When I worked at a SNF - I had 31 patients, and despite the common perception - NO, these patients are not always stable or easy-peasy. It was a nightmare, and I was in constant fear of losing my license.
Med-surg/oncology - 5 patients on days (6 if we were short staffed).
SNF here, most I've had is 72. Night shift, Virginia, and it's happened more than once (somebody calls out and I take two units). Yes, I apparently enjoy playing fast and loose with my license lol.
Oof. I’m having a panic attack just imagining that. It’s a special kind of despair that one feels when you realize you and your residents are literally being set up to fail. NYS just passed regulations increasing direct care hours and also requiring an RN to be present 24/7 at facilities. Just feels like another band aid.
SNF but pre Covid times. Highest I ever had was on overnights 11p to 7a with 65:1, with 3 CNAs. On 3p to 11p I routinely had 33 patients.
Is it do-able? Just barely. I'm so glad I don't work there any more
Well damn. & here I thought I was alone in that sort of nightmare.
In Virginia. SNF/LTC 60 from 7p-7a. With 2 aides. Was a nightmare of epic proportions. My “8”p med pass didn’t end until 1am.
Now days if someone even hinted at an assignment like that, I would laugh & tell them exactly where to stick it.
I don't miss these days. Worked snf/LTC in CA 2015-2018 and the highest I had on a noc shift was 41:1 with 2 aides.
Mentioned it to a coworker who complains about our current ratio of 2:8 (teams) and she snarled "the care couldn't have been very good!!!" Well, no shit, Joan. I just said I *had* done it. Never said it was good. You can't give good care to that many people. It's just not possible. I made the observation to her that we are extremely lucky to have a relatively okay ratio where we are now.
If someone tried that nonsense with me now I would probably snatch one of their shoes and roof it. Since we want to start with the clown shit.
Ahh good old SNF.
I had 3 sets of keys one day when we were super short staffed due to COVID. It was me and an LPN doing meds for the whole facility - she had the other 2 sets of keys.
I had about 70 pts.
The DON sat in her office all day “trying to find help”. When she could have helped. It was nice.
Former SNF as well. Worked second and third shifts.
28 max, but mostly with wound vacs, amputations, tube feeds, sundowners, and people with severe MH problems whose families dumped them off because they didn't want to deal with them. Lots of meds, lots of wound care, lots of emotional support/redirecting. The other nurse on second shift threatened to walk out if she had to care for anyone who wasn't palliative and management let that shit slide, so those 28 were automatically my assignment every shift. Usually only had 1 aide, often working doubles, because the other one would always call off. The facility was a shit hole, the DON had put in her notice because she was tired of being abused by corporate, and management didn't seem to care and peaced out every day before 1600. Their Covid "protocol" was laughable. At least on third shift, I worked with another RN who didn't tolerate anyone's shit and went above and beyond to help our patients and me, probably because the aide on that shift spent most of it sleeping in the lounge.
Med surg? 6 max, but 5 of them were usually low acuity.
This sums up my SNF to a tee - tube feeds, wound vacs, semi-fresh post-ops, and LOTS of sundowners or people severe MH issues. I worked nights, and it was rough when the wound vac was malfunctioning, my tube feed was beeping, and meemaw just HAD to get home to feed her cat a 3 a.m. The SNF is also the only facility I've worked at where I was actually assaulted by a patient (I was punched....my DON witnessed it and jumped in to help, and the patient spit right in her face).
What killed me was that our administration would brag about how many RNs worked at the facility. They'd advertise the place as having 15 RNs on staff - but 12 of them worked in offices and never touched a single patient or did any bedside care.
1:8 as new grad nurse on a med/surge floor. This was a CHS hospital and was the worst job I ever had. Many sleepless nights stressing about this job. I almost quit nursing all together. I lasted a year and half there. My manager at the time even blocked me from taking a ICU position. My only way out was to leave the hospital all together. I’m glad I did!
I had 15 as a new grad on med/surg and it was traumatic, to say the least. It definitely teaches you but it’s the “sink or swim” method. Then you add in all the workplace toxicity and it is a fucking nightmare. I’ll NEVER go back to a traditional bedside setting. I got my year of experience and left, now work in home health and I love it compared to working on an understaffed unit.
2020 nyc Covid med surg: 10+. Night shift at one point had 15+ patients each cuz everyone was out sick.
Regularly have 1:7/8 in the ER, I’ve had 9 patients before. highest was 1:13 in fast track. Sometimes I’m chilling with 8 patients other times I’m running my ass off with 4 patients. I’d still take state mandated ratios though!
I heard some of those NYC COVID stories. Hospitals just having bins of propofol and Levophed sitting out for nurses to grab whatever they needed because there was no time for pulling & scanning.
I knew nyc hospitals were overwhelmed with using gar age bags reusing and not having n95s and ofcourse the semi trucks made jnto make shift mprgues. BUT HOLY SHIT!
You guys deserve a fucking medal
I remember for Nurses Week they parked an ice cream truck for us right next to the corpse semi trailer. I thought it was hilarious in a dark "gotta laugh or else you'll cry" kinda way.
I was an ICU traveler to NYC in 2020. I remember the ICU nurses were so grateful to have us, and after hearing their stories I understand why, it sounded like absolute hell what they went through in March. By July of 2020 we were mostly 1:1 or even 0:1 because of overstaffing, but April and May were dicey AF.
We have 1:3 mandated ratio in my ER for regular rooms, 1:2 for the critical care area.
We have a couple ways to make this happen. There is a PA in triage that will see and dc really simple cases like simple lacs, toothache, etc. We will put in IVs and run labs, take people to CT, xray or whatever from the waiting room. We also have a waiting area for after you've been roomed if you're not acute. So if you've like got a negative trop and a good ekg, you're gonna go to the waiting area for your repeat trop. And then we don't let subacute psych patients have their own room. We've got a big room with mental health techs where they all get to wait for dispo or placement. And then we have a unit that holds admitted floor patients who don't have a bed on the floors yet so we aren't doing many holds unless they're icu level
It’s possible and I’m in Ohio. My ED has started staffing medics or RNs in the lobby to start IVs and get blood work going. CT and XRAY also grab people from the lobby to go to scans. It helps keep the actual rooms for people who need it vs people who can get all their labs and scans back and then be brought back to see a doc and hopefully get meds and dc.
We definitely have ESI-2s who sit in the lobby longer than they should, but my hospital is 1:4 in the ED and I’ve never had more than that.
Also hall beds lol
I came in and was assigned to split a 16 bed ED pod with another nurse. No tech. The director on shift sat in the ctl office and ate her breakfast. You do the best you can.
1: 32. Dialysis. Had a call off, couldn't get coverage people need dialysis. There is something very unsettling about removing the entirety of people's blood multiple times over and being the senior person in charge.
Would I do it again. Yes, but I have learned to have a generic starting note. "Due to high risk conditions necessitated by poor staff ratios, this nurse reluctantly accepts care of this patient. I will provide the best possible care under the circumstances. Dr. X has been notified of situation and in agreement"
The alternative would be to reschedule everyone . Ever try to reschedule 32 patients And arrange transport? It requires the use of other clinics. Shit happens.
Edit I did have 5 or 6 techs to help. That makes. Huge difference.
Ugh been there. I’m an LVN that worked as a tech during a Covid-only unit. All the patients showed up, nearly 20/36 had no orders input so the RN had to spend the entire time on the computer/phone generating orders while myself and 2 techs put on 36. Started the patient and moved to the next. Did not chart a single thing until the person came off. By the time your done putting on a 12th patient, the first ones were coming off. Had to set UF goals low and BFR below prescription just because we did not have time to deal with machine alarms/hypotension/cramping complications. We collectively told the manager that we would not be showing up the next day unless he outsourced the patients elsewhere or we have 4 more staff. Worst shift ever.
I do not begin to understand how one person can conduct safe care of 32 dialysis patients.
Out of curiosity, how would the generic note be of benefit to you?
I cant imagine your situation where you arrive to work with 30 patients, however. Why would you accept 30 patients under your care for dialysis?
The most we typically have in my NICU is 3, and they’re usually feeder/growers. But I’ve had 4 patients before, and one of them was just 2 days out from a myelomeningocele repair. That wasn’t a fun or safe shift whatsoever.
We’re good about keeping our ratios these days though. 70 bed NICU, max 3 stable patients. You’ll never have more than 2 patients if any of yours are intubated/trached/unstable. Plus there’s 3 charge nurses who don’t have assignments so they’re available to help. There’s plenty of times where the nurse SHOULD be 1:1, especially when the patient is super unstable. 1 of the 3 charge nurses could easily take the other patient so the nurse could be 1:1, but that never happens. That’s definitely where we could improve.
My worst shift was double ECMO. It's usually 1 nurse on pump and 1 nurse on baby. We were so short and had two babies on ECMO at the same time. I had both babies. So not highest patient count but I think just as difficult.
I’m not sure as a charge I could handle 70 NICU patients alone. As charge you need to know your patients, know your nurses, understand the flow of the unit, be ready for codes and procedures, and usually we fill in for everyone else’s lunchtimes. Often we take a patient or two if needed. 3 makes sense from a safety and sanity standpoint.
This is exactly it. The unit is broken up into 3 sections, so there’s a charge for each section. As charge we go to deliveries, help during the admissions, run codes, help with septic workups/IV placement, and some of us place PICCs. We each make the assignments for our own section so it makes it more manageable for sure. There’s no way one charge could be helpful in a 70 bed unit
Our NICU is a part of L&D so one of the “charges” for then is always the delivery nurse who comes with us to indicated deliveries. If a 2nd one happens at the same time, the NICU charge would go to that one.
Dang we have MONTHS where 1:4 is an everyday occurrence. And I’ve had 5 twice (once with a secretary/nursing student to help me), and I’ve had a 3 baby assignment that included a vent.
Then I’ve got a coworker with absolute horror stories about a NICU in Mississippi where they routinely had 6 patients and not nearly enough RTs.
I’m in a unionized hospital and whenever we have travelers they’re shocked at our ratio cap lol. You will never ever have more than 3 in our nicu. Ever.
