The large patient to nurse ratio is giving us a bad rap.
Patients and their families do not feel well cared for (and on some occasions are actually not well cared for) when we are running in and out of their rooms trying to get to our next patient.
When I was a student, I believed that the patient to nurse ratio should be limited to 5 patients:1 nurse (or less.) I remember that people would chuckle or roll their eyes at the idea.
Now that I am a nurse, I still FIRMLY believe that the patient/nurse ratio should be 5:1 or less.
It's a quality issue.
It's a care issue.
It's a safety issue.
As far as I know, CA is the only state with a limit. This needs to change in the other 49.
I work in Cali and did ICU because of that strict ratio. I switched to ER and despite our learns rules it's not uncommon for them to bend them. You can have a sick ICU pt and three others. I've had 4 ICU pts in the ER before and was drowning despite begging for help there just was no one available. I had two gI bleeds, stroke and a clogged VP shunt. Possibly the worst night of my career. One of my GI bleeds was active and had a hugb of 5 and I was pouring blood in, the other was also in Dts getting Valium pushes every 10 minutes. My other two appeared to be stable but I couldn't really check on them much. I finally left that hospital. It wasn't uncommon to miss major stuff because of how short staffed we were. 14 to 16 nurses isn't adequate for a 66 bed level 1 trauma ER with 50 patients in the waiting room and another 10 to 20 in the hallways every day.
I still encounter unsafe assignments and it really takes good team work, standing up for ourselves and a lot of paperwork from the union when unsafe staffing occurs.
I couldn't imagine having the nurse/patient ratios that some of you have.
I work in a hospital where we have ICU (1:2), Progressive care (1:3), and Acute care (1:4-5). The benefit to this system is that as the patient's acuity decreases, the ratio increases accordingly. It takes into account the acuity of the patient. Not only that, but the HOA strictly enforces this ratio.
I knew my job was awesome, but I didn't realize that some hospitals do not have progressive care. A friend came from an outside hospital, and she was talking about the 1:6 ratios that the nurses had at her old hospital. She explained that some of those patients would be considered progressive care by the hospital we work at, and they were included in the 1:6 ratios. I couldn't even imagine the stress of that job.
Also, according to my other thread of "I don't understand the anxiety part of nursing"...I'm starting to see why some are stressed. Chalk it up to ignorance, and consider me informed now.
For those of you with these ratios, I don't have an answer, but I completely agree that this is unsafe. I hope you do find jobs where the ratios are better. You are unsung heroes in the medical world.
Come to the ICU side, we have 1:2 ratios. Sometimes 1:1, and sometimes 1:3 when we are really short, but three patients is the most I've ever had at any ICU job. I swear it's worth moving to ICU just for the ratios. Yeah, those two are busy, but there's still only two of them - so the highest number of people you could have on a call light at one time is two.
From my observations, that "1:3 when we are really short" eventually hits the powers that be as:"Hmm, they take three patients and seem to deal with it ok. Why not save some $$ and staffing hassles and not try so hard to get coverage the next time?" I think the charge nurses really need to buck that trend. Our ICU ALWAYS pulled in an agency nurse if they couldn't get coverage. I don't know what the pulse there is right now, but once you open that gate, floodwaters tend to head downstream eventually. IMO, there should be a legally mandated 1:2 max ratio in ICU, and other mandated ratios for stepdown, Tele, and floor.
NickiLaughs, ADN, BSN, RN
2,387 Posts
I work in Cali and did ICU because of that strict ratio. I switched to ER and despite our learns rules it's not uncommon for them to bend them. You can have a sick ICU pt and three others. I've had 4 ICU pts in the ER before and was drowning despite begging for help there just was no one available. I had two gI bleeds, stroke and a clogged VP shunt. Possibly the worst night of my career. One of my GI bleeds was active and had a hugb of 5 and I was pouring blood in, the other was also in Dts getting Valium pushes every 10 minutes. My other two appeared to be stable but I couldn't really check on them much. I finally left that hospital. It wasn't uncommon to miss major stuff because of how short staffed we were. 14 to 16 nurses isn't adequate for a 66 bed level 1 trauma ER with 50 patients in the waiting room and another 10 to 20 in the hallways every day.
I still encounter unsafe assignments and it really takes good team work, standing up for ourselves and a lot of paperwork from the union when unsafe staffing occurs.