I work in a long term care facility. I am also on the contract negotiating committee for our local union. During negotiations the subject of staff was obviously discussed. I was informed by our administrator that the state of Michigan only requires that long term care facilities such as our have an RN on staff for 8 hours out of every 24. The 1:30 ratio for staff to patient is all licensed staff to patients. That means that when those counts are figured they are using ALL licensed staff in the building for each individual shift to current patient census. In our case we have 78 patients in the building and they are including the DON, ADON, Social Services Director (who is an RN), the MDS (an LPN) coordinator ,the afternoon shift supervisor who is an LPN who never works afternoon shift, 2 ward clerks (who are CNA) and 2 float/treatment nurses in our count but there are currently 1 nurse and 4 CNA to 35 patients on the day shift and afternoon shift. On the night shift there is 2 nurses and 5 CNA to 78 patients. I am one of those nurses on day shift. The only time you see those in management out on the floor helping with patient care is if the state inspectors are in the building. I spend 80% of my 12 hour shift passing meds, 10% helping the CNA with patient care, and 10% doing assessments and charting. I am lucky if I get a chance to take a break and go to the bathroom. Bottom line the patient to nurse ratios need to be realistic for the types of illnesses we are seeing in the 21st century. This isn't the 1950s.