1:5 is standard med surg ratio by law in California where I work. It can be okay, or it can be too much. It depends on the acuity of the patient. Sometimes you have a few patients that have soooooo much going on, and it is barely manageable unless your other patients are easier. Also, it depends on ancillary staff...do you have a nurses aid, a charge nurse who can pitch in maybe pass a med here or there or help with an admission? When I was a new grad, I took 6-8 patients on med/tele pm shift.ON a bad night we would have up to 10 patients. It was very challenging and stressful. I had to take direct admits straight from the doctor's office with active chest pain on med/surg/tele! :-( (Why didn't they go to the ED first?!) Personally, I think 1:4 for med surg would be more manageable, but you never see that ratio EVER on med/surg. I always loved it if I had one or two ambulatory patients who were stable, because you know you're going to have another one or two who are on isolation, needing Q 1-2 Hr frequent pain med IV, complicated dressing change, ambulation, frequent suction, a million piggybacks every hour, TPN, accuchecks, etc. I think 1:5 is as good as you'll get. But it isn't always easy. Depends on what is going on with the 5 you have! Good luck!