What is the nurse-patient ratio where you work?

[kaliRN]

So I recently learned on allnurses that California is the only state that has mandated nurse-patient ratios. I was honestly shocked and found it educational how hard fought a battle that was and how many other states are trying to pass similar laws. But it sparked my curiosity as to the average nurse-patient ratios in other states? What are the ranges of patients an RN sees on the unit/floor?

In California the ratios are as follows:

ICU, CCU, NICU/PICU, PACU, L&D, and ER patients requiring "intensive care:" 2:1

Step-down units: 3:1

Telemetry, Pediatrics, ER, Antepartum/Postpartum: 4:1

Med-Surg: 5:1

Psych: 6:1

*The only exception is a local or state declared emergency.

I became an RN after this law was in place for some time, so I really would be interested in the experience of others.

[SarahMaria, MSN, RN]

On my forensic psychiatric unit in Connecticut, it is usually one nurse to 20 patients. This can be difficult.

[TaraACelestin]

I belI've every state should have some sort of plan like this in line. I'm in the nursing field and am inspired to further my career and edication. I see it in every way some nurses are naturally meant to do the job some want to do the job but need some assistants. Then there are those that are there for the letters behind there name and a pay check. Those are the ones I believe God puts there for me to strive to give me the extra push in my busy life to continue. To be that concerned ear for those patients and families. Though I know I am not a psychologist, but it does not take a piece of paper to qualify you to care or show compation. The way God does for us everyday.

[TaraACelestin]

I am just glad to be in the medical profession. God will put me were I need to be to help and comfort the sick and needy. Also those who are unfortunate not to have families just us nurses to comfort them.

[NurseFifty]

I suggest everyone read the CA law in its entirety. The following is an excerpt. It means the MDS and the ADON should not be counted.

"....Nurse Administrators, Nurse Supervisors, Nurse Managers, and Charge Nurses,

and other licensed nurses shall be included in the calculation of the licensed nurse-to

patient ratio only when those licensed nurses are engaged in providing direct patient

care. When a Nurse Administrator, Nurse Supervisor, Nurse Manager, Charge Nurse or

other licensed nurse is engaged in activities other than direct patient care, that nurse

shall not be included in the ratio. Nurse Administrators, Nurse Supervisors, Nurse

Managers, and Charge Nurses who have demonstrated current competence to the

hospital in providing care on a particular unit may relieve licensed nurses during breaks,

meals, and other routine, expected absences from the unit....."

So that facility you mentioned is already violating the law. You can report then to the DOL.

It is the facilities' problem to provide enough staff. It is not the employee RN on the floor who shoulder's this administrative problem regarding running the facility.

If you are an ADON or someone who manages staff, then you should probably read more into what the law is and what it means, because if you enforced it incorrectly, you are liable for breaking it.

[herring_RN, ASN, BSN]

i:5 california... not sure how i end up with 2 additional (7) when an LVN is on the floor. i have no aids/assistance/whatever you want to call it. i do EVERYTHING myself...

Your hospital is violating the law.

This section of the California Code of Regulations outlines what MUST be performed by a registered nurse for every patient:

https://govt.westlaw.com/calregs/Document/IFD69DB90621311E2998CBB33624929B8?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=%28sc.Default%29

Here is the section with the ratios and competency requirements:

https://govt.westlaw.com/calregs/Document/I8612C410941F11E29091E6B951DDF6CE?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=%28sc.Default%29

Clearly the above makes it clear that all patients must be assigned to a registered nurse.

Some nursing practice alerts regarding working with an LVN:

http://www.nationalnursesunited.org/page/-/files/pdf/nursing-practice/advo-alerts/rn-lvn-role-assessment.pdf

http://www.nationalnursesunited.org/page/-/files/pdf/nursing-practice/advo-alerts/co-signing-lvn-chart.pdf

http://www.nationalnursesunited.org/page/-/files/pdf/nursing-practice/advo-alerts/lvn-break-coverage.pdf

http://www.nationalnursesunited.org/page/-/files/pdf/nursing-practice/advo-alerts/lvn-transport.pdf

http://www.nationalnursesunited.org/page/-/files/pdf/nursing-practice/advo-alerts/iv-meds-role-of-rns-lvns.pdf

On a unit where patients require frequent suctioning, dressing changes, tube feedings and such assigning an LVN rather than a CNA can make it possible to assign an RN more patients because an LVN may perform those tasks.

No RN may be assigned more than five med/surg patients, four telemetry patients, or three step-down patients at any time. That includes meal and rest breaks.

[Everline]

1:5 on day shift, 1:6 on night shift. This is a neurology floor with overflow M/S. It can go higher at certain points in the year or when people call out, of course.

[Tenebrae, BSN, RN]

New Zealand

I work three days in a LTC facility. I have over all responsibility for 35 residents. We have health care assistants who cover the cares for most of the residents 5:1 ratio. Myself and the enrolled nurse generally have direct care of the sickest 2 patients

I also work for an agency per diem

- long term pysch rehab 1-3 patients per nurse

- med surgical between 1-4 patients per nurse

[Dandilyun]

I am in California, and the Post Partum ratios are not exactly 4:1. That is 4 COUPLETS, or 4 moms and 4 babies, so 8 patients to assess and chart on. AWHONN guidelines suggests 3 couplets, and I am proud to say my director worked very hard to make that the standard in our facility.

[SlickSouthpaw]

My past work, which had half the facility as long term patients and the other half as *short term* and worked officially under the title of "Medical Rehabilitation Center" had nurses at 1 to 30 patients, and I had anywhere between 13-20 patients as a CNA depending on census. Needless to say, there's a reason why it's former work.

Thankfully this new job has me at 10 patient avg in terms of care.

[shesanurse]

I can feel your pain... i am an lvn for a 40 bed unit. Soooo stressful, have BS checks, insulin to give, a lot of meds, GT, Txs, dr orders to carry out, demanding pts, vip relatives, name it i have it... makes me want to quit my job every single day.