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.

[dirtyhippiegirl, BSN, RN]

I work nights on mixed acuity burn unit. We have a wound care tech/PCA about half of the time for a 17 bed unit. No unit secretary and we do all of our own admissions.

Max is 1:4 medsurg/tele patients.

1:2 ICU patients although max is 2 patients if you have an ICU patient. So a pretty sweet assignment is 1 ICU pt and 1 walky-talky m/s who will be d/c'ing soon.

If it's a big, unstable burn we'll often flip and do 2:1 esp. if there's no wound care tech to debride and help dress the burn.

I'll admit that our staffing ratio is easily the best in the hospital for nights. I think because our staffing matrix is old and based off when BID dressing changes, routine tanking, as well as bigger burns in general, were the norm. The attendings that we have now prefer qday or even q-every-other-day changes and we can go weeks without tanking a patient.

[DoeRN]

We were just discussing in our staff meeting having an admission/discharge nurse. This is I improve patient satisfaction, since most patients think they can march out the door as soon as the Dr says they will be discharged today. We are hopeful that management will try this idea!

I am shocked by the ratios listed here! I work in a PCU/ med tele floor (15 beds if each). In PCU 3:1 is the max for any shift. On med tele it is 4:1 on days, 4-5:1 on PMs & up to 5-6:1 on nights. We never go over the max. Our admissions are capped or usually a nurse on call is called in.

Wow I want to work at your hospital. I worked on a PCU recently and had 6 patients on days! I wasn't too happy about that and will never take a full time assignment on that floor. I'm a float nurse and the nurse manager actually asked me if I would take an assignment there. I thought she was joking at first. I said no, I will continue to float. The first hospital I worked at when I graduated had ratios like yours. I should have never move out of state. Another reason why I'm going back to school.

[turnforthenurse, MSN, NP]

I just cannot understand why more hospitals don't invest in an admissions RN for each shift. To me that would be such a help for the floor nurses. We have one where I work, but only from 11a to 11p and only 3 days a week. It is just one position for now. If each unit had one, it would take such a burden off everyone and I really think it would be cost effective.

But I am not in management, so what do I know???

Where I work, they will "sometimes" send someone to function solely as the admission nurse. But it isn't consistent. It helps the floor nurses out SO much and I wish they would do it all of the time.

Our unencumbered (as in they don't take patients) dayshift charge nurse will help with admissions and discharges...but on nights we don't have that luxury. Whoever is in charge still has to take a full load of patients.

[jessica.womble]

The hospital we do our clinicals for school is starting a program with admission/discharge team that will float floor to floor to speed up discharges and admissions. But this will in turn help the floor staff and not pull the team RN or charge nurse from their other duties. I agree with a statement made last week. More hospitals should adopt this plan. I have actually worked at this hospital and know from experience how much this will help all the way around.

[CherylRNBSN]

I work on a very busy med-surg floor. Our ratio is 6:1. I punched out at 2040 tonight. And I know I have excellent time mgmt skills.

The ratios are too high! They pile as much on us as they can get away with. We can't eat a 30 minute lunch without getting up to give a pain med or toilet someone (b/c the aid is busy), or receive a pt or send one to OR. While I make sure I get a 15 min brkst break, I NEVER take my other 15 minute break, which I am docked for. I think it is wrong and it is poor management to expect staff to work a 13 or 14 hr shift without their breaks.

How can you take care of 6 high acuity pts safely? You can do it, but you are killing yourself. It leads to BURNOUT. And higher infection rates, higher complication rates, which leads to...higher mortality. And staff turnover.

I had a pt in sickle cell crisis requiring q 2 hr pushes. Two fresh surgeries needing pain mgmt. Two units of blood to hang. Those pts got all my attention, while my others were pretty much ignored.

Our ratios should be no more than 5:1. Preferably, 4:1.

I am in a room trying to hang blood when I see that the IV is leaking, and must be restarted. While I have FOUR pts. calling for pain meds, and the OR wants to come get my other pt....

No human can be three or four places at one time, yet...that is expected of us.

IT SUCKS! What can we, as Professional Nurses, do?

I am very worried about the future of nursing and healthcare. And I would never leave a loved one who was really ill alone on a Med Surg floor. B/c there is no guarantee they will be turned, or fed, or medicated as they SHOULD be. Or that their condition will be monitored as closely as it should.