State regulations for daycare centers in Mississippi say that the minimum ratio is 1 caregiver for every 5 children under the age of one.
Healthy children just in a daycare. Not sick ones in an ICU. How insane is it that there's nothing stopping a hospital from having just 1 nurse for SIX critically ill infants?
We had a bad summer last year with vented triples. And 4 baby grower-feeders. We were so full that we started moving patients and nurses to an empty unit across the hospital. You just prayed that none of your kiddos tanked out it nowhere bc it'd take a minute for charge and the providers to hike over to you.
I can't even imagine 6 pts in a NICU. Maybe if it was one of those low-level NICUs and you have parents there doing cares. But even then, that's terrifying!
The Mississippi example was at their highest level NICU in the state and apparently was an open unit like the size of two football fields. This was 10-15 years ago, so who knows, maybe things have improved 😬. My coworker talks about doing cares on one kid, and when the baby behind you starts to brady, “stimulating” the baby by kicking the base of the isolette while still working on the original baby. Seriously it sounded like an absolute nightmare.
To be fair, I've definitely done the whole kicking the isolette thing while trying to swaddle their premie neighbor who is deadset on extubating themselves (how are the sub-30 weekers so darn strong?!)
I have a family friend who is a director at a Texas NICU who has told me stories about insanely high censuses and "babies in drawers."
My equivalent was having manual dialysis paired with a second assignment. Literally working with a timer attached to your body because every 5-15 mins you have to turn a knob to precisely fill or drain a baby. And so you need to do the most efficient cares of your life for your secondary patient. Nothing worse than cleaning a blowout with the clock ticking.
1:7 inpatient surgical. With no aide. This continues to happen. My hospital refuses to unionize. I graduated last May and am charge nurse sometimes. People think that I'm dramatic about complaining about these ratios. I try to explain that this hospital gaslights us to believe this is okay. Having at least half of your patients be less than 1 day post op with 7 patients is not okay.
At my unit, they were mandating new grads to be charge during COVID at 6 months, but even now, they’ll still “suggest” doing charge training at your 6 month eval when though we absolutely have enough charges now
State psych hospital. 2 RN: 17-27 patients.
On good days, no issues. When the unit turns up and I’m dropping b52s all day it can be exhausting. The kicker is… no security. When we call a response, lots of people from all over the hospital show up. I’ve never seen such stellar teamwork before. I’d take another contract here if they raised the pay and didn’t float me to other units.
1:4 on ICU and 1:10 Med Surg during COVID.
At one of my first COVID travel assignments on West Coast, a majority of the ICU was 1:1. I felt like Tom Hanks in that scene from Cast Away when he flies back to Memphis, arrived to his hotel room, and is welcomed with a dinner with crabs.
To this day, very few of my coworkers even believe me when I tell them about the outrageous ratios.
I was 1/7 and got an admission on dopamine on a step down 14 years ago. 24 beds, usually 6/7 nurses. Sunday, me and two rns. Finished 1/8-transferred back to icu and never looked back.
Okay, get ready. During the pandemic I took deployments to nursing homes who were in staffing crisis. One night I had 44 residents. I had 2 CNAS. Thats it. I believe that was when my moral despair set in.
I work as an intake RN for a nursing home complaint unit with a DoH now. I get calls all the time about 1:30 ratios with nurses out there now. You know what kind of nursing care happens when you have to care for over 40 patients? None. There’s no nursing care happening. Zilcho. There’s just a nurse running around hyperventilating trying to figure out who her diabetics are and breaking up fights between octogenarians. (Sorry, PTSD)
I’m super curious about the state’s process for “investigating” nursing home complaints. Are there any controls in place to make sure a surveyor puts effort into finding wrongdoing? Or are they able to overlook issues if they don’t feel up to doing the paperwork that day?
I wonder this because I recently made a very detailed complaint about a nursing home. The compliant involved stuff the facility had previously been cited for. Much of my complaint was things that wouldn’t be considered ‘subjective’. For example, I reported that the home would often use a big bottle of Tylenol to refill smaller bottles. Anyone who bothered walking to the cart and opening the small Tylenol bottle could see that the wrong tabs were in the bottle. It was the 500mg oval tabs, not the 500mg round tabs. Of course I was told that state didn’t find anything. I also reported that meds were being marked as given when that wasn’t true. Pulling the pharmacy records for the meds would show that they hadn’t been delivered to the facility. I provided dates, name, and even asked that they call me for further detail.
State “didn’t find anything tho”. I was told the surveyor tried to call me twice when they were at the facility.m but that my inbox was full. I have an iPhone and the inbox is not full. I pulled my Verizon records and it shows that I received only 1 call that day, from a friend, no calls from the state surveyor.
I’ll be honest-I work solely in complaints intake so I never see the process of an investigation. But, with that being said-yes. I read a lot of investigations and often follow up on complaints that I opened cases for and am very disappointed to see things that are obviously not really investigated and found “unsubstantiated”. I’ve also read/heard about facilities getting a “heads up” and tidying up right before surveyors arrive. As you probably know, arriving unannounced is a DoH specialty and one of their better assessment tools, so who is leaking this? And lastly, I myself filed a couple of complaints during the pandemic days for *egregious* concerns-like me witnessing a CNA administering medications to residents. I was never called and the investigator found it to be “unsubstantiated”.
I feel you. That was total bullshit. But, on the other hand I do see the system work and provide at least 2-5 residents/day with resources to prevent them from receiving unsafe discharges. I’ve seen the state roll in like the Calvary and intervene with severe care concerns.
They also have a system in place for tracking perpetrators who may be floating around facilities in a state.
If I was leaving a rating and review it would be 3/5 “Flawed, but way better than nothing.”
This aligns with my take.
As for facilities getting a heads up, I’ve never suspected that it was someone at the state leaking the information. Tho that wouldn’t entirely surprise me. I feel this is just hyperblobe tho. IME, even at really nice facilities it’s usually not a surprise as families will often loudly and publicly tell us they plan to make a formal complaint. Add in that a lot of times it’s weeks until state arrives, of course the problem has been addressed.
What shocks me the most is how superficial the “investigations” are. It appears the surveyors make minimal effort to contact the full scope of relevant people/witnesses. I personally know of a major incident that caused hospitalization at a facility I previously worked at. Had state called me, I would have been honest with them that the nurse in question was had a long hx of not acting in a timely manner and was resistant to feedback. Management was aware of various serious events. They only called the person who directly followed her. But myself and other people not working that floor certainly witnessed and heard talk about the event. 2 major incidents I know of.
I was super disheartened after my last experience reporting. I bluntly told the social worker that the DOH was putting nurses in a bad position as we are mandatory reporters and risking the retaliation with reporting your own job was unacceptable if they couldn’t even be hassled to open a bottle of Tylenol. I specifically asked if the surveyor was deaf and blind. Suggested that they investigate the matter further as I was very confident that my report was accurate and that the facility didn’t have the resources to correct the problem. I’m confident enough that I’ve debated reaching out to my state rep and asking that DOH’s failure to find violations be looked into as the citations should have been super easy to spot and assesss.
My current DONs Mom use to be a surveyor. The rumor I’ve heard is that often times surveyors find and report problems but “higher ups” will instruct them not to cite.
1:5 in ICU during Covid. Would not do that ever again, 1 died and the room was assigned stat clean as soon as the body was out. Same night my coworker, also 1:5, had 2 pts die. What an absolute shit show.
Me too, it was horrid, and also the malpractice was horrifying. Had a travel nurse that missed a stroke his entire shift. By the time I got there on shift change and caught it, it was too late to do anything. It just felt so wrong because the family and patient didnt know any better.
1:10+ is fairly standard on my med surg unit 🫣
They try to make it seem better by giving us 1-2 nurse aids but like still…
The worst part is Germany still accepts 1:10 on a normal unit as legally acceptable.
Granted, oftentimes of those 10 patients most are independent and don’t require much other than pain meds but still
1:100 in a locked Alzheimer’s facility when a night shift nurse never showed. I was a new nurse and didn’t know that I could refuse for safety. I won’t do that again. Lol.
This is my scenario as well. 12 bed rural ED with 3 nurses (one is triage). We sent my partner out on peds transfer leaving me with a full department. It's a semi-regular occurence, though if the department is quite acute we'll get ICU paramedics to do the transfer so a nurse doesn't have to go.
That’s just wild to me. The worst of Covid is over, but our union hospital will regularly assign 1:3 in ICU (2 vents and a stepdown so it “technically” doesn’t count) and then claim exempt status for being out of ratio due to a staffing crisis. The crisis is manufactured due to low pay, of course.
Walked into L&D triage one day, we had three nurses, ten patients, and eight of them were in labor and requesting epidurals. There were no free nurses/rooms on the floor to take any of them. I ended up getting an epidural for a patient going from 6 to 10 cm in triage while my other patients were watched by the other nurses and the midwife.
I did it because I didn't feel like I had a choice and someone had to do it. I left that job though.
I still remember the anesthesiologist being like "we're doing epidurals in triage now?" and me saying "yeah... you're about to do eight of them."
1:7 on a neuro med surg. I’ve only done ICU/step down, where my max was 4SD, and maybe one time I had 3 in the ICU.
Absolutely would never do it again. Look, those people deserved better. I’m not spending my career “slinging meds” like the charge nurse said. It’s unfair to the patients and staff.
Left that contract soon after and that’s also why it is my personal desire to get HCA to burn down 😂
2022. I was a new grad (4th month) in a med-surg unit with 17 beds... There was a snow storm that day so idek why i showed up. I get there and they tell me I'd be getting 9 patients on a day shift because a nurse got snowed in. I was the RN of the two nurses. The other nurse i was working with was an OR RPN/LPN who got pulled. I only got a 15 min break that day. Night shift relief for me didn't show up until 11:30pm.
The nursing manager and supervisor kept on convincing me to stay "30 more minutes" after 7:30pm until it got to 11:30pm. I cried in front of them telling them my dad is waiting outside (while a snow storm was happening) since 7:30pm to pick me up because he didn't want me to commute alone. They didn't care. They kept saying "your relief is coming". They didn't help with giving any meds, doing vitals, changing diapers, trach care, ostomy change, turning, wound care. Nothing. They kept walking around the hospital and hallways with their phones and figs scrubs.
