Today in the chart

Insights From A Nurse With A 1:40,000 Patient Ratio

Staffing considerations need to extend beyond ratios.

One of my all-time favorite jobs was being a first-aid nurse at a Major League Baseball (MLB) stadium. It wasn’t because of the compensation, technology, or guaranteed breaks; I never really got a break. But what I absolutely loved about working at the stadium was the diversity of patients I treated, the incredible team I worked with, and the energy of fans doting on their favorite players. The stadium had a capacity of over 40,000 spectators, and I was the only nurse. I worked with many paramedics and EMTs, and we had one doctor that could be paged, but we primarily worked autonomously. There was something about our teamwork that made it work. Our technology was simple; walkie-talkies, a stethoscope, and paper charts. Honestly, sometimes my days were easier there than when I managed the complexities of working as a bedside ER nurse. 

As we grapple with the staffing shortage, many turn to ratios for safety; myself included. But is this all we should be doing? There are so many considerations a system should have far beyond a ratio to meet the ever-changing resource allocation needs of patients with unpredictable medical complaints.


Sometimes smart technology isn’t always efficient.

Technology should help the end-user, not make a shift more complex and disorganized. I found that some of the technology implemented in my hospitals did not fit the needs of my department. We were making something simple, far more complex, and it started with the fact that there were not enough end-users consulting on innovation. While I don’t necessarily agree with paper charting, what I will take away from my experience at the MLB stadium was that paper charting worked for that environment. I often shuffled through stands to pick up patients seizing in their chairs. There was no time for electronic charting; I wrote my notes on a napkin and kept moving. Innovating technology that is easy for the end-user is critical for safety. MDs and nurses often deal with crises. We need easy-to-use technology which should involve incorporating medical professionals into innovation. 

Ancillary Staff 

We do not pay enough attention to or show gratitude to ancillary staff.

If you ask me who the real heroes are in a hospital, it’s not a nurse or a doctor; It’s the ancillary staff, the lab techs, housekeeping, unit clerks, certified nursing assistants, radiology techs, and transporters. One of the hardest shifts I had as a bedside nurse was when my department didn’t have a unit clerk and I was responsible for hundreds of incoming calls in addition to my patient load. One of the worst days was when there were no radiology techs to take my patients to x-ray. I often left my other critical patients unattended while I helped manage their trip to radiology. At the stadium, I worked with hundreds of ancillary staff members, who made my job efficient and manageable. As we consider staffing needs, we need to incorporate ancillary staff into the conversation. Patient safety goes beyond setting ratios and just considering nurse staffing.  


There is immeasurable value to good teamwork.

I would often walk into my shifts and look at the staffing sheet and know if my day would be difficult based on who was working (you know what I’m talking about). This went for nurses, MDs, and ancillary staff. There is a level of emotional intelligence, respect, and patience that is required for good teamwork. Some carry it naturally, while others may need to learn these skills. You could have tons of staff who are difficult to work with or minimal staff who are team players willing to go the extra mile to help ‘their people.’ At the MLB stadium, I was the only nurse, but my team was efficient, positive, and willing to go beyond their scope to help their coworkers. It’s up to you to decide what kind of teammate you want to be. I innately believe that if we give healthcare professionals the environment to establish good teamwork with education implemented, hospital units would be more efficient. Think about nursing school. We spent a semester learning how to make beds, yet there was not one class related to teamwork and collaboration, which comprises most of a nurse’s career. Something feels wrong about that. 

While my days as an MLB first-aid nurse seem like a far-distant memory, a blur of chaos but fun and excitement, I will never forget the joy that I got working with my teammates and getting through really difficult times together. It’s hard to compare that to hospital needs because it is different. But what I believe rings the same is that any department needs user-friendly technology that fits the needs of that environment, considerations for staffing ancillary members, and good teamwork. Ratios have protected many nurses and should still be a consideration, but we need to think bigger. 

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