Nurse to Patient Ratio

Nurses Safety

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:mad:RATIO 11 TO 1 AND ONE CNA...NOT SAFE....HOW DO YOU STOP IT AND WHAT CAN YOU DO!!! UNSAFE AND POOR PATIENT CARE....PLEASE HELP!

Specializes in Nursing Home/ Long Term Care for 2 years.
Advice: Walk away and save your license.

What other help can we give?

Totally AGREE!!!!:)

Specializes in Oncology, Medical.

Worked short last night. Most of us had 7 patients (no aides or anything, just nurses) and this is a med/onco floor. It was ridiculous. I had one person getting chemo, had an additional 6 IV meds throughout the night, often required nebulizers due to wheezing and shortness of breath, and required pain control. Another person was on a chemo protocol (she had several IV meds, though not cytotoxic, but they had to be timed precisely). Another person had a fresh trach and new G-tube feeds and required regular pain control. Another person had a packing dressing and, when I came on, had about another hour or so of blood infusing. In another room, I had two confused patients who were total care, incontinent, etc. And it was difficult to ask for help because all the other nurses were running around like crazy, too (actually, one RPN offered to help but, of course, most of my tasks by that point in time were only with the RN scope of practice...*sigh*)!

It felt totally unsafe. I hate when you feel like you gave sub-standard care even though you tried your hardest. It's an awful, awful feeling.

Specializes in Med/Surg.

In the hospital I work at we usually have 5-6 on nights (mostly 6) and one nursing assistant and a charge nurse who sometimes carries patients depending on census on a busy Medical/Surgical Unit. It can be hectic at times depending the acuity of the patients, if they are getting tube feedings, IV abx, if they are detox, fall precautions, or total care NH patients. I agree that 5 patients is doable, but at the 6th or 7th and it totally throws you off, with all the medications, chart checks, orders, MARS, charting, and everything else that you need to do. When I hear people saying 60 patients in the nursing home I about fall over, that is why I never wanted to work in LTC because of the staffing. I do not see how anyone can provide "safe and effective" care for 60patients over the course of 8 hours even 12 if you have 60 patients and need to do 60 assessments, and meds for all in your 12 hours you would get 5 minutes per patient and that doesn't even include your charting? I know people are sleeping at night (sometimes) but that is ridiculous and not safe at all. If one of them went bad in the middle of the night, it may take you longer to react because you are watching 59 other patients, while trying to pass your meds, obtain vitals and document.11 to 1 is too many people to assess, document, pass meds and manage no matter what time of the day it is! Safe ratios for nurses is 6:1 max for a medical surgical unit is what I have found in research. I have trouble managing the 6th patient I do not see how I could manage another 5 on top of that. WOW. WOW that is not safe at all and I would consider looking for another job in an environment that cares about the well being of the staff and of their patients.

Wow! For some reason I had not looked at this thread before and am pretty blown away at what some nurses - and patients! - are enduring in many parts of the country.

We know we are lucky in California to have legal ratios, but I had not fully grasped how much worse some places can be.

I think it's worth throwing out a few things to think about:

1. Our ratio law and its implementation did not just happen - it took a long fight by a strong union that engaged thousands of nurses and pushed legislators to do that right thing. And it was not an easy push, by any means.

2. The ANA - the organization that many still (erroneously) think of as the voice for nursing has consistently fought against real ratio laws, working with the hospital industry to derail them everywhere.

3. Ratios don't just make our lives better, they save our patients lives - solid studies show that too many patients per nurse produces significantly more patient mortality.

4. Management will push us as far as we will put up with. When enough nurses stand together and say no, these staffing practices will change - and not until then.

5. Ratio laws have been introduced in legislatures in a number of states: Ohio, Illinois, Massachusetts, Texas, Florida, and probably more I don't know about. But we won't see those laws pass until enough nurses come together and take action to support them.

I work nights at a SNF. Presently my ratio is 1:65 with 2 CNA's.

Specializes in Oncology, Medical.
Wow! For some reason I had not looked at this thread before and am pretty blown away at what some nurses - and patients! - are enduring in many parts of the country.

We know we are lucky in California to have legal ratios, but I had not fully grasped how much worse some places can be.

I think it's worth throwing out a few things to think about:

1. Our ratio law and its implementation did not just happen - it took a long fight by a strong union that engaged thousands of nurses and pushed legislators to do that right thing. And it was not an easy push, by any means.