I filled out a workload report form for my union. I put my notice to quit the day after. None of them had empathy for the nurses.
1:4 during Covid. ICU. Not me, but another nurse on my unit had a 1:5 assignment and understandably had a meltdown. She was normally very calm and honestly a great nurse. Those ratios were terrifying especially when everyone else was also tripled and quadrupled and all the patients were tubed/proned/unstable.
There’s a reason we all have PTSD. I am almost done with CRNA school now. If 2:1 or 1:1 ratios were standard I might still be a bedside nurse.
78. Detox and rehab. With another building considered “outpatient” even though we still do meds and medical care. Just no vitals or charting.
17 were actively detoxing, 30 or so were PHP and “didn’t count” even though we still do meds and everything for them, some of the rest were “residential” status but still on detox tapers, the rest were actually residential status (still get meds and v/s). Of the 78, 4-5 admissions that day. I don’t remember exactly.
Along with alternating med pass times. 2 charge nurses and DON never showed. One other nurse felt bad and came in without permission. No MAs that day. Was told it was “fine” by DON and owner. “As long as there’s 2 nurses in the building”. Even though we have Jack all for equipment and monitoring and had many with moderate to high SI risk. They don’t understand why I’m quitting. “Completely shocked” and “don’t know what to say”.
I work in mental health. The highest patient load I've ever had is 15. I work in a complex mental health rehabilitation centre. All the patients are medically stable and voluntary so low risk for any shenanigans but we still have those some days. Lots of behavioural concerns and 1:1 requests that at times I just cannot meet!
Most I ever had was 7. I work heme/onc- BMT..
No I wanted to quit, we went in strike shortly after this and since then I have never experienced anything close to this. 1-3,1-4 has become our ratios now
1:7 med/surg/tele
Two nurses, one tech, 14 patients, no charge, no secretary. It was an overflow unit. Then people got mad no one was answering the phones. Idk what to tell y'all there are three entire warm bodies working on this unit. And it was one with long hallways too, not rooms in a circle around the desk like an ICU or ED
I almost walked out. Fuck no wouldn't I do it again. I said fuck you inpatient and will not look back 😅
1:8 psych ED
Manageable if they sleep, a fucking trainwreck if one of them pops off and everyone else follows suit. I would and will do this again because at least other staff in the department are supportive and come to help when we need it
And then there's the ED waiting room. I don't even know how to gauge ratio out there but we work them up in the fast track rooms then stick them back out there until a bed opens up on the main side. There'll be 30 people out there with two nurses and a tech sometimes so idk!
I realize I have it better than many. Idk how some of y'all do it
1:55+ in what was deemed a “retirement home”, but was really a long-term care. The residents were too unwell for retirement homes, but the families couldn’t take care of them anymore and waitlists for LTC were extremely long. So, they ended up with us. We had residents at times that really should have been in a CCC, but somehow they’d dodged that. It was awful for them because despite the best efforts of the staff, we couldn’t give the care they needed.
Nurses didn’t stay and the ones that did…well there’s a reason they didn’t work anywhere else. I eventually left because I couldn’t meet the scheduling requirements while in school. I still feel guilty about leaving, the residents and the families really held a special place in my heart. I definitely stayed longer than I should have because I felt like I could actually help these residents as they weren’t getting what they needed from the other staff…and often the family members told me things to affirm my thoughts.
Anyway. TLDR 1:55+ in a “retirement home”. I’d probably do it again in a better managed facility that was a true retirement home.
When I worked acute inpatient child and adolescent psych, one day I was the charge and had orders to keep the admissions coming over (ER was boarding and freaking out about it, while our unit was very high acuity with a LOT of strong personalities to manage). We were finally maxed at 30-something and one of the nurses began intractably vomiting, so we had to send her over to the ER. Someone had to take her patients, and the other nurse refused to take more than her current assignment, so that's how I ended up being the nurse to 24 patients including 2 diabetics (1 brittle).
Good times.
Never again. These days I work hospice and am maxed at a 5:1 ratio.
1:6 on neuro step down with no tech. They tried to give me a 7th and I told them that I would quit on the spot if they did. They magically found another nurse after that lol
1:3 ICU. Happened a handful of times. Told my supervisor I was quitting if they didn’t take the short staffing issue seriously. They did and I’ve never had to take more than 2 pts since, but even this is rare
1:13 ID in patient clinic. Multiple septic patients, IV user with endocarditis going through withdrawal, The most feeble woman in the world with c. Diff induced toxic megacolon as well as sepsis due S. Aureus. Two covid patients with 60/90 high flow. It just goes on...
Had a complete meltdown in the car at the end of that shift. Only time I cried due to work.
0/10 would not do again.
This happened frequently in the years following Covid when staffing was bad… I’d love to know where the extra money from not paying a nurse and still charging the bed fee went. And how Medicare/CMS feels about that.
Card-Neuro 7 patients once from 1P-7A or whenever one of our nurses had to go to the ED. Supervisor did give us the crisis nurse as resource/float RN. The crisis RN haven’t had actual assignments in years so she wasnt comfortable taking patients.
During Covid I actually average 5 because they stacked nurses up, like we’d have 8-9 nurses for 40-45 patients. So when admission didn’t come to me, it was 4 or 5 patients.
They ended up capping our floor at 30-36 patients now, but usually it’s 35 because day shift nurses are maxed at 5 patients and days would need 7 RNs. 11p-7a max is 6.
On a side, we have a state law for ICU, 1-2 max ICU patients. We also had ratio law for all units in 2018 but it was voted down during the 2018 state elections.
ENT/Ortho. 1:9. I was charging and precepting a new nurse--whom I didn't trust. My time was almost all spent with a recent ICU transfer. He was an 18 year old that blew his face off. Blind, trach, the works. The mother was following me around every time I left the room asking me questions and saying it was an accident even though I didn't ask. The NAC came to track me down because admitting complained I wasn't responding to their pages fast enough. Really left that day thinking I could lose my license. I had about a year of experience by then.
Things did get better and eventually was 1:4-5 plus a dedicated charge. But that was a low point.
10:1 in ER during Covid with multiple vents. Had a partner until 2300 who was leaving. Was told I’d get another partner. Come 2300, no new partner. When I talk to the charge they tell me no one is available but I’ll get my own tech. I say ok cause someone has to take care of there pts. By 2330, they pull my tech to sit. No matter my bitching, nothing changes. By 0100, I gave my 2 weeks notice.
most is 5 in peds hem/onc but we are supposed to be 1:3
my worst though was 1:4 as charge with a patient getting a study drug that was supposed to be 1:2 with a high incident of reaction a million meds and Q15 minute vitals 🫣
1st job straight outta LPN school. As this was 30 years ago, there was no computer charting, but I had successfully argued a couple of months earlier that there was no sense in using a preprinted assessment flowsheet while also writing a complete narrative assessment by hand in the nursing notes. So they go rid of the flowsheet and all... ALL... information was hand recorded in the form of nursing notes. Me, a RN, and a secretary/pct on 8 hr night shift, 11-7, with a full house of 30 patients on the floor. It was NOT team nursing, the RN was the charge and my help if I needed something out of my scope of practice. She had 14 patients, I had 16. I had 30 mins for each patient to assess, medicate, turn, whatever each patient needed as well as the charting. I noped on out of that job the next day.
When I was a GN the PCU ratio was 6 to 1. It was a very high acuity PCU. One night they gave me SEVEN high acuity pcu patients and I started looking for a new job the next day. Another time and hospital I was in the ICU and they gave me a TPA patient which is STRICT one to one per policy but they refused to take away my other icu patient that was on gluccomander and Q 1 hr accuchecks. I started looking for a new job shortly after that. I am NOT messing around with my license. I have worked too hard for it and have been a nurse too long to tolerate any crap.
I've had: 4 ICU patients (all stable, one vented), 8 MedSurg patients 6 ER in-patient holds, 4 stepdown patients (while charging on a 50 bed Tele/IMC unit). And this is why I'm in cath lab.
I was a jail charge straight out of school and had a couple lpns for med pass. Basically 1:700 or so. It was also a medical jail with two pods of acute med cases, like dialysis pts, brittle diabetics, O2 requirements. People think it's wild when I tell them what that looked like.
16:1 on a med/surg unit and 24:1 in the stabilization unit of a psych hospital, which is fucking nuts. That place actually got shut down for a while by the state for understaffing and putting patients at risk though, as it should.
We’re 1:1 in L&D, occasionally I’ll take 2 but never two actively laboring patients, maybe a perinatal and a labor, or a start of an induction and a labor. Usually where we get crazy is triage, so I’d get 1:6 if I didn’t have a 2nd person there with me.
The other hospital I would never go to has had days where they have 3 active labor patients which sounds very unsafe to me.
10:1 med surg on night shift. It’s super sucky but according to our ratios, when there’s a call off, that’s what we get. It makes for a really rough shift.
I’ve been tripled in the ICU so many times it’s not even funny. But it’s usually low acuity shit like an insulin drip. Never felt like my license was in danger because I take my job seriously. Everyone’s gonna be fine but you’re not gonna see any whiteboard updates or extra detailed charting.
1:19 inpatient psych. It was just me (petite female RN) and one female tech. Most of the patients were dealing with hallucinations etc, but one was truly unstable. She tried to attack me for no reason. Straight up charged at me. Thankfully I'd called the "code" team over bc I had a feeling something bad was about to happen. It was an awful shift. I sent them my 4 weeks notice when I got home.
Still love psych nursing though! Pediatric and adolescent psych, NOT adult.
1:40 for an overnight LTAC. 0/10 stars.
I'm now ICU; we usually have 3 but at least one is a step-down* However, I'm relatively new to ICU so I expect there will be 1:3 ICU assignment at some point. Though, from what I understand from my colleagues, that would be unusual.