Not b/c the nurses don't WANT to, but b/c they just can't be two or three or four places at once.

I don't see it changing. And that is why nurses leave the bedside. But I guess as long as their is an endless supply of new nurses willing to take it on, they will continue to demand this.

Good for the bottom line, bad for pts. And bad for nursing.

[wooh, BSN, RN]

I like the idea for admissions. I'm not sure I like the idea for discharges. I know when I've helped out a coworker by taking the discharge paperwork in to explain it and get it signed, the patient/family will ALWAYS ask at least one question that I don't know the answer to, but would if I was the primary nurse, or would at least be in a better position to figure out the answer if I was the primary nurse.

But for admissions? So helpful. It turns what can be an hour or so of work into pretty much just getting report.

[jrbl77, RN]

This is a great topic and one of the main reasons that I left floor nursing. You may start with 6 pts, but when you send 1 or 2 home, that paper work usually takes at least 15 mins and of course the pt wants to have left 1/2 hr ago. Then you get 1 or 2 admits to replace the pts that left. The staff nurse ends up a BUSY nurse. Add to that, going to get blood, hanging the blood and then staying with the pt for 15 mins, we are talking about up to 20 mins or more of time. Most important, be pleasant, warm and fuzzy while running around doing all of these things. And get off on time!

[Seasoned]

Google Congressional Bill H.R. 1907.IH

Soon it will be against the law to be out of compliance with the minimum nurse staffing requirement.

An excerpt:

“(A) One patient in trauma emergency units.

(B) One patient in operating room units, provided that a minimum of 1 additional person provided that a minimum of 1 additional person serves as a scrub assistant in such unit.

C) Two patients in critical care units, including neonatal intensive care units, emergency critical care and intensive care units, labor and delivery units, coronary care units, acute respiratory care units, post anesthesia units, and burn units

(D) Three patients in emergency room units, pediatrics units, stepdown units, telemetry units, antepartum units, and combined labor, deliver, and postpartum units.

(E) Four patients in medical-surgical units, intermediate care nursery units, acute care psychiatric units, and other specialty care units.

(F) Five patients in rehabilitation units and skilled nursing units.

G) Six patients in postpartum (3 couplets) units and well-baby nursery units…”

Write your congress representation to support the bill ASAP. Thank and join the ANA (American Nurses Association) for working on this issue and getting nurses this far!!

:yes:Yea, Baby Nurse

[FrostyRN]

I work in a SNF. Yes, by CHOICE. Day shift, 4 CNA's, 2 nurses. Night 1.5 nurses, 3 CNA's. Census? 56 average. We'll get another day nurse and half nurse at night when census is 62, and maybe another CNA. UTAH. Just completed survey, went well, but with a tag for? inadequate staffing! Although Utah has NO ratio limits at all. Wish they did, or that acuity was taken into account.

[awdreher]

I am interested in knowing what ratios are on remote tele med surg floors. I work in Tennessee, in Memphis at a large inner city hospital. The acuity on my floor is high. We take care of all "hospitalist" admissions. Generally the patients have multi system problems, are non compliant and uninsured. Our ratio is 6:1 on day shift and it is impossible to adequately care for the patients and do all of the mandated documentation. Management is constantly adding more documentation tasks to nursing. I need my own scribe!!! On top of that, the push to raise HCAP scores is a never ending anthem from management. How can you raise the scores when you can only be in one place at one time? It is frustrating. I feel like I hang on by a thread. Anyone else out there feel like that? I just joined the campaign for lowering ratios. I have to do something.

[j0yegan]

I work in Illinois as a Postpartum/Nursery RN we usually have a 4:1 ratio. But we don't just have 4 patients, we really have 8 patients.. We take care of Mom and baby.[/quote']

Me too... and that doesn't even count multiples (twins, etc).

[seadobe]

I worked as a traveling nurse for a while and it always amazed me how ratios can fluctuate depending on where you work. Do you think nurses that work with lower ratios are more satisfied with their jobs?

Right now I work in Massachusetts and work with a 3:1 ratio, but we have no aids. Its definitely busy with the high acuity of the patients.

I am working on my masters degree and I would love if anyone would fill out this questionnaire on nurse satisfaction regarding ratios. https://www.surveymonkey.com/s/XXT87DH

THANKS!!