Perhaps a nursing ratio is not the answer, it would be nice to hear from more California nurses about how it works for them. However, I had one crazy-busy-full moon type shifts in the urban ED Level I trauma center I was working in where I racked up 11 patients. Yep, that's right ELEVEN. Patient acuity was not taken into account and there was just a simple rotation-style assignment: when you were up for a patient, you got it. Period. Two of them were vented and one of them one needed charcoal/lavage) and another had a severe ankle fracture and was going to the OR. I went to the charge nurse and told her I was drowning and needed help. Her idea of help: moving the two vented patients into the same room when one came back from CT. Then, I had a "mishap" with the NGT that left me, the patient, and the ventilator looking like a minstrel show. By the ended of the shift I was exhausted, frustrated, and covered in charcoal that never came out of my scrubs. I managed to see the above three patients, the others I barely saw. Luckily they were all were minor and nothing went wrong. But it was luck alone. Can anyone say that this was not an extremely dangerous practice?? And do I have to mention this was at a for-profit hospital...?