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.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I do 2x 3-11 and 3x 11-7 in LTC.
On the 3-11 we have either 34 or 36 patients to 1 nurse and 4 CNA's.
On the 11-7 we have 70 patients to 1 nurse and 3 CNA's. Note that 1 CNA on the prior shift remains in the building until midnight and we have one CNA from the next shift start at 6.
70 patients on the night shift 11-7 and one licensed person? 3 CNA's so they have >20 patients/shift and you don't help them.
It depends on the amount of CNA coverage and call-offs we have. In a Rehabilitation Hospital in Illinois. 7/6:1 on days (lots of OT/PT help), 6/5:1 on PMs, and 7/8:1 on nights. The first number is the usual, the second is with lesser or more CNA help.
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!
I also work in LTC and I have 25 pts. I dont like it, but keep being told that I "need experience" before being considered for work in home health or the hospital setting.
Specializes in Critical care, tele, Medical-Surgical.
I've never worked anywhere with minimum staffing requirements, what happens when you have too many patients and there is no one else to call in?
At my California hospital they always manage to keep the minimum ratio. They only add staff to meet the needs of high acuity patients when nurses act together.
Every so often on a Friday night there is no break relief nurse scheduled. Then all staff from both shifts signs an "Assignment Despite Objection(ADO) form stating in part, "As a patient advocate, in accordance with the California Nursing Practice Act, we are reporting that in our nursing judgment, our assignments pose a risk to the health and safety of our patients. As a result the facility is responsible for any adverse effects on patient care."
This is given to the shift supervisor who has the authority to call for agency nurses. Sometimes she does.
The charge nurse will then call the manager at home. Some managers answer and then works with the supervisor to get more staff or even come in herself.
If it continues over the weekend a delegation of about a dozen goes to the DON Monday morning. Then there is no problem for a couple months. The next time it is another unit with no break relief on a Friday night.
When there is one or more very high acuity patients often one of the patient's physicians will be called or the unit's medical director will be called and the situation explained. Sometimes an order for a sitter or for the RN assigned to the high acuity patient to have no more than two or three patients will be written.
It is more complex than this post, but when nurses work together at my hospital we are able to truly advocate for our patients.
This is the section in hospital licensing regulations that contains the ratios:
Esme12, ASN, BSN, RN
20,908 Posts
Where is this facility so I can report them.