I work at a stepdown unit and our ratio is 4:1, but we often go up to 5:1 without CNA help. We also have opened the critical care waiting room and "transformed" it into patient care areas. Mind you we put 4 patients in the waiting room with NO suction set up, and portable O2 tanks. Can you say ridiculous!?
We also actively titrate Dopamine, Dobutamine, Cardizem, Nitro, etc, take post Op day 1 CABG patients, neuro patients that require Q2 hour neuro checks, and we take all the chest pain patients and all the PTCA patients. We have to have a minimum of 20 patients to have 2 CNA's, otherwise we just have 1, and sometimes NONE. Did I mention we take trached and vented patients? Oh, and our charge nurses are expected to take a full load of patients 75% of the time. The acuity is extremely high.
We have an incredibly high turnover rate and are always short staffed. No agency wants to send us there nurses because they can't handle our unit. And to make everything more wonderful we currently have NO manager for our unit. The administration is ridiculous and all they care about it making $$ and not patient care or safety.
I recently left (the 5th RN this month alone), and when they call me for my exit interview they are going to hear a ton from me!