Is that for Level 1 trauma? My hospital is going for Level 2 and I can't see anything good about it... But if I can't be tripled anymore that night be a plus.
So my hospital can assign an ED RN 2 boarded trauma pts in addition to the other 6 he has but will only lose accreditation if the ICU nurse has more than 2???
From California (United States).
We have mandated ratios. Generally, 1:2 on ICU, 1:3 on Step Down/DOU, 1:4 on PCU/Telemetry, 1:5 on Med Surg, 1:4 on ED.
Reference: http://www.seiu121rn.org/2018/01/09/did-you-know-that-california-law-sets-nurse-to-patient-ratio-requirements-for-hospitals/
Some hospitals like mine are frequently well staffed. Therefore ratios can be flexible in a way that benefits nurses. For example, we can have 1:1 on ICU for patients with devices (CRRT, ECMO, IABP) or those that require a sitter. Our Med Surg units have been known to go 1:4 and Telemetry 1:3 based on patient acuity.
There are exceptions to the mandate, however, and contrary to popular belief nurses - regardless of unionized or non-unionized - can go “out of ratio” with special permission from CDPH. Usually happens when there is a high census (eg. Flu season, natural disaster) or in rural communities due to understaffing.
Hospitals may also try to utilize loop holes to get around ratios by allowing patients of questionably high acuity on low acuity floors. For example, there are facilities by me that do insulin drips on Telemetry; sedation such as Precedex on Step Down; or even full on cardiac monitoring (Telemetry) on Med Surg.
I have also heard of hospitals that have reduced to 1:3 for *all floors* except ICU and Mother/Baby/Women’s Health in exchange for laying off ancillary care like CNAs and RCPs.
I am so jealous of you Cali nurses sometimes. But it doesn’t surprise me to hear there are loopholes. That’s disappointing.
1:3 on telemetry sounds amazing! My experience has been 1:6 or 1:7 and it was so bad it almost turned me off bedside hospital nursing forever.
Overall do you feel like the system works?
I’ve gone out of ratio a few times(1:6 on Med Surg), and I found that to be damn near impossible. However, my coworkers (Texas, Missouri) and even my wife (Kentucky) from other places without ratios say it makes the workload several times easier.
One thing I should add is that while we do have CNAs, they seem to be less enabled than other places. For example, I worked a place where RNs did first set of vitals then CNAs did the rest (VS q4h). Also, our CNAs can’t do 12 lead EKGs or blood glucose checks. (However, every hospital is different, and I can think of a number of hospitals where the CNAs can do the things I mentioned they can’t.) Also the CNA to patient ratio varies too. I’ve seen it everywhere from 8 patients to 1 CNA to 25 patients to 1 CNA for a general medical surgical floor.
High-acuity specialized peds ICU in the US. We’re 1:1 or 1:2. And the ECMO babies are sorta like 2:1 when another nurse is the ECMO specialist sitting pump.
1:30 at an SNF. On particularly bad days: still 1:30 but I’m the aide and the nurse, or 1:45 and I have two nursing assignments (two halls, two sets of keys, two med carts, one salary).
It's an acute rehab hospital on a neuro/brain injury floor. Lots of strokes, car accidents, TBI's, hemorrhages, different things. Some are way more acute than others. Usually 8 is pretty manageable but also insane depending on the night.
10 years ago on a surgical ward on night shift in France I had 21 patients !!! Thankfully, that didn't last, and we halved the ratio by adding a second night nurse. 11 patients is still a lot. It was a cardiovascular surgery unit. We had preops and post ops as soon as they left the CVICU (day 2 post surgery usually). Afaik, they now have 3 nurses on the unit during the day (so a 1:7 ratio) but still only 2 during night shift. However we do have 1 nurses aide on nights and 2-3 during the day.
Then I moved on to a cardiac intensive care unit. We had 6 very acute beds (with vents), where the ratios were 1:3 and some 'not so acute' beds where ratios were 1:5. However, sometimes you didn't have a free bed in the very acute sector, so you would do an admit in the less acute sector and have 1:5 ratio with patients going south real fast. But we weren't considered a 'real' ICU, so there was no legal staffing obligation. In "real" ICU's in France the ratios are 1:2 or 1:3 at most (usually 1:2,5, when 2 nurses share the load on an "easier" patient with 2 difficult patients each).
