I work on an extremely busy surgical floor with frequent admissions and discharges. We get ortho, plastics, and GI surgical patients, plus a host of medical patients. Our ratio is 1:5, but very often we go up to 1:6 on day shift because we are short on nurses. We are also frequently short on techs and often have confused sitter patients, so sometimes an available tech has to sit with a patient. Our standard vitals and I&Os are q8h, but we do post op vitals and about 1/3 the patients have q4 vitals and/or q4 I&O. Patients are often really sick.For experienced med surg nurses, what have you seen change about Med/Surg in the past 10-15-20 years. Documentation, staffing, patient demands, acuity, responsiveness of doctors and physician assistants are all things I'm interested in hearing about.