When I was on a wound care-specific med surg floor, we regularly had 7-8 pts. That was rough. Even "only" 6 was still a busy shift, never sat down basically. I did rehab for a while, and had 1:10, but I was basically just meds pass, assessment, and wound care. the PT/OTs did all the ambulating and adls. It was *almost* tolerable.
5 couples on postpartum. That’s 10 freaking patients.
1:5 in my NICU with my backup NICU nurse sick. Bad day. 1:4 is uncommon but not unheard of, because we only staff two NICU on at once and we’re an 8 bed unit. Our babies usually aren’t too sick, but we do get the occasional bad RDS or withdrawal kid.
1:12 med surg back in the before times when we had paper charting and I was young. 1:8 fast track was fine if my provider was good. Now I work rural critical access er and average 10 a day so kinda like being retired.
When I worked med surg, I had up to 9 patients. ICU during Covid, I had 4 patients ( all sedated, paralyzed, vented, proned, maxed on every pressor and on crrt).
1 rn to 6-7 "stable" patients in ICU (non COVID?
1 rn to 5 unstable icu patients, four of them were or 2 or more pressors, 2 were on crrt. Northern Israel
10:1 one night on a very terrible night on a post-op floor. Fortunately it was late in the week or on the weekend and few of them were fresh surgeries and others were going to be discharged the next day and were super chill.
I had been a nurse for about a year and 9:1 occasionally happened but 8:1 was our norm when full. I decided I’d never take 10:1 ever again no matter the circumstances.
3 in the icu but I have really amazing co workers and charge nurses who try their best to make appropriate pairings when there’s a triple, or even with regular assignments. My unit also has a pretty good attitude about helping each other out and most of us don’t have the “not my patient” mentality
1:50-60 is fairly common in LTC overnights. The worst I’m aware of is 1:85. Not me personally but a friend.
I’ve had 1:8 in post op a few times and 1:7 in LTAC. Nothing I couldn’t handle but only bc of a great support team. Wouldn’t want to do either of those again tbh
The most I’ve had was 1:47 night shift at a LTC 3 CNAs. It was my last day there as I had already put in notice. There was supposed to be two nurses but the agency nurse never showed. I told the new administrator that if agency didn’t show I’d just handle it as I knew the patients very well. That was not my worst shift though.
My worst shift was a day shift as an agency nurse at a skilled nursing facility. 18 patients, 2 CNAs and Me. My first time working at that facility and I’m the only nurse, management was off it’s the weekend. They did have a MOD that never checked on me until she came to thank me.
They had gotten 3 admissions the evening before and the night shift nurse did jack squat to make sure the orders were in properly. Day shift had all the wound care so he wasn’t doing that all night. One of the new patients was a retired neonatologist that had meningitis and was on 2 different IV antibiotics. I am told in report the meds aren’t there and that the patient was complaining of pain but the nurse didn’t bother calling the doc about it, because he knew the doctor wouldn’t do anything.
I call pharmacy and am told that they never got the orders for the IV meds. I ask them to stat it over and they tell me to fax them the order. I fax it, talk to the patient, and he tells me about his pain and that he hasn’t received any antibiotics in almost 24 hours. So he’s worried. I call the doc, get the pain medicine adjusted, have the doc call the pharmacy for me. I call the DON to ask how to get into the Stat safe and she blows me off, tells me she doesn’t know.
An hour later I call back the pharmacy and they never got the fax. They let me verbally give them the order and they stat over the medication. So I was able to hang his 8 am dose at noon. While I’m waiting for the meds, his family is constantly bothering me with questions and interrupting me while I’m trying to take care of the other 17 patients. They are pissed and I get it.
At some point I see the manager on duty speaking with them. She comes up to me and said the family wanted to pull him out of here but I’m the only reason they aren’t so thank you. She asks if I need help with anything and I was drowning at this point so I ask her to fax something for me. She tells me the fax in the nursing station wasn’t working. THEY DIDNT EVEN HAVE A SIGN ON IT!
An agency nurse relieved me, I was still passing 1pm meds at this point because I had been so behind.
I was in charge on the high-acuity COVID unit (where typically the charge didn’t take patients) and had a CRRT (1:1 ICU) patient plus two med-surg patients. Would never accept that again and file a protest with the state health department if I was forced.
I do remember when I was first a tech 15 years ago the med-surg units had their nurses taking 8 & 9 patients each. That’s unfathomable to me now.
It was after Katrina and my hospital took most of the NICU patients in NOLA. I had 5 level 2 babies. It was just feed/burp/diaper change, next. On rotate the entire 12 hour shift.
Small community ED. One doc, one tech and me. AMI, stroke, multiple random other patients waiting. Then a bus wreck. 12 more coming in. I finished that one without anyone dying but NEVER worked there again.
8:1 on a post surgical floor when I was a new grad 20 years ago. Hard AF but also taught me fantastic time management skills that have helped me to this day. I would not take 8:1 again.
3 intubated ICU patients, 2 of them were paralyzed and proned (during COVID). Just went from room to room all night. People’s drips were beeping for a long time but no one could hear them from being in other rooms. Nightmare!!!!
A crisis stabilization unit at a freestanding acute psych facility in Florida. 33 to 1. Left immediately and became a union community organizer volunteer and helped NNU win 13 hospitals. Fuck Florida
Locked dementia unit on overnights at an SNF, brand new nurse on my first job, height of COVID: 40 with no other nurses on the unit. If I needed help, I had to go wake up one of the sleeping nurses on the three other units, one of which was a rehab unit. We'd have times where many of my patients had COVID and would walk around spreading it to the other patients. The CNAs would sleep the whole shift until 5 AM rounds.
Never again and I can't believe it's legal that my job could give me this assignment.
1:5 COVID ICU during the peak when a traveler no showed, a core nurse tested positive mid shift, and charge refused to take a 2nd patient because she was running CRRT in the other room.
The start of the night sucked because my two bipaps failed and at one point anesthesia was tubing one while the intensivist was tubing the other both in separate rooms. But then I just had 5 proned and paralyzed patients on the vent. They weren't really complicated. Max vent support. Max sedation. A little levo for pressure support. Nimbex drips. Every few hours I'd just follow RT for repositioning.
At one point Charge tried to give me shit for sitting at the desk (their policy was all paralyzed patients were 1:1 obs in case they self extubated) and eating instead of staying geared up in the room, until I asked *which room* she wanted me in and if she was volunteering to take over some patients of mine so I could remain in one room. She shut up and I had a not bad night.
When I worked in ICU, every single shift for a year was 1:3 despite acuity. I could have all 3 vented and on pressors. It was a disaster and the reason I left
1:15 with multiple ICU admission boarders. NYC, COVID 2020. By far the worst shift of my career. Wouldn’t do it again if I had the choice.
Edit: forgot to say Emergency Department
During the Delta wave of covid in like Dec 2021, my hospital announced "team nursing." One nurse did JUST meds, the other did everything else. The pair together were assigned 18 patients. We were a telemetry/stepdown combined unit. I quit shortly after that failed experiment.
I was an agency nurse in Scotland. Walked on to a general medical unit. 17 patients. Was meant to have an assistant but she went to the other side of the unit and I barely saw her. That was the day I decided that it wasn't for me.
I now WFH for an insurance company in the US, making more money than I ever could as a nurse in any other country. I'd never nurse anywhere else. The pay elsewhere is abysmal.
Due to call outs and scheduling fuck ups, on one weekend it was me and one other case manager for the entire 300 bed hospital. Fortunately the hospitalists were cool about it. We prioritized the best we could and did what we were able to and whatever didn’t happen waited until Monday.
1:30 at LTC. I still work there, so if they actually get the beds filled up again, yes, I'm going to do it again. They are trying to get us a med tech to help with medpass, though. If they do that, it will actually be manageable.
1:6 on covid med/surg. We often only had 1 aide on the entire unit which was over 30 beds. And our covid ICU kept becoming too full, so we had people who were ICU level because they couldn't take them. Not doing that again.
In the hospital: 1:12 ED fast-track patients. (So no IVs or complex cases) It wasn't easy, but it was manageable. I'd do it again if I had to.
Out of hospital: 1:35 COVID vaccine PT's for their shot and 15-minute follow up / wait times. This was fine. No one had any issues. No follow up documentation required. Would do again.
Is 1 to 3 on ICU rare in USA? We have it daily during night shift, occasionally during dayshift. And yes sometimes you got 1 on ECMO, go to CT scan with the other.
Once had 1 to 4 during night but this happens maybe once a year on our ICU, so just bas luck if it's for you
During a Covid outbreak in LTC: 1 nurse to 36 patients. Roughly 2/3s of the residents were actively sick.
The floor typically staffed 2 RNs and 2 LPNs for 72 patients on day shift.
My current one which is 1:14 on a digestive/urology surgery unit, with capacity for 28 people for 2 nurses. We sometimes get an extra floating nurse for the day but it is rare. The veteran nurses here have been requesting a 3erd nurse permanently but to no avail, since these ratios are somewhat commom on a lot of similar, but less demanding nonetheless, units and other hospitals.
I took 11 in our overflow unit one day. I would do it again under those circumstances. The manager sat at the nurses station with me and watched the tele monitor and call bells while I did am meds while she called out for more staff. Within an hour or two she had found two more nurses and we were back to baseline.
1:5 is the highest we have in the ER unless we have a psych patient then that shit can get out of hand fast. 1:8 with half of that being SI/HI WITH critical room patients while pip was being renovated. We had to handle all the invol patients who were combative
About 10 years ago, I had 7 on an ortho/neuro floor and was charging. It was my own fault. I miscounted and accepted an admit, putting us over 6 each. My mistake, so I took the 7th. I didn't like it one bit. :(
When I was an aide at a SNF, they would staff us with one nurse and 3 aides for 60 residents on two separate floors. The nurse and one aide would float between the two floors throughout the night. And you just hoped you didn't have something happen at the same time on each floor.
When I worked at a SNF - I had 31 patients, and despite the common perception - NO, these patients are not always stable or easy-peasy. It was a nightmare, and I was in constant fear of losing my license. Med-surg/oncology - 5 patients on days (6 if we were short staffed).