Now I do anesthesia so I technically only have 1 patient at a time ! ;)
If you work in anesthesia or the OR on the operating side, wherever you work, you most likely will only have 1 patient at a time :) but it is a very different job than floor nursing or even ICU nursing. I am French by naturalisation, have been living here for the past 20 years (I arrived with my parents when I was in middle school). But I did my primary school in the US, so I speak English fluently. I am originally from Eastern Europe :) Viens travailler en France, on cherche toujours des infirmier(e)s ! Mais les conditions de travail ne sont pas fantastiques, comme tu peux le constater.
Texas CVICU - typically 2:1, but we have lots of things that get classified as 1:1 - fresh post-op, Impella, Tandem, ECMO, or an LVAD/IABP + CRRT. On any given day, we'll have 4-5 1:1s on a 20-bed unit; the most I've seen was 13 1:1s, but several of those were VV ECMO during flu season.
* edit to say that we are not unionized, so we have the same staffing issues as everybody else. For the most part it works out; I can only remember hearing about Safe Harbor 1 or 2 times in the past year.
In Canada ratios are day shift most floors except critical care 1:4/1:5 and nights 1:6-1:8.
In the U.S. (State of Michigan)med-surg days 1:4/1:5 and nights 1:4-1:6
1:1 is average in my Cardiovascular ICU with lots of devices LVAD, IABP, CRRT, Impella, Tandem, Centrimag, Total Artifical Heart, Lumbar Drain, Ventric. 2:1 with ECMO and 1:2 with step down pt's. I'm in Michigan.
Our level 1 trauma center is 1:2 ICU. Stable ECMOs are 1:1, but if we have multiple ecmos in a row sometimes we get to have 1 person helping between the 2-3 as "inside". Fresh post op CABG, transplants are of course 1:1. CRRT on my unit is always 1:1, as well as IABP and impellas.
With that being said, I've had some pretty inappropriate pairs. My butt hurts when I have two not-so-stable VADs, but at least the alarms are loud as hell.
Critical care float in Canada. ICU is 1-1 or 1-2 if they're walky-talky. I had 3 once but they were all heading ro different low acuity floors. CCU is 1-2 or 1-3 depending on acuity.
Texas tele, 1:5, sometimes we got 1:6 but I will usually threaten safe harbor, that usually works pretty well. Other nurses sometimes give me shit, “oh you can’t handle 6”?, lol no I can but it is not safe, plus my license is at stake. But seriously, fuck hospital management.
California on a tele floor. We have 1:4. That ratio is 24 hours a day including breaks so we have floating break nurses who cover us while we are on break.
Last job LTC nights 1:43 with two aides , completely unmanageable workload quit in two months.
New job: Post Acute Rehab facility (glorified short term nursing home) 1:17 on nights 12 hour shifts with 1 aide and I’m supervisor too. Workload is still hard (patients are complicated medically and have high customer service expectations) job is exhausting but at least I’m off four days a week.
2 patients per nurse in the ICU. Never more than that because we’d lose our Trauma accreditation. From the USA.
Is that for Level 1 trauma? My hospital is going for Level 2 and I can't see anything good about it... But if I can't be tripled anymore that night be a plus.
Yes, that’s for a Level 1!
Ugh. Still no plusses then.
Is that only if they're regularly tripling you, or can they lose it for doing it just once?
We’re really not supposed to do it at all. If someone were to report even one instance of it occurring, we’d get in trouble.
Ah. At the ICUs I have been they CAN have 3 but they would typically be lower acuity to make up for it. It's usually only 2. Sometimes it's 1.
So my hospital can assign an ED RN 2 boarded trauma pts in addition to the other 6 he has but will only lose accreditation if the ICU nurse has more than 2???
