Medical/Surgical unit Staffing Ratios

Surgical Services Ratios-Appropriate Registered Nurse staffing ratios may vary slightly in the pre and post areas of the Surgical Services Department depending on how extensive and how large the surgery services are that are provided by the specific hospital. For example, the nursing intensity and the patient acuity will be different for a smaller local community hospital who provides surgery for minor broken bones versus a large major teaching hospital which provides open heart surgery including heart transplants.

Pre-Operative – 1 Registered Nurse (RN): 2 patients. In the pre-operative area, RN’s are interviewing and assessing patients to identify potential or actual problems during or after surgery. The nurses in pre-op often answer a lot of questions from the family and the patient as well as coordinate communicating with the surgeon. One critical component some pre-op nurses have is marking the appropriate surgical limb or site and verifying this with the patient.

Intra-Operative – minimum 2 RNs: 1 patient. During surgery, there are two major roles nurse fill, Circulating Nurse and Scrub Nurse. The Circulating Nurse manages overall patient care in the surgical suite and helps maintain a safe, comfortable environment. The circulator ensures patient safety during the procedure and coordinates with the surgeon, scrub nurse, technician and anesthesia provider to provide quality care. The Scrub Nurse uses sterile technique while selecting and passing instruments and supplies and maintains patient safety. The scrub nurse acts a s a patient advocate at all times especially while the patient is under anesthesia. The scrub nurse assists with completion of surgical “counts” to be sure no foreign objects are left unaccounted for. The scrub nurse also helps with reposition of the patient and provides warming blankets so the patient’s core temperature doesn’t drop to a dangerous level.

According to the Association for PeriOperative Registered Nursing, at a minimum, one perioperative RN circulator should be assigned to each patient undergoing an operative or other invasive procedure and be present during that patient’s entire intraoperative experience.1

Post-Operative – 1:1 for initial immediate recovery and then 1:2 as a patient progresses through recovery and is considered for transport up the in-patient unit. After surgery, the patient travels from the surgical suite into the post-op area for recovery. In the first few minutes to an hour the patient is assessed frequently to determine that they are recovering from surgery with in normal limits. Assessments can range in frequency from every 5 minutes times four, every 15 minutes times four and then every 30 minutes until transfer to the in-patient unit. The RN is assessing vital signs including but not limited to heart rate, heart rhythm, core body temperature, and breathing especially vital as they wake up from anesthesia and may experience sever nausea and vomiting from the anesthesia medication. For patients who lost a lot of blood during surgery the nurses in recovery would be replacing this as well. To hang a unit of blood, 2 Registered nurses much verify that it is the right blood type and right patient. Finally pain assessment is critical part of post-operative nursing care. If patients are in moderate to severe pain they may not recover as best they could if the pain was managed appropriately. Therefore, depending on how many surgical cases are done, when nurses are in the initial stages of recovery they can only assess one patient at a time. Once the patient safely arrives at the vital signs taken and normal once every 30 min., then that nurse could begin to recover another newly arriving surgical patient.