staffing/patient ratios that work

I would say that most things about patient:staff ratios are positive. A lot of people have noted that in CA, when they started the ratios they took away the ancillary staff, which is true and does create new problems, but the fact of the matter is, we have laws in place which state how many patients a nurse can legally and safely care for. That is a huge step in the right direction and forward movement to the bigger goal of safe staffing for our nation. I would go into more detail on that but I'll answer your other questions.

We do have a team approach in our unit. In yours, you could have 5 patients to every nurse with your charge nurse having a patient load or you can have each nurse take 6 patients while your charge takes 2 and helps the rest of the team with accuchecks, prn meds and covers breaks. Ideally, you should have one more nurse here to work with so your charge doesn't have to take a patient load of his/her own and is free to help the rest of the nurses more. Your technicians should no more than 8-9 patients each and should be assigned to the highest acuity patients. In our hospital our ratio is 5:1 for RNs in med-surg, and while not mandated, CNAs ratio is 8:1. Charge nurses do not have a patient assignment but will occasionally take an admission at the end of the shift after everyone's breaks have been covered. Many times we do not have techs to help us though, and we are used to doing total care on our patients and just take turns helping each other out.

We do not stagger shift times; we have 12 hour shifts, 7-7:30, and during shift change either nurse is open to doing things that need to be done for the patient if need be. Of course the smart thing to do is to round on all your patients before shift change to address their needs and hope nothing comes up from 7-7:30 but of course it never fails that someone will want their morphine.

Our current staffing model is based on a combination of the CA state requirements and the hospital's staffing matrix, which looks complicated as heck, and is at this point in time based on unit census (although we are trying to get it changed so that it is based on pt acuity).

I hope my tired hazy babbling contained some of the info you were looking for!

well I work on a telemetry/stepdown unit with 29 beds and the nurses(charge included) take 4-5 patients a piece depending on the grid on nights. occassionally the charge will take only 3, and we also do not have any techs either on nights. on days, nurses take 3 patients and have 2 techs(lucky!) It's a bit hecktic when you first start on this floor but after you get used to the heavy load it's not bad.