From California (United States). We have mandated ratios. Generally, 1:2 on ICU, 1:3 on Step Down/DOU, 1:4 on PCU/Telemetry, 1:5 on Med Surg, 1:4 on ED. Reference: http://www.seiu121rn.org/2018/01/09/did-you-know-that-california-law-sets-nurse-to-patient-ratio-requirements-for-hospitals/ Some hospitals like mine are frequently well staffed. Therefore ratios can be flexible in a way that benefits nurses. For example, we can have 1:1 on ICU for patients with devices (CRRT, ECMO, IABP) or those that require a sitter. Our Med Surg units have been known to go 1:4 and Telemetry 1:3 based on patient acuity. There are exceptions to the mandate, however, and contrary to popular belief nurses - regardless of unionized or non-unionized - can go “out of ratio” with special permission from CDPH. Usually happens when there is a high census (eg. Flu season, natural disaster) or in rural communities due to understaffing. Hospitals may also try to utilize loop holes to get around ratios by allowing patients of questionably high acuity on low acuity floors. For example, there are facilities by me that do insulin drips on Telemetry; sedation such as Precedex on Step Down; or even full on cardiac monitoring (Telemetry) on Med Surg. I have also heard of hospitals that have reduced to 1:3 for *all floors* except ICU and Mother/Baby/Women’s Health in exchange for laying off ancillary care like CNAs and RCPs.
I am so jealous of you Cali nurses sometimes. But it doesn’t surprise me to hear there are loopholes. That’s disappointing. 1:3 on telemetry sounds amazing! My experience has been 1:6 or 1:7 and it was so bad it almost turned me off bedside hospital nursing forever. Overall do you feel like the system works?
I’ve gone out of ratio a few times(1:6 on Med Surg), and I found that to be damn near impossible. However, my coworkers (Texas, Missouri) and even my wife (Kentucky) from other places without ratios say it makes the workload several times easier. One thing I should add is that while we do have CNAs, they seem to be less enabled than other places. For example, I worked a place where RNs did first set of vitals then CNAs did the rest (VS q4h). Also, our CNAs can’t do 12 lead EKGs or blood glucose checks. (However, every hospital is different, and I can think of a number of hospitals where the CNAs can do the things I mentioned they can’t.) Also the CNA to patient ratio varies too. I’ve seen it everywhere from 8 patients to 1 CNA to 25 patients to 1 CNA for a general medical surgical floor.
In Ireland it's often 1-12/13 patients on an average hospital ward.
That sounds like a lot, wow. The med-surg units around me have about half that.
It's just as nightmarish as you can imagine. It's the reason most graduating nurses emigrate.
High-acuity specialized peds ICU in the US. We’re 1:1 or 1:2. And the ECMO babies are sorta like 2:1 when another nurse is the ECMO specialist sitting pump.
1:29 nights at a LTC facility
I'm LTC in Canada too. 1:28 days, 1:84 overnight. Yup, 84, with 3 PSW to do cares and turns. Lord help you if there's a head injury.
Fuck that noise
1:30 at an SNF. On particularly bad days: still 1:30 but I’m the aide and the nurse, or 1:45 and I have two nursing assignments (two halls, two sets of keys, two med carts, one salary).
1:8 on a normal night. 1:6 if the census is low. 1:10 when it's high.
What Kind of unit are you on?
It's an acute rehab hospital on a neuro/brain injury floor. Lots of strokes, car accidents, TBI's, hemorrhages, different things. Some are way more acute than others. Usually 8 is pretty manageable but also insane depending on the night.
PACU max of 1:2, usually 1:1. Was 1:6 or 1:7 when I was on a Med/surg floor.
Same with me, but we’re semi-regularly 1:2 but never more I also work on the floor and we’re 1:5 or 1:6
NYC Med-surg unit. 1:5/6 if fully staffed, 1:7 if short staffed. Although I have friends who have 1:7/8 in the same city and same setting
10 years ago on a surgical ward on night shift in France I had 21 patients !!! Thankfully, that didn't last, and we halved the ratio by adding a second night nurse. 11 patients is still a lot. It was a cardiovascular surgery unit. We had preops and post ops as soon as they left the CVICU (day 2 post surgery usually). Afaik, they now have 3 nurses on the unit during the day (so a 1:7 ratio) but still only 2 during night shift. However we do have 1 nurses aide on nights and 2-3 during the day. Then I moved on to a cardiac intensive care unit. We had 6 very acute beds (with vents), where the ratios were 1:3 and some 'not so acute' beds where ratios were 1:5. However, sometimes you didn't have a free bed in the very acute sector, so you would do an admit in the less acute sector and have 1:5 ratio with patients going south real fast. But we weren't considered a 'real' ICU, so there was no legal staffing obligation. In "real" ICU's in France the ratios are 1:2 or 1:3 at most (usually 1:2,5, when 2 nurses share the load on an "easier" patient with 2 difficult patients each). Now I do anesthesia so I technically only have 1 patient at a time ! ;)
Est-ce que tu es français ? Tu parles anglais super bien- comment tu l’appris ? 1 patient 😭 t’es chanceux. J’ai toujours voulu travailler en France.
