Med/Surg floor patient ratios-patient safety


I currently work at a County hospital that truly treats a special patient population. We treat many homeless, prisoners, patients with addictions and psych issues. As you can imagine there are some complicated issues associated with each patient. Sometimes one patient can feel like 2 or 3 considering all the factors associated with a special patient population. About three years ago our ratio changed from 1:4 to 1:5 and just recently due to many patients requiring sitters, most of the CNAs are sitters instead of working the floor. The other night I didn't have a CNA to help and had 4 patients with the possibility of going to 5. My main concern is patient safety and missing something because we are doing both CNA and RN duties. I'm frustrated because I feel that this organization is putting patient safety at risk and my license at risk as well. I'm afraid of retaliation if I speak up and don't know what to do.

Specializes in SICU, trauma, neuro. Has 16 years experience.

Those ratios don't sound horrible unless there's more to what you say.

My first job was a primarily a neuro/ENT floor, so lots of fresh trachs, lumbar drains (which required q1 hr measurement and leveling), tubefeeding, wound care, the psych stuff that comes with extremely disfiguring ENT surgery, the confusion that can happen with brain maladies..... but we also had adults with CF (multiple IV abx, psych issues with the chronic-from-birth illness, occasional insulin gtts), urology (CBIs), and ophthalmology (q 1hr eyedrops.). Typical 0700-2300 ratios were 1:4-5. Typical 2300-0700 ratios were 1:6-7.

I also have worked in LTACH where pts are sicker than med-surg pts. There we had pts on ventilators (actively weaning -- not long term home vents), complex wounds (dressing changes could take 2 whole hours), telemetry, pts/families being extremely difficult from the months in the hospital. Our ratios were also 1:4-5.

It was busy for sure, but I figured since I wasn't battering pts or financially exploiting them, or stealing their narcs, my license was ok. :)

Unfortunately, we don't have the ability to split in half. When working without a CNA, you have to prioritize things. Much of the priority things are the things that require a license -- meds, assessments, interventions for a change in condition, etc. When I have worked with no CNA, I of course prioritize things like eating, answering call lights, changing soiled linens, and toileting. But if there's no help and no more time, that pt won't get a routine bath, or sat up in the chair/ambulated, or routine daily linen changes. It's not ideal, but it is what it is. :no:


54 Posts

Specializes in OR.

Med surg tele, very heavy pts. We get 6 at night. Recently they've been cutting staff so now we sometimes take 7. This is very unsafe imo but they are more concerned about the budget than safety.


17 Posts

I can relate. We get about 7-8 patients on days on the same unit and it feels so unsafe. The quality of patient care declines and I may risk losing my license