Safe Nurse:Patient ratio

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What do you consider a safe nurse-patient ratios for night shift?

I live in WI, and so far I cannot find documented anywhere the maximum patient load a RN can have. The other night we had 18 patients 3 nurses and no nursing assistant. One nurse had to go to the ER because she became ill, which left us with 18 patients and 2 RNs with no help, and an admission on the way. Its a med/surg onc unit with very heavy patients, I have been working for 4 months, and I definitely do not feel safe taking care of 10 patients. I cannot keep up with the assessments, PRN meds, call lights, telephone calls, q 2 hr bed turns, and anything of the unknown that comes up i.e call to the doc, etc. I would like to know if others have experienced patient:nurse ratios like this or worse?

I feel like when I bring this up to people, they say I am complaining because I am new and not use to working yet.

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Specializes in Med/Surg.

Where in WI do you live & work?

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You could ask the General Nursing Discussion forum. I've seen many threads there observing high patient-to-nurse ratios.

I don't think you're "complaining", but observing a phenomenon that appears to be all too common in the nursing workplace. And it seems as though nurses can't expect much support from management or hospital admin to redress the problem ($$$ focus).

There was an article in JAMA by Linda Aiken noting significantly increased mortality risk with each patient added to a nurse's workload. I think the base ratio they started with was 4:1.

Here are some links:

http://jama.ama-assn.org/cgi/content/short/288/16/1987

http://www.dpeaflcio.org/programs/factsheets/fs_aiken.pdf

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i am a new grad and have just experienced the hospital bottom line of $$$ and not patient care and safety. i work pp which is usually not bad. we can have 8 max pts per nurse (which is fine unless there is a high influx of med-surg pts). now on nights with 8 or less pts there is only one RN and one tech. in general less pts per nurse is safer and better care is provided -duh. but hosp admin dont see pts, they only see bottom line. dont see yourself as a complainer, see yourself as looking out for you and your pts. but this story is the same in hosp's all over the country unfortunately.

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Specializes in Cardiac Telemetry, ED.

I don't know about noc shift, but on evenings, I think four patients is quite enough. If you have a particularly busy patient, then four can be too much. As a new LPN, I'd like to have three. I'd feel comfortable with that. But I've had five and six, which I think is far too much. With that many patients, you become too task oriented to see the big picture and really know what's going on with your patients. I think it becomes harder to anticipate problems and be proactive, because you're too busy being reactive and playing catch up.

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Specializes in Acute Care Cardiac, Education, Prof Practice.

Up in Portage at Divine Savior I held 5-7 pts easy on thier basic med surg. Most more complex pts went to ICU. I was a new grad at this point.

Here in Atlanta with complex medical/cardiac I take on 6 pts most nights. I manage it, but I have to stay on top of everything and keep moving. Which is nice, keeps me awake ;)

I don't believe at this time Wisconsin has any legislation on ratios, I do know that Divine Savior uses a system of acuity scoring from the UW-Madison to help decide how many nurses they need each night (8 hour shifts there)

Here in Atlanta we do 12 hours and basically have 6 no matter what because at 24 pts we are full on this unit. If the acuity is high (many many lvl 4's) we can sometimes get a 5th nurse.

During the day I know there are generally 5 nurses for the same population.

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Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.

I work on abusy/heavy surg/onc unit, for nites we are staffed for 18 pts w/ 2 RN's and 1 PCA, we can't get more staff, even if we have a bunch of sick ones, our load is 7-8 for nites, 5-6 for eves. if our census is 24 we have 3 RN's and b2 PCA's, at 28 (our max) we have 4 RN's/3 PCA's --for nites, accuity does not factor in only the $$$$. I have had 11 pts at nite:madface:

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Specializes in Acute Care Cardiac, Education, Prof Practice.
I work on abusy/heavy surg/onc unit, for nites we are staffed for 18 pts w/ 2 RN's and 1 PCA, we can't get more staff, even if we have a bunch of sick ones, our load is 7-8 for nites, 5-6 for eves. if our census is 24 we have 3 RN's and b2 PCA's, at 28 (our max) we have 4 RN's/3 PCA's --for nites, accuity does not factor in only the $$$$. I have had 11 pts at nite:madface:

It amazes me on here how many facilities honestly sound like they need to be reported to get them to change anything.

That doesn't sound like a safe floor.

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Specializes in Med Surg, ER, OR.

Safe - 1:1 or 1:2

Practical - 1:3 or 1:4

Realistic - 1:5 or 1:infinity

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What do you consider a safe nurse-patient ratios for night shift?

I live in WI, and so far I cannot find documented anywhere the maximum patient load a RN can have. The other night we had 18 patients 3 nurses and no nursing assistant. One nurse had to go to the ER because she became ill, which left us with 18 patients and 2 RNs with no help, and an admission on the way. Its a med/surg onc unit with very heavy patients, I have been working for 4 months, and I definitely do not feel safe taking care of 10 patients. I cannot keep up with the assessments, PRN meds, call lights, telephone calls, q 2 hr bed turns, and anything of the unknown that comes up i.e call to the doc, etc. I would like to know if others have experienced patient:nurse ratios like this or worse?

I feel like when I bring this up to people, they say I am complaining because I am new and not use to working yet.

That is not a safe ratio. Not close.

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Specializes in Geriatric, Medical/Surgical.

At my facility we have a staffing grid that does not take into account patient acuity. On nights, we get 2 nurses up to 18 patients, 3 up to 25, 4 up to 28, and 5 for 29 or 30 (or max...I've never seen 5 nurses on nights). We usually get 2 PCAs

Last night, we had 3 nurses for 29 patients.

What doesn't make sense to me is that if there are 18 patients, we have 2 nurses...9 each, and if something goes wrong, and the other nurse needs help, there are a LOT of patients not being looked after. But once there are 30 patients, the max per nurse is 6, and a lot more help on the floor if something goes wrong.

I feel comfortable with up to 6 patients...more than that and I start forgetting my patients names/diagnoses and have to constantly look at my jot sheet.

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Specializes in Oncology, Orthopedics, Geriat., Renal.

I am a new graduate nurse, due to take NCLEX within the next month. When I signed up for my job it was an Oncology/Ortho floor. Now due to radical changes it is a Renal/step down Cardiac floor and the Nurse patient ratio is 1:8-10 on a 33 bed unit with 1-2 CNA's. Needless to say, I am a little intimidated by the whole thing because the most patients I took care of in clinicals is 3. Most of the other floors are worse (or so I have heard). Any advice?

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