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Nurse to patient Ratio

Reda Reda (New) New Expert Nurse

Specializes in ER, Management. Has 15 years experience.

Hey guys,

I work as a nursing director in a hospice/LTC hospital in KSA, we have 160 bed capacity with an occupancy rate of 90%, I cannot find any research or resource for the exact needed amount of nurse or PCA(patient care assistant). currently, we are doing 1 to 6, 1 to 7 in a 36 patient unit. on the shift there is 2-3 PCA helping out. all of the patients are bedridden, and some have a tracheostomy.  any inputs? I feel that the nurses are really struggling..

Closed Account 12345

Has 12 years experience.

How many nurses do you know who could effectively care for 6-7 bedridden patients, several of whom have trachs, most of whom probably have severe pain and/or anxiety, with bare minimal assistance from a PCA? 

These patients are sick. Just because they're dying doesn't mean they aren't deserving of quality nursing care. In fact, the fact that they're dying makes this ratio even more upsetting because your nurses are so overloaded they don't have time to just be present with these patients or offer additional comforts and support.  Give these patients the dignity they deserve at the end of their lives by ensuring enough staffing that they don't need to lay around wet or soiled for long stretches before someone helps them.

I'd drop your nurses to 4-5 patients each, and I'd have two nurses share a PCA. Total care bedridden patients take time and physical presence. Hospice is such a special field; treat your angel nurses better so that they can really be there for these people.


Specializes in ER, Management. Has 15 years experience.

I totally agree with you and according to my experience, yes 4-5 is an optimum ratio, however the COVID situation made things worse... the nurses who leave we couldn't replace them because there is no replacement. So I am really struggling to find a solution to decrease the workload as much as possible and I am open to suggestions, I was thinking of decreasing the nursing care as much as possible, here we are taking the vital signs q4, were I am searching for a reference to backup the idea of taking v/s q12/q8/q6 according to patients condition. 

So if you have any idea's I will appreciate it. 

Closed Account 12345

Has 12 years experience.

You could offer good financial incentives to your existing nurses to pick up extra shifts to improve your staffing ratios as a temporary solution - like $250 bonus pay, plus time and a half for hours worked.  Take what you can get if someone is willing to pick up an extra 8 hours instead of the full 12; at least that helps relieve the burden for a good chunk of the shift. I don't think it's right to pressure anyone to pick up extras, but you may be surprised how much money talks coming into a holiday season where people tend to spend more than they should. 

If you can't fill your open nursing positions, it's time to hire agency/travel nurses.  We're coming into flu season, and you're going to have nurses out sick, or nurses who have to quarantine 2 weeks with covid + spouses, or any number of issues. It is a patient safety issue that you have access to full staffing on any given shift.  It's an expensive option, but the patients and your nurses deserve it. 

Until one of those options fixes RN staffing, double the number of PCAs you're staffing.  If you have enough PCAs present to truly meet the patients' basic needs like toileting, bathing, clean linens, and taking vital signs, and they're hard working PCAs who work as a team, that would allow your nurses to focus on care that requires a professional nurse.  Offer your PCAs incentives to pick up extra shifts until you can hire more people, too - $100 bonus and time and a half for hours worked.  

Jedrnurse, BSN, RN

Specializes in school nurse. Has 28 years experience.

I know that you're busy, but if you'd really like to get some good insight as to what's needed, schedule yourself as a staff nurse for a few shifts. (One probably wouldn't be sufficient.)

On 10/12/2020 at 3:22 PM, Jedrnurse said:

I know that you're busy, but if you'd really like to get some good insight as to what's needed, schedule yourself as a staff nurse for a few shifts. (One probably wouldn't be sufficient.)

THIS.  THIS x 1,000,000.


Specializes in ER, Management. Has 15 years experience.

Nunya, and Jedrnurse. I totally understand that the nurses are suffering... the problem is in the administration. I am struggling to provide additional PCA.. plus I am not able to retain any nurse what so ever... so I was reaching out to see any new methods... or if anyone has an idea which can be implemented.. and cheap at the same time. I am an ER nurse for 10+ years.. I know the struggle but I am new to the admin world and I HATE IT.

2-3 more PCAs are probably needed. It seems like you are in a position where you need to look at a team based nursing model as opposed to a primary nursing model if you are truly not able to do anything about staffing levels. Start looking at Lean management to cut out tasks that do not add value (value does not just mean $$$) and to look at the actual set up of the unit.

