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Neurosurgical/Stroke/Medical Unit Staffing?

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1 Currently the facility I am working for is trying to re-do staffing for the upcoming year (our year rollsover in the summertime) and currently they are cutting corners in nursing/ancillary.

Last staffing ratios we saw were dayshift nursing 7:1 (currently 5-6:1), and night shift 7-10:1 (currently 6-7:1).

Our hospital is the only local hospital which has a dedicated neuro unit ; therefore, they apparently have said they dont have anything to compare staffing with and staff us as a "regular" medical unit.

The unit is a "neuro" unit - we accept back surgeries, SCI, ischemic & hemorrhagic CVAs, SAH/SDH, seizures and also medical patients (usually those on isolation since our unit has a lot of private rooms). This is not a neuro ICU.

Unit can hold a max of 30 pts, but census is usually 22-27.

I'm curious to see if anyone here can provide me (possibly with a copy??) of their variance/staffing tables for their facilities neuro unit, particuarly one around 25-35 beds.
I don't work there anymore, so I can't provide any actual documentation. But that is crazy. We usually had 3-4 patients, although we were a total care hospital, so no aids. But regardless of that, that is still too many patients. You have to do neuro checks and all that, which there is no way you can do if you have 7+ patients. You would have real potential to miss a major problem with that many. Good luck!

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I know a friend in nursing school who had clinical on a dedicated neuro floor (total care) and they had 4 to 5 on days and usually 6 max on nights.your ratio seems really heavy!

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What kind of acuity are we talking, because that's really going to dictate what is safe.You said it's not a neuroscience ICU, so is it a step-down unit, or a medical/surgical floor that focuses neuro diagnoses? Big difference.

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I worked on a 33 bed neuro floor. The ratio was 5 on days and 6 sometimes 7 on nights. We always had aids. We would have 1 aid for no more than 14 patients unless of course there was a staffing issue. We had a dedicated charge nurse who only took a patient if we had a staffing issue. Your ratios seem very unsafe.

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I work in a large tertiary care teaching facility. Our Neuro ICU is 10 beds with a 2:1 ratio, just outside is the Neuro IMCU with 6 beds and a 3:1 ratio, the Floor status Neuro unit is around the corner with 15 beds and 5:1 status. Our Med/Surg ratios are 6:1, PCU 4:1, Burn IMC 5:1 (we have a wound team to do dressings), and the ICUs are 2:1 or 1:1 depending on acuity. The ratios are the same regardless of time of day.Your ratios are too high to deliver safe, competent, quality care and not miss the subtle early neurological changes in a patient's status. Remember pupil chages are a LATE neurological sign!!!!

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I work on a unit with 23 floor status beds and 9 stepdown. We have a 3:1 ratio in stepdown and 5-6:1 on the floor. Six of our 23 floor beds are in an Epilepsy Monitoring Unit and assigned to one nurse, although those beds aren't always filled with seizure patients and the non-seizure pt(s) might have a different nurse. We budget for a free charge who helps with acuity but doesn't routinely take patients. With all beds full we are fully staffed with 9 nurses, including the charge, 4 aides, and a unit clerk. Staffing is the same for days or nights.Every unit has it's challenges, of course, but I think 5:1 is about the max you can run on a neuro unit and provide adequate care. It's like having a mix of LTAC and psych, with patients requiring total care and/or climbing over the bedrails. At 5:1 we can be proactive, at 6:1 we're mostly reactive, putting out fires. More than 6:1 seems like asking for disasters.

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Quote from Mike A. Fungin RNWhat kind of acuity are we talking, because that's really going to dictate what is safe.You said it's not a neuroscience ICU, so is it a step-down unit, or a medical/surgical floor that focuses neuro diagnoses? Big difference.

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Quote from NurseyPoo7I dont really know how to respond to this. We do get pts straight out of ICU... e.g. s/p TPA, cranies, back surgeries which had complications during surgery.A lot of our patients are total care.. some pts stay 3+ weeks in the hospital depending on their deficits & dx

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I have worked on a tele unit that I have had 8 patients at one time. I was charge. Guess what the CEO wanted us to have 9 patients a piece. Admin wonders why we have a increase in falls and we are unable to catch skin problems on admissions. To be honest my focus are ABC's. About 2 months ago I heard someone called Joint Commission about the unit. Each nurse had no more than 5 patients and the unit was a 28 bed unit now its less. Its a little better but now it is micromanaged and this not going to work either. Instead working over people shoulders jump in and help. By doing this maybe staff will work together and stay on the unit longer. I moved to another positioned in which I float to three different units based on need. I love it. A person gets fed up with things and it is time for a change.
Author: jone  3-06-2015, 16:31   Views: 1266   
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