So I recently learned on allnurses that California is the only state that has mandated nurse-patient ratios. I was honestly shocked and found it educational how hard fought a battle that was and how many other states are trying to pass similar laws. But it sparked my curiosity as to the average nurse-patient ratios in other states? What are the ranges of patients an RN sees on the unit/floor?
In California the ratios are as follows:
ICU, CCU, NICU/PICU, PACU, L&D, and ER patients requiring "intensive care:" 2:1
Step-down units: 3:1
Telemetry, Pediatrics, ER, Antepartum/Postpartum: 4:1
Med-Surg: 5:1
Psych: 6:1
*The only exception is a local or state declared emergency.
I became an RN after this law was in place for some time, so I really would be interested in the experience of others.
I'm in Mississippi working night shift in an LTAC and our med/surg max ratio is 6:1 which can be challenging because these are usually total care patients. 5:1 is much more comfortable and when staffing allows that's what we run. ICU (what we call high observation) patients that are vented or require more frequent monitoring for whatever reason has a max ratio of 3:1.
I feel for night shift because no matter how many patients are on the unit they do not get a secretary or a CNA. I do not work night shift but the world seems to think that it is easy because all the patients are sleeping. Ha! Sick people are just as sick day or night. The only thing different is that it is quiet without P.T., O.T. food service, portable radiology, case managers, docs, etc. I worked 4 night shifts in my tons of years and there is no way I could do it. I applaud those who do.
I currently work on a med-surg floor in Michigan. On days we are 6-7:1 and on nights it's been ranging anywhere between 6-10:1, depending on staffing and the census of course.
With most California hospitals only hiring nurses with acute care experience it leaves new grads with little choice but to work at these LTC facilities. We need to work too. Even if the conditions are deplorable.
My facility offers insurance at rates so astronomical no one working there can afford it. The entire facility has kids on medi-cal. Now that's the real joke.
The Ca hospital that I work for has hired new grads the last 4 years. And lots of them, all full time. That does not mean they are getting full time work but they are working. But I believe we had a contract with the University and now it is done with so I have a feeling we are not going to hire new grads for a bit. If working at a LTC gives you experience go for it. And maybe you will be good at it and enjoy it. We sure need good nurses there!
I work on a combo med/surg- tele- rehab unit at a small hospital. Our census has been low- less than 10 lately. sometimes we work with 10 pts and 2 RN's, may have 1 cna, depends. The problem is getting all these pt up and down to the bathroom etc. they are often 2 person assist. My last shift, I was giving 2 units of blood to one pt,needed to stay in pt room for 1st 15 min.When my other pt's called and needed to go to the bathroom-Well? you can only do one thing at a time. This is a 12 hr day shift. Oh and on the weekends, we have to do all the resp trts.
Here in rural Missourah, I work in a 24 bed telemetry step-down unit with usually a 4:1 ratio on nights, and no aide, tech, etc. So we do EVERYTHING for our patients. I do understand it is worse other places 5:1 or 6:1, I'm not sure if that's with a tech or not.
JRB, if we have 10 patients we have two RN's and no cna whatsoever. It can be very difficult esp since our acute hospital med surg is starting to look like a skilled nursing. All these old folks being kept alive when nature needs to take its course. I took care of 88 yr old who is a FULL CODE and demented, feeding tube, blood transfusions, etc. etc. What is wrong with this picture? To top it off, he is contracted and hard to turn and they want us to get him up with a lift for every meal. Give me a break. His "every meal" is a feeding tube constantly being infused. And the family refuses a foley. And he cannot be without oxygen. And I am running around crazy smashing up cholesterol meds to push into his feeding tube? Makes no sense.
In California, there isn't a ratio of nurses to patients in long term care. Instead there is a ratio of "direct care staff to patient". AM is 5 to 1, pm is 8 to 1 and noc is 13 to one. The ratio includes nurses+c.n.a. to patient.
One nurse with three CNA could be taking care of 32 on the pm shift. BUT! The ratio takes into consideration nurses in the building, not nurses on the floor. So if a nurse is working in an office of your facility(actually officially scheduled to be there) at the same time you are on the floor, that nurse affects the ratio so you could be assigned even more patients.
An example is the MDS coordinator sitting in his/her office. He affects how many patients the nurses on the floor are assigned. I know this because I am an MDS coordinator as well as ADON in a SNF. Monday through Friday, they count me into the ratio even though I don't work on the floor. On weekends, the am superviser affects the ratio.
Depending on the size of the facility, the DON can also be counted as direct care staff so that would affect your patient load.
It is very interesting reading and I recommend any LTC nurse in California go online and read it.
At least this is what I read at the California Health Department website yesterday.
Well isn't that just convenient for LTC facillities! It "looks" like they re staffing way better than they actually are. Nurses shouldn't work like that. If they couldn't find anyone foolish enough t work like that, then they would have to staff better to attract and keep them?
It's not a matter of foolishness. It's a matter of that being the only jobs out there. No matter what I think about the staffing in my facility, those residents need care, and I have to pay the mortgage. Maybe residents' families should stop grousing about the bill, and start insisting on better staffing ratios!
I work in IL on acute rehab unit and we have no ratio.. Depends on how well we are staffed.. Lately it's been 2 cnas w a full house 15-16 patients a piece.. Very crazy and unsafe.. I wish we did have a set patient nurse ratio..
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aei631
27 Posts
I'm in Mississippi working night shift in an LTAC and our med/surg max ratio is 6:1 which can be challenging because these are usually total care patients. 5:1 is much more comfortable and when staffing allows that's what we run. ICU (what we call high observation) patients that are vented or require more frequent monitoring for whatever reason has a max ratio of 3:1.