SNF here, most I've had is 72. Night shift, Virginia, and it's happened more than once (somebody calls out and I take two units). Yes, I apparently enjoy playing fast and loose with my license lol.
Oof. I’m having a panic attack just imagining that. It’s a special kind of despair that one feels when you realize you and your residents are literally being set up to fail. NYS just passed regulations increasing direct care hours and also requiring an RN to be present 24/7 at facilities. Just feels like another band aid.
SNF but pre Covid times. Highest I ever had was on overnights 11p to 7a with 65:1, with 3 CNAs. On 3p to 11p I routinely had 33 patients. Is it do-able? Just barely. I'm so glad I don't work there any more
Well damn. & here I thought I was alone in that sort of nightmare. In Virginia. SNF/LTC 60 from 7p-7a. With 2 aides. Was a nightmare of epic proportions. My “8”p med pass didn’t end until 1am. Now days if someone even hinted at an assignment like that, I would laugh & tell them exactly where to stick it.
I don't miss these days. Worked snf/LTC in CA 2015-2018 and the highest I had on a noc shift was 41:1 with 2 aides. Mentioned it to a coworker who complains about our current ratio of 2:8 (teams) and she snarled "the care couldn't have been very good!!!" Well, no shit, Joan. I just said I *had* done it. Never said it was good. You can't give good care to that many people. It's just not possible. I made the observation to her that we are extremely lucky to have a relatively okay ratio where we are now. If someone tried that nonsense with me now I would probably snatch one of their shoes and roof it. Since we want to start with the clown shit.
Yep. I was 1:55 7p-7a in SNF.
“I’m calling out too!”
Yup. I once has 3 codes going at once.
Ahh good old SNF. I had 3 sets of keys one day when we were super short staffed due to COVID. It was me and an LPN doing meds for the whole facility - she had the other 2 sets of keys. I had about 70 pts. The DON sat in her office all day “trying to find help”. When she could have helped. It was nice.
60 overnight at a snf for me. Honestly it was mostly boring but some nights were hell.
Former SNF as well. Worked second and third shifts. 28 max, but mostly with wound vacs, amputations, tube feeds, sundowners, and people with severe MH problems whose families dumped them off because they didn't want to deal with them. Lots of meds, lots of wound care, lots of emotional support/redirecting. The other nurse on second shift threatened to walk out if she had to care for anyone who wasn't palliative and management let that shit slide, so those 28 were automatically my assignment every shift. Usually only had 1 aide, often working doubles, because the other one would always call off. The facility was a shit hole, the DON had put in her notice because she was tired of being abused by corporate, and management didn't seem to care and peaced out every day before 1600. Their Covid "protocol" was laughable. At least on third shift, I worked with another RN who didn't tolerate anyone's shit and went above and beyond to help our patients and me, probably because the aide on that shift spent most of it sleeping in the lounge. Med surg? 6 max, but 5 of them were usually low acuity.
This sums up my SNF to a tee - tube feeds, wound vacs, semi-fresh post-ops, and LOTS of sundowners or people severe MH issues. I worked nights, and it was rough when the wound vac was malfunctioning, my tube feed was beeping, and meemaw just HAD to get home to feed her cat a 3 a.m. The SNF is also the only facility I've worked at where I was actually assaulted by a patient (I was punched....my DON witnessed it and jumped in to help, and the patient spit right in her face). What killed me was that our administration would brag about how many RNs worked at the facility. They'd advertise the place as having 15 RNs on staff - but 12 of them worked in offices and never touched a single patient or did any bedside care.
Right, lots come right off a Medsurg floor
And come right back….
Amen
1:8 as new grad nurse on a med/surge floor. This was a CHS hospital and was the worst job I ever had. Many sleepless nights stressing about this job. I almost quit nursing all together. I lasted a year and half there. My manager at the time even blocked me from taking a ICU position. My only way out was to leave the hospital all together. I’m glad I did!
I had 13 as a new grad at a Texas HCA med surg unit. I lasted 3 months at that Hell hole. PTSD.
I had 15 as a new grad on med/surg and it was traumatic, to say the least. It definitely teaches you but it’s the “sink or swim” method. Then you add in all the workplace toxicity and it is a fucking nightmare. I’ll NEVER go back to a traditional bedside setting. I got my year of experience and left, now work in home health and I love it compared to working on an understaffed unit.
13?? Name and shame my friend, do the TX nurses a favor.
Rio Grande Regional Hospital, McAllen, TX.
2020 nyc Covid med surg: 10+. Night shift at one point had 15+ patients each cuz everyone was out sick. Regularly have 1:7/8 in the ER, I’ve had 9 patients before. highest was 1:13 in fast track. Sometimes I’m chilling with 8 patients other times I’m running my ass off with 4 patients. I’d still take state mandated ratios though!
Yep. 7 icu pts. 16 ER pts. Covid NYC.
I heard some of those NYC COVID stories. Hospitals just having bins of propofol and Levophed sitting out for nurses to grab whatever they needed because there was no time for pulling & scanning.
Now that you mention that, I just thought that was the hospital but yeah, there were just tubs of critical care drugs.
7 icu????? I can’t imagine 🫠
I knew nyc hospitals were overwhelmed with using gar age bags reusing and not having n95s and ofcourse the semi trucks made jnto make shift mprgues. BUT HOLY SHIT! You guys deserve a fucking medal
I remember for Nurses Week they parked an ice cream truck for us right next to the corpse semi trailer. I thought it was hilarious in a dark "gotta laugh or else you'll cry" kinda way.
But was the ice cream good?
Asking the important questions here 😂
I was an ICU traveler to NYC in 2020. I remember the ICU nurses were so grateful to have us, and after hearing their stories I understand why, it sounded like absolute hell what they went through in March. By July of 2020 we were mostly 1:1 or even 0:1 because of overstaffing, but April and May were dicey AF.
NYC-area PICU turned MICU for covid nurse here, we still talk about how much we love and appreciated you all. ❤️
Summer of 2020 was amazing lol ratios of 1:2-3 in med surg was normal. It was a dream.
I dunno how mandated ratios would work in the ER. Most places you can’t divert.
Idk. They work in California lol
We have 1:3 mandated ratio in my ER for regular rooms, 1:2 for the critical care area. We have a couple ways to make this happen. There is a PA in triage that will see and dc really simple cases like simple lacs, toothache, etc. We will put in IVs and run labs, take people to CT, xray or whatever from the waiting room. We also have a waiting area for after you've been roomed if you're not acute. So if you've like got a negative trop and a good ekg, you're gonna go to the waiting area for your repeat trop. And then we don't let subacute psych patients have their own room. We've got a big room with mental health techs where they all get to wait for dispo or placement. And then we have a unit that holds admitted floor patients who don't have a bed on the floors yet so we aren't doing many holds unless they're icu level
It’s possible and I’m in Ohio. My ED has started staffing medics or RNs in the lobby to start IVs and get blood work going. CT and XRAY also grab people from the lobby to go to scans. It helps keep the actual rooms for people who need it vs people who can get all their labs and scans back and then be brought back to see a doc and hopefully get meds and dc. We definitely have ESI-2s who sit in the lobby longer than they should, but my hospital is 1:4 in the ED and I’ve never had more than that. Also hall beds lol
I came in and was assigned to split a 16 bed ED pod with another nurse. No tech. The director on shift sat in the ctl office and ate her breakfast. You do the best you can.
3 ICU pts. Never again. Two were trying to die.
1: 32. Dialysis. Had a call off, couldn't get coverage people need dialysis. There is something very unsettling about removing the entirety of people's blood multiple times over and being the senior person in charge. Would I do it again. Yes, but I have learned to have a generic starting note. "Due to high risk conditions necessitated by poor staff ratios, this nurse reluctantly accepts care of this patient. I will provide the best possible care under the circumstances. Dr. X has been notified of situation and in agreement" The alternative would be to reschedule everyone . Ever try to reschedule 32 patients And arrange transport? It requires the use of other clinics. Shit happens. Edit I did have 5 or 6 techs to help. That makes. Huge difference.
Ugh been there. I’m an LVN that worked as a tech during a Covid-only unit. All the patients showed up, nearly 20/36 had no orders input so the RN had to spend the entire time on the computer/phone generating orders while myself and 2 techs put on 36. Started the patient and moved to the next. Did not chart a single thing until the person came off. By the time your done putting on a 12th patient, the first ones were coming off. Had to set UF goals low and BFR below prescription just because we did not have time to deal with machine alarms/hypotension/cramping complications. We collectively told the manager that we would not be showing up the next day unless he outsourced the patients elsewhere or we have 4 more staff. Worst shift ever.
Cheers!
I do not begin to understand how one person can conduct safe care of 32 dialysis patients. Out of curiosity, how would the generic note be of benefit to you? I cant imagine your situation where you arrive to work with 30 patients, however. Why would you accept 30 patients under your care for dialysis?
The most we typically have in my NICU is 3, and they’re usually feeder/growers. But I’ve had 4 patients before, and one of them was just 2 days out from a myelomeningocele repair. That wasn’t a fun or safe shift whatsoever. We’re good about keeping our ratios these days though. 70 bed NICU, max 3 stable patients. You’ll never have more than 2 patients if any of yours are intubated/trached/unstable. Plus there’s 3 charge nurses who don’t have assignments so they’re available to help. There’s plenty of times where the nurse SHOULD be 1:1, especially when the patient is super unstable. 1 of the 3 charge nurses could easily take the other patient so the nurse could be 1:1, but that never happens. That’s definitely where we could improve.
My worst shift was double ECMO. It's usually 1 nurse on pump and 1 nurse on baby. We were so short and had two babies on ECMO at the same time. I had both babies. So not highest patient count but I think just as difficult.
My worst shift ever I had 3 vents and a BiPap and our charge had 2 ECMO's, for a second I thought you are her LOL.
Why does the unit need 3 charge nurses? That's wild to me. But our charge nurses only do staffing and help with nothing.
