What is the nurse-patient ratio where you work?

Nurses Safety

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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.

I'm on a tele floor and it's 6:1 for days and nights.

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In LTC where I work it's approx. 25+ residents to 1 nurse. (Missouri) We have a trach pt, 2 on g-tubes, pts constantly needing pain meds or other PRN meds. We have to resolve conflict & family issues, call the drs., read labs, do vitals, & chart on almost all of our pts. It's overwhelming so most nurses leave as soon as they get their 1 yr. experience.

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Specializes in Emergency Nursing.

Michigan (Detroit Area); non-union, Magnet hospital, Medical Progressive Care (Step-down) - 3:1

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Specializes in Oncology.
I do long term and rehabilitation care in California and the ratio is 30 pts to 1 nurse on my unit. Some of them can become critically ill fast. I am still expected to get the job done, with no overtime. LTC still has a long hard uphill battle to face. People think we do a bad job..say bad things about us...but you try having 30 pts.

I would lose my mind if I had the responsibilty of 30 patients at one time, even once! I applaud you for the job you do, while wondering (really hard) why anyone would even attempt such a thing? There isn't enough money to convince me to take on that job!

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Specializes in Oncology.
I am in CA on a very busy med/surg/ortho/oncology floor and it is 5:1. We have a union and have fought hard to get this and also pay a lot of $ to the union. But.......the Corporation (that is what I call hospitals now) have found their way to hit us. Now the ratios for having CNA gets higher and higher so often we do not even have one. When the census is low we do not get one. So please tell me Mr. Corporation, how does having 5 patients and no CNA make sense just because there is low census? I still have 5 patients and now I am the RN and the CNA. Another trick is that the CNA's are only working 7 hrs so they arrive 30 min after shift change and leave 30 min before shift change. So now the lights are on while we are in report just to save a few dollars. Makes no sense.

I am so with you on this! The "corporation" changed their staffing grid about a year ago and we do the same thing when the census is low, it doesn't make a lick of sense that when the census goes down, we have MORE patients to care for? We haven't had an aide on night shift for I don't even know how long? So I completely understand where you're coming from, wearing all the various hats at night, I'm the RN, the aide and the secretary, if we get an admission (which we almost always do!). We have had 4 nurses resign in the last month and there's probably more to come. They're all new nurses that haven't even been off of orientation for very long, but the working conditions were so bad and some of them stated that they feared their nursing licenses were in peril. These are crazy times for nurses!

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In California, there isn't a ratio of nurses to patients in long term care. Instead there is a ratio of "direct care staff to patient". AM is 5 to 1, pm is 8 to 1 and noc is 13 to one. The ratio includes nurses+c.n.a. to patient.

One nurse with three CNA could be taking care of 32 on the pm shift. BUT! The ratio takes into consideration nurses in the building, not nurses on the floor. So if a nurse is working in an office of your facility(actually officially scheduled to be there) at the same time you are on the floor, that nurse affects the ratio so you could be assigned even more patients.

An example is the MDS coordinator sitting in his/her office. He affects how many patients the nurses on the floor are assigned. I know this because I am an MDS coordinator as well as ADON in a SNF. Monday through Friday, they count me into the ratio even though I don't work on the floor. On weekends, the am superviser affects the ratio.

Depending on the size of the facility, the DON can also be counted as direct care staff so that would affect your patient load.

It is very interesting reading and I recommend any LTC nurse in California go online and read it.

At least this is what I read at the California Health Department website yesterday.

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In California, there isn't a ratio of nurses to patients in long term care. Instead there is a ratio of "direct care staff to patient". AM is 5 to 1, pm is 8 to 1 and noc is 13 to one. The ratio includes nurses+c.n.a. to patient.

One nurse with three CNA could be taking care of 32 on the pm shift. BUT! The ratio takes into consideration nurses in the building, not nurses on the floor. So if a nurse is working in an office of your facility(actually officially scheduled to be there) at the same time you are on the floor, that nurse affects the ratio so you could be assigned even more patients.

An example is the MDS coordinator sitting in his/her office. He affects how many patients the nurses on the floor are assigned. I know this because I am an MDS coordinator as well as ADON in a SNF. Monday through Friday, they count me into the ratio even though I don't work on the floor. On weekends, the am superviser affects the ratio.

Depending on the size of the facility, the DON can also be counted as direct care staff so that would affect your patient load.

It is very interesting reading and I recommend any LTC nurse in California go online and read it.

At least this is what I read at the California Health Department website yesterday.

I forgot to add one point that is subjective in my opinion. The state lists the above ratios as minimums but then also says facilities have to have enough staff to provide quality care.

They suggest that if a larger ratio of direct care staff is needed, the facility has to provide them. They don't really define what good care is though.

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i work in tampa on a hospital med-surg unit. our patient ratio is 6 to 8 and the turnover is high.

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Specializes in 1st year Critical Care RN, not CCRN cert.
i work in tampa on a hospital med-surg unit. our patient ratio is 6 to 8 and the turnover is high.

I know at fletcher on 5main and the other med-surg floors it's brutal. 80% totals and the aides are pulled for 1:1 baker acts constantly. Makes for a tough night. I never rounded on those floors in school but many of my classmates did. Horror stories abound from there.

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Specializes in Public Health Nurse.
I live in Florida and work on a remote tele/med surg floor and our ratio is 5 to 1. But a lot of the time we are 4 to 1. I have floated to CCU in my hospital and the ratio there is 2 to 1. There are other hospitals nearby that have 8 to 1 ratios for med surg. I am very grateful to work in a hospital that is well-staffed.

Lizzie which hospital is that? I am in Florida.

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Specializes in Oncology.
In California, there isn't a ratio of nurses to patients in long term care. Instead there is a ratio of "direct care staff to patient". AM is 5 to 1, pm is 8 to 1 and noc is 13 to one. The ratio includes nurses+c.n.a. to patient.

One nurse with three CNA could be taking care of 32 on the pm shift. BUT! The ratio takes into consideration nurses in the building, not nurses on the floor. So if a nurse is working in an office of your facility(actually officially scheduled to be there) at the same time you are on the floor, that nurse affects the ratio so you could be assigned even more patients.

An example is the MDS coordinator sitting in his/her office. He affects how many patients the nurses on the floor are assigned. I know this because I am an MDS coordinator as well as ADON in a SNF. Monday through Friday, they count me into the ratio even though I don't work on the floor. On weekends, the am superviser affects the ratio.

Depending on the size of the facility, the DON can also be counted as direct care staff so that would affect your patient load.

It is very interesting reading and I recommend any LTC nurse in California go online and read it.

At least this is what I read at the California Health Department website yesterday.

Well isn't that just convenient for LTC facillities! It "looks" like they re staffing way better than they actually are. Nurses shouldn't work like that. If they couldn't find anyone foolish enough t work like that, then they would have to staff better to attract and keep them?

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I am on a cardiac progressive care unit where we start and monitor drips and patients who "minor code" on the general floors come here; we have 5-6 patients on days, 6-7 on nights with 1-2 patient care techs for 32 beds. Sucks but nobody is hiring out here. Been this way for a long time.

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