2. The ANA - the organization that many still (erroneously) think of as the voice for nursing has consistently fought against real ratio laws, working with the hospital industry to derail them everywhere.

3. Ratios don't just make our lives better, they save our patients lives - solid studies show that too many patients per nurse produces significantly more patient mortality.

4. Management will push us as far as we will put up with. When enough nurses stand together and say no, these staffing practices will change - and not until then.

5. Ratio laws have been introduced in legislatures in a number of states: Ohio, Illinois, Massachusetts, Texas, Florida, and probably more I don't know about. But we won't see those laws pass until enough nurses come together and take action to support them.

I'm just curious: what is the legal nurse-patient ratio in Cali? I'm in Canada so I'm ill-informed about this.

I'm just curious: what is the legal nurse-patient ratio in Cali? I'm in Canada so I'm ill-informed about this.

I don't know them all off the top of my head - it varies by unit, but here are some samples:

ICU - 1:2

stepdown unit - 1:3

specialty unit (peds, tele, oncology) 1:4

Med/surg 1:5

Emergency 1:4 (unless a patient is heading for an ICU - then the ICU ratio applies)

A couple of other items that can be just as important as the numerical ratios: These ratios are in effect "at all times" which means days and nights and includes break and meal periods - in other words, to be legal there should be designated people to relieve you during meals and breaks - not just another nurse "watching" your patients.

And these ratios are supposed to be floors, not ceilings - hospitals legally should staff up from that for high acuity patients.

Both of those issues are not complied with as often as the basic numbers - a lot of hospitals try to fudge it in various ways and enforcement is uneven - it's always a work in progress.

Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

Try being one RN for a 100 patients and supervising about 10 staff! That happened to me one night. I had no break, running round like an idiot, had the other RN came on ignoring me and giving me cheek (I complained), had lots of other problems that night too.

I will not work aged care now; those staffing levels are disgusting. I wish the families were more aware of these problems, problems is they don't want to care for their 'loved' one or can't and they just ignore what's going on.

Nobody cares about the elderly and demented now.

Specializes in PCU, LTC.
I don't know them all off the top of my head - it varies by unit, but here are some samples:

ICU - 1:2

stepdown unit - 1:3

specialty unit (peds, tele, oncology) 1:4

Med/surg 1:5

Emergency 1:4 (unless a patient is heading for an ICU - then the ICU ratio applies)

A couple of other items that can be just as important as the numerical ratios: These ratios are in effect "at all times" which means days and nights and includes break and meal periods - in other words, to be legal there should be designated people to relieve you during meals and breaks - not just another nurse "watching" your patients.

And these ratios are supposed to be floors, not ceilings - hospitals legally should staff up from that for high acuity patients.

Both of those issues are not complied with as often as the basic numbers - a lot of hospitals try to fudge it in various ways and enforcement is uneven - it's always a work in progress.

I'd be happy with anything even close to those ratios. I work on a stepdown cardiac unit, and the normal staffing ratio is 5:1, often we go up to 6:1, and on that rare day when you're down to 4:1 you just spend the day dreading the admissions you might get. The worst part is, on the rare occasion that we're staffed well enough that everyone will get 4:1, more often than not, our nurses are pulled to regular Med/Surg floors so that they can have 5:1 ratios.

On one occasion, I was pulled off of my floor, leaving them with a ratio of 6:1 to go to a Med/Surg Oncology floor where I was assigned 5 patients, and the rest of the floor got a 3:1 ratio. I would have complained, but I felt like I was on vacation with only 5 Med/Surg patients.

Specializes in 3 years MS/Tele, 10 years total ICU, 5 travel.

...and this is why I desperately want OUT of med-surg. Except, reading this, apparently it's EVERY type of unit. Is there no where sane left?

negligence will probably be rampant there....i feel more sorry to myself and my patients because we have a 25:1 ratio here....tons of work...i can say that you are still luckier than me hehehhe....

Specializes in PCCN.
...and this is why I desperately want OUT of med-surg. Except, reading this, apparently it's EVERY type of unit. Is there no where sane left?

if there is, i would love to know where it is.

as far as I see it it all sucks. A walking liability.Not a matter when , but how bad.(although go ahead and sue me- cant get blood out of a stone.....

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