Question: What is the suggested nurse/patient ratio and the suggested CNA/patient ratio for a medical-surgical floor?

Complete Question: What is the suggested nurse/patient ratio and the suggested CNA/patient ratio for a medical-surgical floor? I am the Unit Practice Council (UPC) chair for my medical-surgical unit, and we are tasked with manipulated our staffing grid.

Answer: Many states have mandated nurse to patient ratios. If you have not already done so, we encourage you to investigate this in your state. For example, California mandates a minimum of 1 RN: 6 patient ratio on medical-surgical units.

Because of the variability in patient population and services of med-surg units (medical only, mixed medical & surgical, telemetry, etc.) it is difficult to define one ratio that works for all med-surg units. In addition, patient acuity and census will impact the ratio and staff skill mix.

In general, med-surg units staff with a 1 RN to 4-6 patients day shift, and 1:6-10 night shift. C.N.A. staffing varies as well, from a care cohort model of 1 RN and 1 C.N.A. for 7-10 patients to 1 C.N.A. for half the unit, or 1 C.N.A. for the entire unit. The duties of the C.N.A. vary in each of these models.

A good staffing plan will need to have contingencies built if for periods of increased/decreased census, patient safety needs (1:1), and flexibility due to staff skill level and mix.

The AMSN Healthy Work Environment statement "Advocate for a Healthier Workplace" includes a section on Staffing Issues and Strategies that provides guidelines for design a staffing matrix and staffing mix appropriate to the patient population.

The ANA also supports a unit-by-unit approach featuring staff involvement in making decisions based on census, acuity, patient outcomes, and education/experience of nurses, which is where you are now with your unit practice council. See factsheet obtained from nursingworld.org.

(Published 2013)

Comments

Staffing Ratios

Our orthopedic unit staffs up to 1:6 for RNs and PCAs. This is a 16 bed unit. However, since this department has a large turnover, and admits multiple post-operative patients, we have built staffing guidelines based on acuity. Basically, we add a nurse so that RNs do not need to take more than 3 fresh post-op patients per shift. So, if we have 10 patients coming, we would have 4 RNs on, but may stagger the start times. We also have a discharge nurse for 8 hours each weekday. They teach joint classes, complete follow-up phone calls, provide discharge teaching, talk on the unit, or even take a modified assignment if needed.The med-surg unit has a ratio of 1:5. PCAs take up to 8 patients. This is a 15 bed unit. When we expand to 20 beds, we would have 4 RNs, 3 PCAs, & a HUC for a census of 16 to 20. We also have a charge nurse for 8 hours during the day who takes a 2 patient assignment, attends interdisciplinary rounds, tasks, and completes project work 7days a week. This is in addition to the core staffing.On both units, we keep the staffing the same for all shifts. Except we do not have a HUC from 2300-0700. Our PCA ratios probably seem better than most, but we have limited resources. For example, we do not have transports or PT assistants. The PCAs end up helping with PT/OT sessions and transporting back and forth to tests. 

Staffing Ratios

Our orthopedic unit staffs up to 1:6 for RNs and PCAs. This is a 16 bed unit. However, since this department has a large turnover, and admits multiple post-operative patients, we have built staffing guidelines based on acuity. Basically, we add a nurse so that RNs do not need to take more than 3 fresh post-op patients per shift. So, if we have 10 patients coming, we would have 4 RNs on, but may stagger the start times. We also have a discharge nurse for 8 hours each weekday. They teach joint classes, complete follow-up phone calls, provide discharge teaching, talk on the unit, or even take a modified assignment if needed.The med-surg unit has a ratio of 1:5. PCAs take up to 8 patients. This is a 15 bed unit. When we expand to 20 beds, we would have 4 RNs, 3 PCAs, & a HUC for a census of 16 to 20. We also have a charge nurse for 8 hours during the day who takes a 2 patient assignment, attends interdisciplinary rounds, tasks, and completes project work 7days a week. This is in addition to the core staffing.On both units, we keep the staffing the same for all shifts. Except we do not have a HUC from 2300-0700. Our PCA ratios probably seem better than most, but we have limited resources. For example, we do not have transports or PT assistants. The PCAs end up helping with PT/OT sessions and transporting back and forth to tests.