IMHO, any more than 8 patients is too many for a pca to handle if they are expected to perform all basic care plus vital signs. Now, it does depend on the acuity level of each patient. I know many charge nurses that will not consider this when they make out the cna assignment. They go down the list counting and then draw a line; every pca gets 12 patients. This is the easiest way to do it, but not easy for the cna. Let's say cna #1 has 8 self-care patients and 4 assist while cna #2 has 6 total-care patients, 5 assist, and 1 self-care. This is NOT a fair assignment. I know it is difficult enough for the charge nurse to decide which nurses are going to get which patients, and that worrying about the cna's would only add to that; however, an overloaded cna means the patient ultimately suffers!
Also, consider the fact that oral care is the most overlooked part of care. Now, I normally have 12 patients. It is NICE, but impossible to come in, get report on 12 patients, and then go around and wash their faces and brush their teeth all before breakfast trays arrive on the floor. I would LOVE it if I had that kind of time! I once had a patient's family member ask me, "you're not going to wash her face? You wash your face in the morning don't you?" Again, I would love to wash each and every one of my patients' faces; however, it just is not realistic. Normally, before I even finish receiving report, I already have call lights going off for patients wanting to go to the restroom, family members who just got there and are furious that there mom is in a wet bed, family members wanting to know if dad is going to get a bath "sometime TODAY!" (it's only 7am!!), bed alarm is going off because the patient will not stay in bed and we can't use restraints, but hey we don't need restraints because we have bed alarms; it doesn't matter that we may be understaffed and not have the staff to run to the room as soon as the alarm goes off, but that's ok because we can just blame the staff if the patient falls for not responding in a timely manner.....I think you see what I am getting at. CNA work is tough. I enjoy helping others, but sometimes all I can do is just NOT enough. More than 8 patients is WAY too many, but hospitals do not care because they can always point a finger while collecting a bigger check by running floors short staffed. All of this is just my take on things though.