No. Some states specify a minimum nurse-to-patient ratio for various hospital units. If the hospital exceeds the maximum number of patients per nurse, it can request a waiver from public health authorities. Increasing the number of patients per nurse is usually approved by the state if the hospital can demonstrate that it has no alternative other than leaving some patients completely without nursing care.
To protect themselves and their patients, nurses should pay attention to very basic considerations, such as:
- Voice concerns: If the nurse is falling behind and treatments are not being completed, the nurse should immediately notify the charge nurse or manager responsible for the unit and continue to do his/her best to provide the care and services required by the plan of care and treatment and the patient’s evolving condition.
- Raise questions: The standard of care adopted by your hospital during a crisis may allow individuals who would not normally be involved in clinical functions to participate in patient care as long as they are competent to do so. The nurse is typically responsible for coordinating and overseeing the care given by others. Make sure you understand the role you and others are being asked to play, especially if certain members of the healthcare team are asked to perform novel duties.
- Prioritize: When there is insufficient time to attend to all duties, the nurse should use his/her critical thinking skills to prioritize care and services. The physician or team overseeing the care of the patient should be promptly notified if any ordered medications or therapies are delayed or missed.
- Tell the patient story: Some hospitals cope with surges in patient census by streamlining nursing documentation. Regardless of the hospital’s approach to streamlining, the basic functions of the medical record should be sustained. These fundamental functions of the medical record are:
- To record the care and services provided to the patient;
- To capture the patient’s reaction to care and service;
- To track the patient’s condition and progress; and
- To communicate the patient’s condition and progress to the rest of the healthcare team.
Greeley typically finds that a streamlined medical record (fewer checkboxes and pull-down menus) is actually a better way for nurses to fulfill these imperatives. For example, ongoing assessments are often best documented in a brief narrative note rather than pages of “structured” data where all patients appear the same.
Don’t misunderstand. There are many elements of the medical record that require a high degree of granularity. Obvious examples include documentation related to medications and objective signs/symptoms. But we’ve found that eighty percent or more of the documentation nurses are asked to do is unnecessary and does not contribute to the care process. The best method of telling the patient’s story over time, their condition and progress, is a brief narrative note, which can substitute for hundreds of daily “clicks,” and, at the same time, do a much better job of tracking and communicating the patient’s condition.
- Be professional: Follow the nursing process: assess, plan, provide nursing care, repeat. And always do the right thing.