Let’s say you went to work tonight on telemetry and were given 8 patients. As we all know, the acuity on telemetry floors has gotten higher, but the staffing is the same or worse. Let us just say that tonight was a completely unmanageable 8:1 ratio.

What will you do? 

Ok so you took the assignment, knowing it was unsafe but that you had no choice if you wanted to keep your job. However, your hospital’s unwritten policy is that you may never, ever tell a patient you are understaffed. So you are constantly getting growled at by patients who want their soda, their bathroom trip, and their pain medications faster. They just think you are lazy. Or slow. Or worse.

What is the big secret? Oh right, patient; they want you to feel safe whether you are or not. Because honesty is not important. Your impression of your care gets you to mark ‘extremely satisfied’ on your survey. Then the hospital can get full reimbursement. Whether you were actually safe or not  AND YOUR NURSE IS FORBIDDEN TO TELL YOU THAT YOU ARE IN DANGER.safe staffing

If healthcare facilities wish to admit patients, they should hire and staff appropriately. They should pay agency staff if necessary, hire more nurses and offer premium pay. There should be no excuse for this awful, unsustainable staffing level.

If the optimal staffing on telemetry is 4:1, then it should never be worse than that. Our patients deserve the best care they can get. We have a responsibility to keep them safe.

When we are discussing long term care, the ratios only get worse, and more dangerous. There are never enough CNA’s to take care of our elders, and they suffer. Make no mistake, they are often neglected, and they are lonely. No one has any time to spend with them. They are also in danger of dying of the simplest things;  UTI+Altered mental status+ fall+ broken hip+ sepsis is a common trend. Just because nobody had time to properly assess them

Would you like to hear my opinion? Probably so since you came all the way to the website to read it.

I believe that all healthcare organizations should have to post that they are understaffed at the front lobby and ER doors. I believe that shift report at the bedside should include: “Mr Smith, our patient to nurse ratio should be 5:1 to keep you safe. Our staffing tonight is 7:1.”  Our patients deserve to know that they are less safe than they should be.

This should be a law, and impact any facility that takes Medicare or Medicaid. Meaning pretty well all of them.

Miraculously, I am sure the staffing would improve immediately.



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Author Janie Garner

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Join the discussion 12 Comments

  • That is an outstanding proposal. I am fortunate enough to be in a nice place. And, Grateful as well. but, I have worked in my share of horrific situations in other places.

  • I think that would be heaven on earth!

  • Karen says:

    How can we make this happen?

  • Ramona Gonzaez says:

    Restaraunts have to post occupancy rates, we have to post reports of injuries and complaints, we post patient rights and billing information, make satisfaction surveys available at the drop of a hat….why not make available nightly safe staffing status? If I knew the safe level of care was 3:1 in the ER and it was posted 5-1 for the night, should we be on drive by? If Med-surg is 5:1 and they are posted 8:1, shouldn’t prn staff be called in? I mean really, it’s just lives here, right? WHAT IS MORE IMPORTANT?!?!? It’s time to make this happen!!!! I don’t understand how one aspect of hospital reimbursement is driven by satisfaction surveys when we are set up to fail!!! Satisfaction by the patient at the expense of the nursing staffs demise!!!

  • Stephanie says:

    As a nurse manager, I am always hiring staff. I am over hired. We have nurses who make changes in their lives and decide to drop their point status, get married and move away, finish their advanced degrees and get new jobs-it’s a revolving door.
    There’s also the fact the there is no evidence to support staffing plans-only math. So even if I have a full compliment of staff, one sick call can throw the day into sheer chaos.
    If this is happening in my unit, it’s happening everywhere. My goals are to be as good to my staff as I can be but to hold people accountable and help me retain staff. We all have to be united in this front. I have the resources to “staff” the unit, the hospital provides me with that-but it is up to the team to make it work. Many nurses don’t see this as their role. They see it as the sole responsibility of the leaders. As an RN for more than 30 years-I think I’m experienced enough to say that it takes all of us to pull together and work as a team.

    • Edna says:

      I also work on a telemetry unit where our ratio is 4:1, but our turn over of pts on a given day, brings the avg pts load on a nurse to 5-7pts that she would have taken care of over her 12hr shift. Our manager also assures us that she is over hired as well. But what really hurts us is, when the hospital census is high. Also, when we get a call in and there’s no one to replace them. We do not have any back-up system for call-ins. Staffing office would make some calls to get people to work(without incentive). Some come in thinking they’ll reap in the benefits of overtime. But they take the risk of being called off, later in the week(because overtime is the first to get cancelled) Well, so much for helping out your unit, right? So much more pressure has been put on nurses theses days to meet high pt satisfaction scores. Morale has been hit hard, since we don’t have the proper support. Happy nurses would produce a happier environment in the work field. It would probably help with job retention and the good old pt satisfaction scores!

  • Amy Wilson says:

    There’s not even close to acceptable staffing rates in SNF and LTC. I’m not even sure if there have been studies done to show what appropriate staffing would actually be. This would be a good place to start in these types of environments. One of the things I heard frequently when I approached regarding more staff is that the CNA staff gets lazier as we get more staff, so it’s best to overwork them so that they stay busy. This is wrong on so many levels. There is so much work undone in SNF/LTC facilities because of understaffing. So many of these ” UTI+Altered mental status+ fall+ broken hip+ sepsis” (directly from article) that can be directly attributed to not enough direct care staff to observe and assist patients/residents/whatever the hell they want to call them now. It’s absolutely amazing how Directors of Nursing and Administrators can bitch, moan, and cry about not having good care out of one side of their mouths, and absolutely doom the clients to never having the appropriate care they need out of the other side. Wouldn’t staff inservices be different if we were teaching the things that always get left out because we don’t have enough staff to actually do them rather than just bitching about things that are never going to change because administration is intentionally handicapping us? I mean, I’m just putting that out there.

    • Erin says:

      Yes! I’m with you. I think this secret needs to get out. With SMYS going to Washington, I think it’s time we all stood up, all over the country, for this.Would SMYS be willing to support national rallies? Not financially, but to provide a unified national front of millions?

  • Lisa says:

    Spot on! Also, I’m so glad to see more readers and commenters on your informative blogs.

  • Denece Forenback says:

    The same should be true when kids are signed up for school. It should be posted on district and private websites and on front doors whether there is a school nurse (more often than not there isn’t one) their credentials, how often they are in each school, and what the ratio is for the coming year. Flint Michigan, for example, is 1:5000. The NASN and AAP recommend 1:750 if the population is healthy. Less if the population has higher acuity such as DM, asthma, anaphylaxis, seizures, special needs, etc., and they all do. Unfortunately federal legislation to promote this died in the last session and has not been reintroduced, yet. Every school should have a registered nurse. Every child deserves one.

  • Hope says:

    I think some hospitals would be in serious problems .Ratio 6:1 on a medsurg floor with PCA ratio 18:1 there is no way the PCA can take care of 18 patients many of them totals,turn Q2 etc so the nurse has to help .Pt c/o pain med late though it is PRN and you are stuck in an isolation room doing wound care for 30 min. Worse if you start with empty beds and get admissions back to back.I actually had a pt c/o that she came to my hospital fot the excellent care that was given but all day she was asking for something and it was never addressed.I was slammed but I took care of the issue since the survey matters. On top of that I was working sick for 2 days( you have 4 day limit call in for the year).Could not take it anymore went to the hosp.walk in and got dx and treated.Thank God I’m off for the next 3 days.

  • Annie says:

    Staffing ratios should be posted for all to see, both at all entrances and online. We are consumers and deserve to know!

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