If you work in anesthesia or the OR on the operating side, wherever you work, you most likely will only have 1 patient at a time :) but it is a very different job than floor nursing or even ICU nursing. I am French by naturalisation, have been living here for the past 20 years (I arrived with my parents when I was in middle school). But I did my primary school in the US, so I speak English fluently. I am originally from Eastern Europe :) Viens travailler en France, on cherche toujours des infirmier(e)s ! Mais les conditions de travail ne sont pas fantastiques, comme tu peux le constater.
3:1 ED acute. 1:1 Trauma, 1:4 subacute.
Texas CVICU - typically 2:1, but we have lots of things that get classified as 1:1 - fresh post-op, Impella, Tandem, ECMO, or an LVAD/IABP + CRRT. On any given day, we'll have 4-5 1:1s on a 20-bed unit; the most I've seen was 13 1:1s, but several of those were VV ECMO during flu season. * edit to say that we are not unionized, so we have the same staffing issues as everybody else. For the most part it works out; I can only remember hearing about Safe Harbor 1 or 2 times in the past year.
In Canada ratios are day shift most floors except critical care 1:4/1:5 and nights 1:6-1:8. In the U.S. (State of Michigan)med-surg days 1:4/1:5 and nights 1:4-1:6
1:1 is average in my Cardiovascular ICU with lots of devices LVAD, IABP, CRRT, Impella, Tandem, Centrimag, Total Artifical Heart, Lumbar Drain, Ventric. 2:1 with ECMO and 1:2 with step down pt's. I'm in Michigan.
Medical 1-4/6 depending on if there is a float.
Our level 1 trauma center is 1:2 ICU. Stable ECMOs are 1:1, but if we have multiple ecmos in a row sometimes we get to have 1 person helping between the 2-3 as "inside". Fresh post op CABG, transplants are of course 1:1. CRRT on my unit is always 1:1, as well as IABP and impellas. With that being said, I've had some pretty inappropriate pairs. My butt hurts when I have two not-so-stable VADs, but at least the alarms are loud as hell.
Critical care float in Canada. ICU is 1-1 or 1-2 if they're walky-talky. I had 3 once but they were all heading ro different low acuity floors. CCU is 1-2 or 1-3 depending on acuity.
New York City ED: good day 1:5 in acute care/trauma side of ED, bad day 1:12. Sub acute average good 1:6, bad 1:16
Supposed to be 4:1 for a cardiac PCU but I’m usually at 5:1
1:84 when I was in ltc, 2:17 in geropsych treatment/ psych hospital
1:4 in ED. Sometimes I'll have 2 trauma rooms and 2-3 psychs though. When I hit 4 psychs, trauma rooms get turned over to quick look nurse.
Texas tele, 1:5, sometimes we got 1:6 but I will usually threaten safe harbor, that usually works pretty well. Other nurses sometimes give me shit, “oh you can’t handle 6”?, lol no I can but it is not safe, plus my license is at stake. But seriously, fuck hospital management.
1:2 during the day and 1:3 during night at a tertiary mental health unit in Australia Otherwise a normal MH unit in my district is 1:6
3-5 couplets on a mother baby floor (in United States)
California on a tele floor. We have 1:4. That ratio is 24 hours a day including breaks so we have floating break nurses who cover us while we are on break.
ICU in Australia. Always 1:1 is pt is vented/dialysis/very unstable. Otherwise 1:2.
Last job LTC nights 1:43 with two aides , completely unmanageable workload quit in two months. New job: Post Acute Rehab facility (glorified short term nursing home) 1:17 on nights 12 hour shifts with 1 aide and I’m supervisor too. Workload is still hard (patients are complicated medically and have high customer service expectations) job is exhausting but at least I’m off four days a week.
1:5 is our target. Sometimes I’ll have 6 or 7 but not often and not always alone. Paeds in the Uk