i work in a va hospital's icu, in a rather rural part of the us. our rn-patient ratio is 2:1, although at times it has been 3:1; we've had to reduce the number of patients we admit because of staffing shortages.
on our med/surg/telemtry and pulmonary floors the ratio has typically been 1:15. when i first stated working here > 5 years ago it was 1:30. an rn would work with one na and an lpn. it felt terribly unsafe and administration wasn't very helpful. "just do the best you can," was the usual response.
i don't think to this day they realize it wasn't an issue of convenience, but instead a safety concern. how can i assess the 15 patients on my team, pass medications twice, help feed a meal, help turn q2h, answer the phone, talk to families, admit new patients, deal with the thousand-and-four problems that every nurse has to face in a typical shift, take off the huge pile of orders the day shift didn't get to, and go home feeling like i did anything more than stick my finger in the hole in the dam and wonder what i missed..
i think it's improving, but slowly and with reluctance. the focus is truly on primary care these days and acute inpatient care seems to be forgotten, or is at least far, far down the list of priorities.
i've seen two rns on the wards in the past year, usually with the support of at least one lpn and na, else two nas. so, at least there are 2 people to care for each 'team' of 15 patients, with an rn to oversee both. but still, they face the same problems. when do you have time to assess anyone? it turns into reactive nursing. because ward nurses do not have time to assess fully, they often only catch complications or changes when they become obvious instead of catching them in the early stages.
every day i'm grateful i came to icu. i know what my patient ate, how much he voided, what his lungs sound like, what his rhythm is, what his labs are, how he's responding to his gtts or meds, his level of orientation, his functional capacity... all the things i need to know, i have the time to find out. the ward nurses are valiantly treading water.
so, what do i think about mandatory staffing levels? our patients need them! the safety of the patient and the caregiver should be of paramount concern.