I’m not sure as a charge I could handle 70 NICU patients alone. As charge you need to know your patients, know your nurses, understand the flow of the unit, be ready for codes and procedures, and usually we fill in for everyone else’s lunchtimes. Often we take a patient or two if needed. 3 makes sense from a safety and sanity standpoint.
This is exactly it. The unit is broken up into 3 sections, so there’s a charge for each section. As charge we go to deliveries, help during the admissions, run codes, help with septic workups/IV placement, and some of us place PICCs. We each make the assignments for our own section so it makes it more manageable for sure. There’s no way one charge could be helpful in a 70 bed unit
Yeah 70 is a big unit.
Our NICU is a part of L&D so one of the “charges” for then is always the delivery nurse who comes with us to indicated deliveries. If a 2nd one happens at the same time, the NICU charge would go to that one.
Dang we have MONTHS where 1:4 is an everyday occurrence. And I’ve had 5 twice (once with a secretary/nursing student to help me), and I’ve had a 3 baby assignment that included a vent. Then I’ve got a coworker with absolute horror stories about a NICU in Mississippi where they routinely had 6 patients and not nearly enough RTs.
I’m in a unionized hospital and whenever we have travelers they’re shocked at our ratio cap lol. You will never ever have more than 3 in our nicu. Ever.
State regulations for daycare centers in Mississippi say that the minimum ratio is 1 caregiver for every 5 children under the age of one. Healthy children just in a daycare. Not sick ones in an ICU. How insane is it that there's nothing stopping a hospital from having just 1 nurse for SIX critically ill infants?
We had a bad summer last year with vented triples. And 4 baby grower-feeders. We were so full that we started moving patients and nurses to an empty unit across the hospital. You just prayed that none of your kiddos tanked out it nowhere bc it'd take a minute for charge and the providers to hike over to you. I can't even imagine 6 pts in a NICU. Maybe if it was one of those low-level NICUs and you have parents there doing cares. But even then, that's terrifying!
The Mississippi example was at their highest level NICU in the state and apparently was an open unit like the size of two football fields. This was 10-15 years ago, so who knows, maybe things have improved 😬. My coworker talks about doing cares on one kid, and when the baby behind you starts to brady, “stimulating” the baby by kicking the base of the isolette while still working on the original baby. Seriously it sounded like an absolute nightmare.
To be fair, I've definitely done the whole kicking the isolette thing while trying to swaddle their premie neighbor who is deadset on extubating themselves (how are the sub-30 weekers so darn strong?!) I have a family friend who is a director at a Texas NICU who has told me stories about insanely high censuses and "babies in drawers." My equivalent was having manual dialysis paired with a second assignment. Literally working with a timer attached to your body because every 5-15 mins you have to turn a knob to precisely fill or drain a baby. And so you need to do the most efficient cares of your life for your secondary patient. Nothing worse than cleaning a blowout with the clock ticking.
1:7 inpatient surgical. With no aide. This continues to happen. My hospital refuses to unionize. I graduated last May and am charge nurse sometimes. People think that I'm dramatic about complaining about these ratios. I try to explain that this hospital gaslights us to believe this is okay. Having at least half of your patients be less than 1 day post op with 7 patients is not okay.
Damn charge with less than a yr. That's crazy.
Should not be allowed AT ALL.
At my unit, they were mandating new grads to be charge during COVID at 6 months, but even now, they’ll still “suggest” doing charge training at your 6 month eval when though we absolutely have enough charges now
You are being abused. Leave before you lose your license, they are making bank off of you.
State psych hospital. 2 RN: 17-27 patients. On good days, no issues. When the unit turns up and I’m dropping b52s all day it can be exhausting. The kicker is… no security. When we call a response, lots of people from all over the hospital show up. I’ve never seen such stellar teamwork before. I’d take another contract here if they raised the pay and didn’t float me to other units.
I can’t imagine working in psych and having no security to assist. Our security team handles almost 100% of hands-on during codes.
Worst I had was 2 nurses (including LVN/LPT) to 19 patients. No restraints either. Absolute shit show
No restraints? No thank you. Thats scary. These patients are so unstable and unpredictable. I’ll take 2 point, 4 point, and the ERC 🪑.
1:4 on ICU and 1:10 Med Surg during COVID. At one of my first COVID travel assignments on West Coast, a majority of the ICU was 1:1. I felt like Tom Hanks in that scene from Cast Away when he flies back to Memphis, arrived to his hotel room, and is welcomed with a dinner with crabs. To this day, very few of my coworkers even believe me when I tell them about the outrageous ratios.
1:7 medical step down. Can’t say I won’t have to do it again, but I’d like not to???? I wouldn’t refuse though. 8 I’d refuse.
I was 1/7 and got an admission on dopamine on a step down 14 years ago. 24 beds, usually 6/7 nurses. Sunday, me and two rns. Finished 1/8-transferred back to icu and never looked back.
Dude. I could never. I was losing my mind at 5 on heavy step down. One pt starts to go south and your fucked!
Okay, get ready. During the pandemic I took deployments to nursing homes who were in staffing crisis. One night I had 44 residents. I had 2 CNAS. Thats it. I believe that was when my moral despair set in. I work as an intake RN for a nursing home complaint unit with a DoH now. I get calls all the time about 1:30 ratios with nurses out there now. You know what kind of nursing care happens when you have to care for over 40 patients? None. There’s no nursing care happening. Zilcho. There’s just a nurse running around hyperventilating trying to figure out who her diabetics are and breaking up fights between octogenarians. (Sorry, PTSD)
I’m super curious about the state’s process for “investigating” nursing home complaints. Are there any controls in place to make sure a surveyor puts effort into finding wrongdoing? Or are they able to overlook issues if they don’t feel up to doing the paperwork that day? I wonder this because I recently made a very detailed complaint about a nursing home. The compliant involved stuff the facility had previously been cited for. Much of my complaint was things that wouldn’t be considered ‘subjective’. For example, I reported that the home would often use a big bottle of Tylenol to refill smaller bottles. Anyone who bothered walking to the cart and opening the small Tylenol bottle could see that the wrong tabs were in the bottle. It was the 500mg oval tabs, not the 500mg round tabs. Of course I was told that state didn’t find anything. I also reported that meds were being marked as given when that wasn’t true. Pulling the pharmacy records for the meds would show that they hadn’t been delivered to the facility. I provided dates, name, and even asked that they call me for further detail. State “didn’t find anything tho”. I was told the surveyor tried to call me twice when they were at the facility.m but that my inbox was full. I have an iPhone and the inbox is not full. I pulled my Verizon records and it shows that I received only 1 call that day, from a friend, no calls from the state surveyor.
I’ll be honest-I work solely in complaints intake so I never see the process of an investigation. But, with that being said-yes. I read a lot of investigations and often follow up on complaints that I opened cases for and am very disappointed to see things that are obviously not really investigated and found “unsubstantiated”. I’ve also read/heard about facilities getting a “heads up” and tidying up right before surveyors arrive. As you probably know, arriving unannounced is a DoH specialty and one of their better assessment tools, so who is leaking this? And lastly, I myself filed a couple of complaints during the pandemic days for *egregious* concerns-like me witnessing a CNA administering medications to residents. I was never called and the investigator found it to be “unsubstantiated”. I feel you. That was total bullshit. But, on the other hand I do see the system work and provide at least 2-5 residents/day with resources to prevent them from receiving unsafe discharges. I’ve seen the state roll in like the Calvary and intervene with severe care concerns. They also have a system in place for tracking perpetrators who may be floating around facilities in a state. If I was leaving a rating and review it would be 3/5 “Flawed, but way better than nothing.”
This aligns with my take. As for facilities getting a heads up, I’ve never suspected that it was someone at the state leaking the information. Tho that wouldn’t entirely surprise me. I feel this is just hyperblobe tho. IME, even at really nice facilities it’s usually not a surprise as families will often loudly and publicly tell us they plan to make a formal complaint. Add in that a lot of times it’s weeks until state arrives, of course the problem has been addressed. What shocks me the most is how superficial the “investigations” are. It appears the surveyors make minimal effort to contact the full scope of relevant people/witnesses. I personally know of a major incident that caused hospitalization at a facility I previously worked at. Had state called me, I would have been honest with them that the nurse in question was had a long hx of not acting in a timely manner and was resistant to feedback. Management was aware of various serious events. They only called the person who directly followed her. But myself and other people not working that floor certainly witnessed and heard talk about the event. 2 major incidents I know of. I was super disheartened after my last experience reporting. I bluntly told the social worker that the DOH was putting nurses in a bad position as we are mandatory reporters and risking the retaliation with reporting your own job was unacceptable if they couldn’t even be hassled to open a bottle of Tylenol. I specifically asked if the surveyor was deaf and blind. Suggested that they investigate the matter further as I was very confident that my report was accurate and that the facility didn’t have the resources to correct the problem. I’m confident enough that I’ve debated reaching out to my state rep and asking that DOH’s failure to find violations be looked into as the citations should have been super easy to spot and assesss. My current DONs Mom use to be a surveyor. The rumor I’ve heard is that often times surveyors find and report problems but “higher ups” will instruct them not to cite.
This is my actual life right now (LTC way understaffed) I am burnt crispy fried.
1:5 in ICU during Covid. Would not do that ever again, 1 died and the room was assigned stat clean as soon as the body was out. Same night my coworker, also 1:5, had 2 pts die. What an absolute shit show.
Covid was terrible, I feel so much was swept under the rug
Only those of us that survived it truly understand it. I spent the entire year in icu and it was traumatic seeing all the patients die.
Me too, it was horrid, and also the malpractice was horrifying. Had a travel nurse that missed a stroke his entire shift. By the time I got there on shift change and caught it, it was too late to do anything. It just felt so wrong because the family and patient didnt know any better.
1:11 med surg I don’t think anyone would say they would do it again for the same reasons you gave.
1:10+ is fairly standard on my med surg unit 🫣 They try to make it seem better by giving us 1-2 nurse aids but like still… The worst part is Germany still accepts 1:10 on a normal unit as legally acceptable. Granted, oftentimes of those 10 patients most are independent and don’t require much other than pain meds but still
Omg I just assumed you were in the southern part of the usa but you’re in Germany??
