What you describe sounds like where I work (except not as many nurse assistants). I work tele, and w/ similar ratios. Nurses are leaving in droves. (You may wonder why- with such good staffing ratios).I think the main reason is that even w/ decent ratios- the pts on our floor are very sick, very heavy, and very complicated.It can burn you out w/ the FAST pace, when you have people going into SVT and Vtach frequently, post ops w/freq. vs, pt getting blood, unstable angina on drips, lots of unstable diabetics w/ Q2H bloodsugars, people needing 2-3 person assist to get them up to a chair, people needing total ADL assist, multiple comlicated dressing changes (many diabetic ulcers), most pts having 10-15 meds on the 9 am med pass alone (many times missing meds and having to req. from pharmacy), not to mention prns for BP/Pain,monitoring labs, the usual noting of orders, calling docs re: pt change in status, etc.RNs are responsible for LVNs pts in additon to their own. RNs do EKGs, and ABts, sometimes phleb.Many of these pts are so complicated and much time is spent coordinating discharge plans, and talking at length w/ family.It can be very very exciting, and rewarding, interesting work. But it is hard and exhausting. What seems to help...making sure each nurse gets at least their 30 min. undisturbed lunch break, having regular staff meetings (to discuss concerns & solutions), offering incentives to work overtime, and allocating extra staff sometimes when the floor is REALLY heavy & we need help. Have you tried asking the nurses at your facility what would help retention? Maybe they have some good ideas. Good luck!