Unsafe Nurse/Patient Ratio?

[lamp]

I work in a very small hospital were the census on the M/S floor can go from 4-20 in a few hours. The average census is about 15 probably. We have some post-ops (overnight stays), general medical problems, telemetry for the cp patients, swingbeds, and a LOT of nursing home patients. There is no tele floor, just us, the ICU, and the ER. Here is the staffing on the floor:

Days

1 RN, 1 LPN (2 if there are around 16 patients), 1 CNA, 1 Secretary, and the manager will come out to help if it gets "busy" - yeah right.

Nights

1 RN, 1 LPN, 1 CNA (that has to leave at 11 if there are 10 pts or less), No secretary, RT, Pharmacist, etc. Occasionally we get another CNA or LPN if it gets busy.

I had 19 patients the other night and it was 1 RN, 2 LPN's, 1 CNA. I just do not feel that this is safe? Do you agree? Talked with managers and CNO, but they do not help - think that this should be plenty (and they have been nurses on the floor before.) To top it off, Administration thinks that we are appropriately staffed, and sometimes think that it should be less!!! What are your ratios? How am I supposed to assess 19 patients the way they should be? Does anyone else think this is crazy?

[psalm, RN]

Numbers don't tell the story. You could have a low census but high acuity. Unfortunately, I don't have the solution for you. But you could try calling your NM at any hour of the night to let her/him know if you are over-extended work-wise...even if the numbers are ok.

[MedicalLPN, LPN]

In my opinion, 19 patients on for two nurses on a medsurg floor is way way too many.