Also, are the nurses stuck taking on roles of a lot of other disciplines (Social work, house keeping, laboratory, case management, etc)? If so, it may be a good time to establish boundaries and get non-clinical tasks off of their plate. 

What do your nurses tell you they are struggling with? Why are they leaving?


Specializes in ER, Management. Has 15 years experience.

egg122 NP,

thanks for this reply.. I will look into lean management as you said. 

yes, I am really in a position where I am tied up, so I'm trying as I said to decrease the burden off nurses as much as possible. 

any motivational ideas also?

I think this would depend on the general work culture of KSA- would having them be a part of the Lean decision making and implementation be something that would be considered motivating there or are decisions expected to be done in a top down manner? Serious question. 

I think expressing gratitude for the work they are doing and being very cautious not to nit pick tiny but ultimately inconsequential errors would help. As other posters have stated, cash always motivates hahaha

Are the nurses working on this unit from KSA or other countries? What are they hoping to do with their careers? Maybe investing in them personally and working towards building a cohesive team will motivate. 

Please don't buy food, it drives me crazy that many administrators think nurses are dumb enough to be placated with pastries or pizza. 

LibraNurse27, BSN, RN

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 7 years experience.

If you quit let management know why, that they made it impossible for you to retain staff and provide safe patient care. Hope it doesn't come to that though


Specializes in ER, Management. Has 15 years experience.

the problem is that quitting was one of my thoughts, but after 4 years starting as a nursing supervisor until being a nursing director now, I am pretty sure that caring about quality care or caring about the nurses is the least bothering thing to them.. so quitting will just let the nurses lose someone who is looking for solutions, rather than just sitting there for the money..

egg122 the majority of the nurses are from abroad, mostly Filipinas. most of them are here as a plan for a couple of years and back home.. so investing in them personally won't give a good outcome. 

PS: They love it when I buy food for them :). for me personally I don't like it.. but for them.. they love it 🙂 


Specializes in LTC.

Please - what's KSA?

You've asked for some motivational ideas - what about preferred parking privileges? I'm betting 'visitor parking' is down so some spots should be open.

How about some additional 'earned PTO'?  Really accrued, shown on each paycheck and then it MUST be used at 8 hrs, say, within a month? And it's short term.

Also, thinking about lightening the load - have you looked at decreasing the med pass by reviewing each pt's med profile to eliminate some meds? I mean how critical is calcium and/or  osteo-biflex for some pts? Can some combo-meds be used? Like the ones that combine a diuretic with a cardiac med as 1 pill? The pharmacy consultant can be an asset for recommendations.

Could some 'pre'stocking' supplies for certain pts be an option?  I realize what goes in a room has to stay there or be tossed. But say, for a bedbound, freq turned pt, maybe 2 extra blue pads and briefs and a few wipes be stocked/provided by each off-going CNA staff? In that room. Incoming staff would have a quick supply, not being required to run & get supplies. NEVER to be overstocked.

Similarly, pre-assembling small dressing bags could be made avail. Nurse would just need to grab a bag that had the specific supplies needed for Ms Jones spec drsg.

Food is not a bad idea, but that soggy, cold pizza is nothing appealing to me. But I have seen where individual wrapped mini-hoagies were a hit! I could grab one, take it home and enjoy on my time. Or let my kids enjoy.

Just some thoughts.

And it's very thoughtful that you have such a caring attitude for good care for you pts and also for your staff. TY on their behalf.




Specializes in ER, Management. Has 15 years experience.

I guess the work settings here in saudi arabia are different than other countries... here we offer accommodation with transpo.. in my hospital rarely there is a nurse with his own car and house... so this free parking won't be of a help for the nursing dep. but good idea though.. I have looked into some books and articles.. I found that more than 35% are rethinking the non renewal of contract because of the sufficient  appreciation from his boss.. I. Guess I should start reorienting the headnurses :)


Specializes in ER, Management. Has 15 years experience.


great Ideas... I like it... 

KSA is Saudi Arabia. I work in LTC hospital 160 bed, with a ratio of 1;6 with 2-3 pca per floor. on average the floor is 30-38 patients. I am also from out of KSA and the staff are mostly from filipins (Small bodies  usually) turning/bathing is a hell for them! thats y I try to get the big bodies as a PCA

out of desperation, I joined this allnurses, and I can see that it is VERY helpful. it is always a great idea to reach out and ask for help.. and that is when you can explore new ideas, it will be a combined experience. 

Thanks, dear.