FYI: nursing ratios don't mean much at all if hospitals use "acuity tools" to change the numbers. For example, if ICU ratio is 1 nurse for 2 patients but then the hospital uses an acuity tool showing "this patient's required care hours aren't really ICU," then the ICU nurse will open to get a third patient. Let's say the floor is full and they are holding a bunch in the ED so you take a step-down admit. Also, they float your tech, and sorry, no secretary. Now there's a code on the floor so that patient gets transferred to ICU, so it's 2 nurses, 6 patients, 5 ICU, with one who just coded or whatever, one step down, and no tech or secretary. It's a nightmare and it happens with regularity. If the ratio says ICU 1:2 that should mean 1:2 ***PERIOD***no matter what, because you don't know what's going to happen and you still are expected to give a certain level of care. Point being, when these ratio laws are passed, they should make clear that these ways the hospitals get around ratios being meaningful should not be legal. 1:2 should mean 1:2. And the same goes for the floor; the legal ratio numbers should not be altered. Sorry, just had to vent because I was so THRILLED at the nursing ratio laws but now come to find out, the hospitals don't go by them anyway. Then they print out some sheet at the end of each month saying the average pt assignment was 1.4 patients per nurse, or some silly number, when often I've had to chart on 4-5 patients transferring and admitting, and end up with 3 in ICU, and it's a good night if I only end up with two. It's very disheartening. Years ago we always had a secretary and never had more than 1:2 in the unit. Once you had second pt, at least you could breathe easy and take care of them. Now you have to rush and be worried to death about what you'll do if you have to take that third. We used to make people 1:1 if they were the super sick, can't even step out of the room for 10 seconds types, but that doesn't happen anymore. Also, organ donation patients and PACU patients that come straight from OR used to be 1:1 (thought that was the law with the recovering patients!), but now we double up with both of those patients too. It's not right. I know it's not like this everywhere, but it's becoming more commonplace in ICU's all over. Not a good trend I can tell you. Nursing unions and lobbyists need to quit wasting our dollars supporting things like Occupy Wall Street and The Robin Hood Tax, and start addressing patient ratios and their enforcement.