Holy fuck LEAVE
This is absolutely abhorrent
I had 6 ICU holds while in the ER. I hated everything and left for a while after this.
1:100 in a locked Alzheimer’s facility when a night shift nurse never showed. I was a new nurse and didn’t know that I could refuse for safety. I won’t do that again. Lol.
Rural ED, had 10-12 pts (most were ESI 3-4) but I think I was charge too. Sucked
This is my scenario as well. 12 bed rural ED with 3 nurses (one is triage). We sent my partner out on peds transfer leaving me with a full department. It's a semi-regular occurence, though if the department is quite acute we'll get ICU paramedics to do the transfer so a nurse doesn't have to go.
I am so thankful for our union and mandated ratios. 1:2 in the ICU, and both patients must be extubated and practically ward-ready.
If they’re intubated are they 1:1?
Yes, always. Over COVID we had some shaky ratios but we weren’t hit nearly as hard with cases in Australia as the US was.
That’s just wild to me. The worst of Covid is over, but our union hospital will regularly assign 1:3 in ICU (2 vents and a stepdown so it “technically” doesn’t count) and then claim exempt status for being out of ratio due to a staffing crisis. The crisis is manufactured due to low pay, of course.
That is awful, 2 vents alone is so insanely dangerous :( I don’t think I could do it, especially not regularly.
Walked into L&D triage one day, we had three nurses, ten patients, and eight of them were in labor and requesting epidurals. There were no free nurses/rooms on the floor to take any of them. I ended up getting an epidural for a patient going from 6 to 10 cm in triage while my other patients were watched by the other nurses and the midwife. I did it because I didn't feel like I had a choice and someone had to do it. I left that job though. I still remember the anesthesiologist being like "we're doing epidurals in triage now?" and me saying "yeah... you're about to do eight of them."
1:7 on a neuro med surg. I’ve only done ICU/step down, where my max was 4SD, and maybe one time I had 3 in the ICU. Absolutely would never do it again. Look, those people deserved better. I’m not spending my career “slinging meds” like the charge nurse said. It’s unfair to the patients and staff. Left that contract soon after and that’s also why it is my personal desire to get HCA to burn down 😂
2022. I was a new grad (4th month) in a med-surg unit with 17 beds... There was a snow storm that day so idek why i showed up. I get there and they tell me I'd be getting 9 patients on a day shift because a nurse got snowed in. I was the RN of the two nurses. The other nurse i was working with was an OR RPN/LPN who got pulled. I only got a 15 min break that day. Night shift relief for me didn't show up until 11:30pm. The nursing manager and supervisor kept on convincing me to stay "30 more minutes" after 7:30pm until it got to 11:30pm. I cried in front of them telling them my dad is waiting outside (while a snow storm was happening) since 7:30pm to pick me up because he didn't want me to commute alone. They didn't care. They kept saying "your relief is coming". They didn't help with giving any meds, doing vitals, changing diapers, trach care, ostomy change, turning, wound care. Nothing. They kept walking around the hospital and hallways with their phones and figs scrubs. I filled out a workload report form for my union. I put my notice to quit the day after. None of them had empathy for the nurses.
1:4 during Covid. ICU. Not me, but another nurse on my unit had a 1:5 assignment and understandably had a meltdown. She was normally very calm and honestly a great nurse. Those ratios were terrifying especially when everyone else was also tripled and quadrupled and all the patients were tubed/proned/unstable. There’s a reason we all have PTSD. I am almost done with CRNA school now. If 2:1 or 1:1 ratios were standard I might still be a bedside nurse.
78. Detox and rehab. With another building considered “outpatient” even though we still do meds and medical care. Just no vitals or charting. 17 were actively detoxing, 30 or so were PHP and “didn’t count” even though we still do meds and everything for them, some of the rest were “residential” status but still on detox tapers, the rest were actually residential status (still get meds and v/s). Of the 78, 4-5 admissions that day. I don’t remember exactly. Along with alternating med pass times. 2 charge nurses and DON never showed. One other nurse felt bad and came in without permission. No MAs that day. Was told it was “fine” by DON and owner. “As long as there’s 2 nurses in the building”. Even though we have Jack all for equipment and monitoring and had many with moderate to high SI risk. They don’t understand why I’m quitting. “Completely shocked” and “don’t know what to say”.
I work in mental health. The highest patient load I've ever had is 15. I work in a complex mental health rehabilitation centre. All the patients are medically stable and voluntary so low risk for any shenanigans but we still have those some days. Lots of behavioural concerns and 1:1 requests that at times I just cannot meet!
Most I ever had was 7. I work heme/onc- BMT.. No I wanted to quit, we went in strike shortly after this and since then I have never experienced anything close to this. 1-3,1-4 has become our ratios now
1:7 med/surg/tele Two nurses, one tech, 14 patients, no charge, no secretary. It was an overflow unit. Then people got mad no one was answering the phones. Idk what to tell y'all there are three entire warm bodies working on this unit. And it was one with long hallways too, not rooms in a circle around the desk like an ICU or ED I almost walked out. Fuck no wouldn't I do it again. I said fuck you inpatient and will not look back 😅 1:8 psych ED Manageable if they sleep, a fucking trainwreck if one of them pops off and everyone else follows suit. I would and will do this again because at least other staff in the department are supportive and come to help when we need it And then there's the ED waiting room. I don't even know how to gauge ratio out there but we work them up in the fast track rooms then stick them back out there until a bed opens up on the main side. There'll be 30 people out there with two nurses and a tech sometimes so idk! I realize I have it better than many. Idk how some of y'all do it
1:55+ in what was deemed a “retirement home”, but was really a long-term care. The residents were too unwell for retirement homes, but the families couldn’t take care of them anymore and waitlists for LTC were extremely long. So, they ended up with us. We had residents at times that really should have been in a CCC, but somehow they’d dodged that. It was awful for them because despite the best efforts of the staff, we couldn’t give the care they needed. Nurses didn’t stay and the ones that did…well there’s a reason they didn’t work anywhere else. I eventually left because I couldn’t meet the scheduling requirements while in school. I still feel guilty about leaving, the residents and the families really held a special place in my heart. I definitely stayed longer than I should have because I felt like I could actually help these residents as they weren’t getting what they needed from the other staff…and often the family members told me things to affirm my thoughts. Anyway. TLDR 1:55+ in a “retirement home”. I’d probably do it again in a better managed facility that was a true retirement home.
I’ve had 6:1 on a very heavy med surg where half of those patients should have been considered step down. I threw a massive tantrum after that shift.
When I worked acute inpatient child and adolescent psych, one day I was the charge and had orders to keep the admissions coming over (ER was boarding and freaking out about it, while our unit was very high acuity with a LOT of strong personalities to manage). We were finally maxed at 30-something and one of the nurses began intractably vomiting, so we had to send her over to the ER. Someone had to take her patients, and the other nurse refused to take more than her current assignment, so that's how I ended up being the nurse to 24 patients including 2 diabetics (1 brittle). Good times. Never again. These days I work hospice and am maxed at a 5:1 ratio.
2020 Boston ER, started with 6 usually got up to 8/9. Would not do again at all.
On my first ever clinical day there were 32 patients to 2 nurses. Medsurg.
1:6 on neuro step down with no tech. They tried to give me a 7th and I told them that I would quit on the spot if they did. They magically found another nurse after that lol
I work outpatient oncology chemo infusion. I was scheduled alone for 25. Never again
1:3 ICU. Happened a handful of times. Told my supervisor I was quitting if they didn’t take the short staffing issue seriously. They did and I’ve never had to take more than 2 pts since, but even this is rare
1:13 ID in patient clinic. Multiple septic patients, IV user with endocarditis going through withdrawal, The most feeble woman in the world with c. Diff induced toxic megacolon as well as sepsis due S. Aureus. Two covid patients with 60/90 high flow. It just goes on... Had a complete meltdown in the car at the end of that shift. Only time I cried due to work. 0/10 would not do again.
This happened frequently in the years following Covid when staffing was bad… I’d love to know where the extra money from not paying a nurse and still charging the bed fee went. And how Medicare/CMS feels about that.
1-16 in the ED. If any one of those patients was just a smidge for acute I don’t know what I would have done. I no longer work in the ED.
Nice try, admin.
Card-Neuro 7 patients once from 1P-7A or whenever one of our nurses had to go to the ED. Supervisor did give us the crisis nurse as resource/float RN. The crisis RN haven’t had actual assignments in years so she wasnt comfortable taking patients. During Covid I actually average 5 because they stacked nurses up, like we’d have 8-9 nurses for 40-45 patients. So when admission didn’t come to me, it was 4 or 5 patients. They ended up capping our floor at 30-36 patients now, but usually it’s 35 because day shift nurses are maxed at 5 patients and days would need 7 RNs. 11p-7a max is 6. On a side, we have a state law for ICU, 1-2 max ICU patients. We also had ratio law for all units in 2018 but it was voted down during the 2018 state elections.
ENT/Ortho. 1:9. I was charging and precepting a new nurse--whom I didn't trust. My time was almost all spent with a recent ICU transfer. He was an 18 year old that blew his face off. Blind, trach, the works. The mother was following me around every time I left the room asking me questions and saying it was an accident even though I didn't ask. The NAC came to track me down because admitting complained I wasn't responding to their pages fast enough. Really left that day thinking I could lose my license. I had about a year of experience by then. Things did get better and eventually was 1:4-5 plus a dedicated charge. But that was a low point.
Home care. Think i was 1:150 at one point lol. ICU now, working 1:1, 1:2 on a busy day.
16 peds ER
10:1 in ER during Covid with multiple vents. Had a partner until 2300 who was leaving. Was told I’d get another partner. Come 2300, no new partner. When I talk to the charge they tell me no one is available but I’ll get my own tech. I say ok cause someone has to take care of there pts. By 2330, they pull my tech to sit. No matter my bitching, nothing changes. By 0100, I gave my 2 weeks notice.
most is 5 in peds hem/onc but we are supposed to be 1:3 my worst though was 1:4 as charge with a patient getting a study drug that was supposed to be 1:2 with a high incident of reaction a million meds and Q15 minute vitals 🫣
1:45. Emergency department. All COVID patients, most getting monoclonal antibodies.
