What is the nurse-patient ratio where you work?

Nurses Safety

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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 commented and it did not show so apologize if this is repeat. Our hospital used to have tons of heart pts thus tele floor. Now I see little difference or reason for pts other than hearts to be monitored unless they are unstable. So to answer your question medsurg/tele I have no clue. The tele floor may have 4:1 instead of 5:1 but they have to have vital signs every 4hrs. Other than that they are just like med surg or actually less work due to they do not get ortho pts unless they have heart issues. They do not get fresh post ops unless they have heart issues. So they end up with a lot of little old ladies with copd. Why are 85-90 yr olds on monitors? I ask that question and no answer.

I work on a Skilled/Acute Care Unit where the ratio is 8:1, soon to be 10:1. Hence, why I am looking for another job in a specialty area such as the OR or PACU.

Specializes in Oncology.
I work Oncology in upstate NY and we have 4-6 patients on nights(2-3 PCAs as well.) We never have more than 6(our floor will actually cap admissions to avoid worse ratios.) When I worked in Central Texas, we would have up to 8(also Oncology.) 8 patients didn't feel safe. We never capped admissions there. And we also only had 1 or no CNA on nights and did our own blood draws, etc. My current place has phlebotomy, clinical support, etc.

All I can say is Wow. I work in oncology in Pittsburgh and when working nights, we can have as many as 8 patients a piece (the least is 6) with no aid, and we also have to do our own blood draws from central lines, ports and Piccs, plus we function as secretary when we get admissions. Would love to have the staffing you have!

Specializes in Oncology.
medsurgtele, in CA the ratios are in effect for several years now and there is no difference due to shift worked.

Med/Surg 5:1

Tele 4:1

ICU 1-2:1 depending on acuity

Could only dream about and wish for ratios like this!:cat:

I don't know how you all do it! Yes the ratios are good in CA but still it is usually a difficult shift. Maybe our patients are in worse shape? I don't know, but if it is hard for us here in CA I can't imagine what it is for others. I can start a shift with 4, discharge 1, get an ER admit, and a post-op and believe me it is hard. Hanging blood, starting IV's, etc. If I believe that my care can be "iffy" I am wondering how you all feel your care is with so many? Must be a nightmare at times.

Specializes in Oncology.
I don't know how you all do it! Yes the ratios are good in CA but still it is usually a difficult shift. Maybe our patients are in worse shape? I don't know, but if it is hard for us here in CA I can't imagine what it is for others. I can start a shift with 4, discharge 1, get an ER admit, and a post-op and believe me it is hard. Hanging blood, starting IV's, etc. If I believe that my care can be "iffy" I am wondering how you all feel your care is with so many? Must be a nightmare at times.

We recently switched to blocked assignments, so now there are days (I work 12 hr days and nights) when you can lose almost your entire assignment and start getting ER admissions and have/process as many as 8-11 patients in an extreme case. Before the block assignments, we would assign patients according to acuity, isolation and planned discharges so that one nurse didn't get a whole assignment of isolations, several patients that needed blood or platelets or a whole assignment that was going to be discharged and of course, more than one patient receiving chemo at the same time. Yeh I don't know how we do it either? We just play the hand we're dealt and some just don't make it and quickly leave, some of them very shortly after they re even off of orientation (as mentioned in previous post). It's a mad, mad world in nursing these days. I don't see controlled ratios coming to Pittsburgh too soon in the future, if ever. There are so many nursing schools just in Pittsburgh alone pumping out nurses every year and I'm sure the hospitals don't think they ever have to do anything for us.

I do long term and rehabilitation care in California and the ratio is 30 pts to 1 nurse on my unit. Some of them can become critically ill fast. I am still expected to get the job done, with no overtime. LTC still has a long hard uphill battle to face. People think we do a bad job..say bad things about us...but you try having 30 pts.

you're right...we also have the same ratio in the Philippines... As a nurse, we want the best care we can give to our patients, but having to much is something else! I hope people could understand our situations...

lol OMG! ONLY FIVE PATIENTS PER RN WOW :woot:!! that is being spoiled I would be in heaven if I had ONLY five patients we always have seven if we have less we ALWAYS get an admission and the RN does the admission to the hospital where we are at right in the room and its alengthy process plus have all the home meds taken care of and get the docs to sign or approve med req. and this is night shift. and Med Surge its the hardest floor at our facility. WOW five patients :woot:

Specializes in Critical Care; Cardiac; Professional Development.

ICU/Neuro step down unit. Our Ratio is 3-4:1 on days, 4-5:1 on nights. This is in DFW, nonunion, Magnet hospital.

Specializes in ER, progressive care.

We recently switched to blocked assignments, so now there are days (I work 12 hr days and nights) when you can lose almost your entire assignment and start getting ER admissions and have/process as many as 8-11 patients in an extreme case. Before the block assignments, we would assign patients according to acuity, isolation and planned discharges so that one nurse didn't get a whole assignment of isolations, several patients that needed blood or platelets or a whole assignment that was going to be discharged and of course, more than one patient receiving chemo at the same time. Yeh I don't know how we do it either? We just play the hand we're dealt and some just don't make it and quickly leave, some of them very shortly after they re even off of orientation (as mentioned in previous post). It's a mad, mad world in nursing these days. I don't see controlled ratios coming to Pittsburgh too soon in the future, if ever. There are so many nursing schools just in Pittsburgh alone pumping out nurses every year and I'm sure the hospitals don't think they ever have to do anything for us.

We assign patients according to acuity/total care, isolation and planned discharges. We also have a designated pediatric nurse and we make sure they do not get any other patients in isolation...then we just determine who gets admits, we usually just go down the line unless somebody has to give blood products or they have a lot of totals, then we try not to give them the first admit.

Specializes in Med/Surg, Acute Rehab.

I just cannot understand why more hospitals don't invest in an admissions RN for each shift. To me that would be such a help for the floor nurses. We have one where I work, but only from 11a to 11p and only 3 days a week. It is just one position for now. If each unit had one, it would take such a burden off everyone and I really think it would be cost effective.

But I am not in management, so what do I know???

Specializes in Cath Lab & Interventional Radiology.
I just cannot understand why more hospitals don't invest in an admissions RN for each shift. To me that would be such a help for the floor nurses. We have one where I work, but only from 11a to 11p and only 3 days a week. It is just one position for now. If each unit had one, it would take such a burden off everyone and I really think it would be cost effective.

But I am not in management, so what do I know???

We were just discussing in our staff meeting having an admission/discharge nurse. This is I improve patient satisfaction, since most patients think they can march out the door as soon as the Dr says they will be discharged today. We are hopeful that management will try this idea!

I am shocked by the ratios listed here! I work in a PCU/ med tele floor (15 beds if each). In PCU 3:1 is the max for any shift. On med tele it is 4:1 on days, 4-5:1 on PMs & up to 5-6:1 on nights. We never go over the max. Our admissions are capped or usually a nurse on call is called in.

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