s of nurses required. The informatics formats do not necessarily "paint" accurate pictures for those affected; merely #'s that don't actually reflect reality. Something to consider when it's your license on the line.

[Diane5]

Hello. Our unit is presently capped at 21 patients (3 districts). Census has been low throughout the hospital. However, 7 patients who are quite sick is more than enough for us. When we are not capped we have 8 or nine at times. It is a 28 bed unit. Staffing for breaks is difficult with one or two aids for the unit at night. How would you handle only 2 nurses????? As soon as one codes you are sunk...what are the odds that only 1 patient on the entire floor will have issues?? That would be a nice floor

[monster]

With the electronic health care record the balance between giving quality patient care and the documentation requirements placed on the nurses by management/regulators is not sustainable. The EHR is being used as a punitive tool for performance rather then a tool to help with communication in the best interest of the patient. Where nurses would have to document at the bedside in a chart, we're having to sign on to a system and document everything from pre/post pain, turns, lines, drains, tubes, iv sites, assessments, wounds, diet,care plans, education plans, vitals, i/o, .........there's no time for the patient. The current practices are not in line with the times. Nurse/patient ratios are out of range. The nurses have become overstressed data entry clerks, with our backs to the patient. We must come together as a united group of nurses throughout the nation to fight for safe staffing so we can give quality care to our patients. It's no joke. Our licenses are on the line. How can we allow this to go on. Are we nurses or slaves to the system. Lots of talk but no action. It's all about the bottom line. Money.

[NURSEDETROIT]

With the electronic health care record the balance between giving quality patient care and the documentation requirements placed on the nurses by management/regulators is not sustainable. The EHR is being used as a punitive tool for performance rather then a tool to help with communication in the best interest of the patient. Where nurses would have to document at the bedside in a chart, we're having to sign on to a system and document everything from pre/post pain, turns, lines, drains, tubes, iv sites, assessments, wounds, diet,care plans, education plans, vitals, i/o, .........there's no time for the patient. The current practices are not in line with the times. Nurse/patient ratios are out of range. The nurses have become overstressed data entry clerks, with our backs to the patient. We must come together as a united group of nurses throughout the nation to fight for safe staffing so we can give quality care to our patients. It's no joke. Our licenses are on the line. How can we allow this to go on. Are we nurses or slaves to the system. Lots of talk but no action. It's all about the bottom line. Money.

You are so correct in your assessment here. . .This is exactly the purpose of the "EMR." They are being used as a punitive tool to punish. . . They provide the raw data for managers to punish you the nurse, a electronic sword that can and will be used against you. The nurse does become so focused on data entry; then, who ends up having any kind of time for and spend with any of the patients? It's not just about doing a required task, but the art of the conversation and observation of the patient; not just gathering data. . . But, again, it is the information that is front-loaded into these programs that creates the unrealistic ratios we have to contend with. Also, it's THE LACK of any information front-loaded into all these programs to account for all the extra time spent with patients doing assessments and reassessments and other non-task related time. . . Hence, the unrealistic ratios. . . the only thing they look at are the #'s; not the circumstances or conditions. . .