I work at a Level IV CAH in rural Eastern Washington. Per CA guidelines, we can only have 25 beds (not including OB, observation or post-surgery patients). Our facility has about 15 long term swing-beds (like a nursing home) so we're only allowed to have 10 other in-patients in acute. However, we have also had 3 OB/mother-baby couplets and several observation patients at the same time. The LTC side is handled by one nurse. Acute has two nurses, charge and second nurse. The charge nurse also covers the ER, so if the ER is busy, the second nurse (ME!!) must handle all of the floor patients. Unfortunately, I am a baby (only 8 months of being an RN) and sometimes I get SOOO overwhelmed!
Theoretically, we have nurse managers during the week and on-call staff on the weekends to help, but nobody will sign for call (we already work 3 to 5 12-hr shifts per week). Luckily, our census hovers around 6-8 patients (we've had NO patients before - I felt useless) and the ER is usually steady, but not overwhelming.
On the up-side, I have been forced to hone my organizational and nursing skills at warp-speed to keep up. IF I ever move to town and work at a large hospital, I know I will be able to keep up!