One of the contributing factors to the ongoing exodus of nurses from the profession is the problem of the decline in patient safety due to inadequate staffing levels in the acute care setting. It is difficult if not impossible to provide good nursing care to any of your patients when you are overwhelmed with more responsibilities than you can safely handle. You need to ask your interviewers: “What is your nurse/patient ratio and how is it determined?”
An additional issue to inquire about would be how many assistants are available to you. Often one certified nursing assistant is assigned to two or three nurses, making their patient load double or triple that of yours. While you are busy admitting or discharging patients, administering medication or chemotherapy, monitoring telemetry, changing wound dressings, assisting the physicians, etc., the certified nursing assistant is doing the dirty work that you don’t have time to do – for two or three times the number of patients. Bed baths, changing bedpans, changing linens, checking vitals, assisting patients to and from the toilet, fetching supplies and equipment, tracking you down to pass on a request from a patient for PRN pain medication, and any number of other tasks that have been delegated to him or her. The certified nursing assistant does for you what you do for the physician.
There is no one-size-fits-all ideal nurse/patient ratio in the acute care setting. The numbers need to be flexible to allow for changing patient acuity. Arbitrary enforcement of a predetermined number is poor nursing practice, as is fudging the acuity levels to meet the nurse/patient ratio requirements. It costs patients their lives and nurses their licenses. Unfortunately, with staffing levels at an all-time low due to the current economic climate combined with administrative budgetary decisions (that have mostly to do with the bottom line and little to do with the reality of nursing care, no matter the economy), an unreasonable patient load is often the rule, rather than the exception to it, and acuity level tinkering does occur.
Some facilities deal with the problem better than others. Ideally the charge nurse on each shift should not be a position that is rotated among the staff – it should be a position held by one nurse with supervisory and management skills and training. In addition, the charge nurse should not have a patient assignment of his or her own but should be readily available to help out wherever needed around the unit to keep things running smoothly, particularly if the unit has a large number of high acuity patients. This allows for increased accountability (no number fudging!), better continuity of care for the patients, and a more stable, collegial working environment for all staff on the unit.
The kind of facility you want to be a part of is forward thinking, pays attention to what its nurses really need, and implements policies and procedures – such as those discussed in the previous paragraph – that help, rather than hinder.