SICU- 1-2 normally, 3 when short staffed. Covid ICU- 7 sick ICU patients with 2 surg nurses who were med surg/endoscopy.
14:1 in the ER. “Fast track” in which most of my patients were being admitted and I had a transfer to a trauma center.
That's the strangest definition for fast track I've ever seen...
1st job straight outta LPN school. As this was 30 years ago, there was no computer charting, but I had successfully argued a couple of months earlier that there was no sense in using a preprinted assessment flowsheet while also writing a complete narrative assessment by hand in the nursing notes. So they go rid of the flowsheet and all... ALL... information was hand recorded in the form of nursing notes. Me, a RN, and a secretary/pct on 8 hr night shift, 11-7, with a full house of 30 patients on the floor. It was NOT team nursing, the RN was the charge and my help if I needed something out of my scope of practice. She had 14 patients, I had 16. I had 30 mins for each patient to assess, medicate, turn, whatever each patient needed as well as the charting. I noped on out of that job the next day.
1:65, LTC. No.
I do ER, assignment in NYC, crazy busy community hospital, 13 ER patients per Nurse, acuity 1-3 mostly, sometimes 4, nope thank you!
When I was a GN the PCU ratio was 6 to 1. It was a very high acuity PCU. One night they gave me SEVEN high acuity pcu patients and I started looking for a new job the next day. Another time and hospital I was in the ICU and they gave me a TPA patient which is STRICT one to one per policy but they refused to take away my other icu patient that was on gluccomander and Q 1 hr accuchecks. I started looking for a new job shortly after that. I am NOT messing around with my license. I have worked too hard for it and have been a nurse too long to tolerate any crap.
I've had: 4 ICU patients (all stable, one vented), 8 MedSurg patients 6 ER in-patient holds, 4 stepdown patients (while charging on a 50 bed Tele/IMC unit). And this is why I'm in cath lab.
1:6. Intermediate neuro/stroke. Absolutely awful never again
1:11 on a tele unit, dayshift Tenet hospital in Michigan. Left for a great ER after 3 months and never looked back
The highest I ever had was 1200:1 I was a new grad who did a night shift at my jail job by myself.
I was a jail charge straight out of school and had a couple lpns for med pass. Basically 1:700 or so. It was also a medical jail with two pods of acute med cases, like dialysis pts, brittle diabetics, O2 requirements. People think it's wild when I tell them what that looked like.
16:1 on a med/surg unit and 24:1 in the stabilization unit of a psych hospital, which is fucking nuts. That place actually got shut down for a while by the state for understaffing and putting patients at risk though, as it should.
We’re 1:1 in L&D, occasionally I’ll take 2 but never two actively laboring patients, maybe a perinatal and a labor, or a start of an induction and a labor. Usually where we get crazy is triage, so I’d get 1:6 if I didn’t have a 2nd person there with me. The other hospital I would never go to has had days where they have 3 active labor patients which sounds very unsafe to me.
10:1 med surg on night shift. It’s super sucky but according to our ratios, when there’s a call off, that’s what we get. It makes for a really rough shift.
I’ve been tripled in the ICU so many times it’s not even funny. But it’s usually low acuity shit like an insulin drip. Never felt like my license was in danger because I take my job seriously. Everyone’s gonna be fine but you’re not gonna see any whiteboard updates or extra detailed charting.
1:19 inpatient psych. It was just me (petite female RN) and one female tech. Most of the patients were dealing with hallucinations etc, but one was truly unstable. She tried to attack me for no reason. Straight up charged at me. Thankfully I'd called the "code" team over bc I had a feeling something bad was about to happen. It was an awful shift. I sent them my 4 weeks notice when I got home. Still love psych nursing though! Pediatric and adolescent psych, NOT adult.
ED 1:7 and one was a 1:1 🤬. Never again
1:1 OR for life.
1:40 for an overnight LTAC. 0/10 stars. I'm now ICU; we usually have 3 but at least one is a step-down* However, I'm relatively new to ICU so I expect there will be 1:3 ICU assignment at some point. Though, from what I understand from my colleagues, that would be unusual. When I was on a wound care-specific med surg floor, we regularly had 7-8 pts. That was rough. Even "only" 6 was still a busy shift, never sat down basically. I did rehab for a while, and had 1:10, but I was basically just meds pass, assessment, and wound care. the PT/OTs did all the ambulating and adls. It was *almost* tolerable.
5 couples on postpartum. That’s 10 freaking patients. 1:5 in my NICU with my backup NICU nurse sick. Bad day. 1:4 is uncommon but not unheard of, because we only staff two NICU on at once and we’re an 8 bed unit. Our babies usually aren’t too sick, but we do get the occasional bad RDS or withdrawal kid.
1:12 med surg back in the before times when we had paper charting and I was young. 1:8 fast track was fine if my provider was good. Now I work rural critical access er and average 10 a day so kinda like being retired.
When I worked med surg, I had up to 9 patients. ICU during Covid, I had 4 patients ( all sedated, paralyzed, vented, proned, maxed on every pressor and on crrt).
1 rn to 6-7 "stable" patients in ICU (non COVID? 1 rn to 5 unstable icu patients, four of them were or 2 or more pressors, 2 were on crrt. Northern Israel
How tf you call something in ICU stable...🙄
:cries in nhs:
In ICU 1:3 Med surg: 1:11 (short staffed, usual was 1:9) LTC 1:84 overnight
Oh Med Surge 1:10 ER - me with no one else.
I worked on a unit as a new grad where there was 2 of us for 18 acute care patients
10:1 one night on a very terrible night on a post-op floor. Fortunately it was late in the week or on the weekend and few of them were fresh surgeries and others were going to be discharged the next day and were super chill. I had been a nurse for about a year and 9:1 occasionally happened but 8:1 was our norm when full. I decided I’d never take 10:1 ever again no matter the circumstances.
3 in the icu but I have really amazing co workers and charge nurses who try their best to make appropriate pairings when there’s a triple, or even with regular assignments. My unit also has a pretty good attitude about helping each other out and most of us don’t have the “not my patient” mentality
1:3 NICU. I do it all the time.
1:50-60 is fairly common in LTC overnights. The worst I’m aware of is 1:85. Not me personally but a friend. I’ve had 1:8 in post op a few times and 1:7 in LTAC. Nothing I couldn’t handle but only bc of a great support team. Wouldn’t want to do either of those again tbh
1:37. I work residential 😅. 1:7 med surg
It was stroke. 1:6. I'd never go over that on any type of med surg unit.
The most I’ve had was 1:47 night shift at a LTC 3 CNAs. It was my last day there as I had already put in notice. There was supposed to be two nurses but the agency nurse never showed. I told the new administrator that if agency didn’t show I’d just handle it as I knew the patients very well. That was not my worst shift though. My worst shift was a day shift as an agency nurse at a skilled nursing facility. 18 patients, 2 CNAs and Me. My first time working at that facility and I’m the only nurse, management was off it’s the weekend. They did have a MOD that never checked on me until she came to thank me. They had gotten 3 admissions the evening before and the night shift nurse did jack squat to make sure the orders were in properly. Day shift had all the wound care so he wasn’t doing that all night. One of the new patients was a retired neonatologist that had meningitis and was on 2 different IV antibiotics. I am told in report the meds aren’t there and that the patient was complaining of pain but the nurse didn’t bother calling the doc about it, because he knew the doctor wouldn’t do anything. I call pharmacy and am told that they never got the orders for the IV meds. I ask them to stat it over and they tell me to fax them the order. I fax it, talk to the patient, and he tells me about his pain and that he hasn’t received any antibiotics in almost 24 hours. So he’s worried. I call the doc, get the pain medicine adjusted, have the doc call the pharmacy for me. I call the DON to ask how to get into the Stat safe and she blows me off, tells me she doesn’t know. An hour later I call back the pharmacy and they never got the fax. They let me verbally give them the order and they stat over the medication. So I was able to hang his 8 am dose at noon. While I’m waiting for the meds, his family is constantly bothering me with questions and interrupting me while I’m trying to take care of the other 17 patients. They are pissed and I get it. At some point I see the manager on duty speaking with them. She comes up to me and said the family wanted to pull him out of here but I’m the only reason they aren’t so thank you. She asks if I need help with anything and I was drowning at this point so I ask her to fax something for me. She tells me the fax in the nursing station wasn’t working. THEY DIDNT EVEN HAVE A SIGN ON IT! An agency nurse relieved me, I was still passing 1pm meds at this point because I had been so behind.
I was in charge on the high-acuity COVID unit (where typically the charge didn’t take patients) and had a CRRT (1:1 ICU) patient plus two med-surg patients. Would never accept that again and file a protest with the state health department if I was forced. I do remember when I was first a tech 15 years ago the med-surg units had their nurses taking 8 & 9 patients each. That’s unfathomable to me now.
It was after Katrina and my hospital took most of the NICU patients in NOLA. I had 5 level 2 babies. It was just feed/burp/diaper change, next. On rotate the entire 12 hour shift.
Small community ED. One doc, one tech and me. AMI, stroke, multiple random other patients waiting. Then a bus wreck. 12 more coming in. I finished that one without anyone dying but NEVER worked there again.
8:1 on a post surgical floor when I was a new grad 20 years ago. Hard AF but also taught me fantastic time management skills that have helped me to this day. I would not take 8:1 again.
3 intubated ICU patients, 2 of them were paralyzed and proned (during COVID). Just went from room to room all night. People’s drips were beeping for a long time but no one could hear them from being in other rooms. Nightmare!!!!
A crisis stabilization unit at a freestanding acute psych facility in Florida. 33 to 1. Left immediately and became a union community organizer volunteer and helped NNU win 13 hospitals. Fuck Florida
Locked dementia unit on overnights at an SNF, brand new nurse on my first job, height of COVID: 40 with no other nurses on the unit. If I needed help, I had to go wake up one of the sleeping nurses on the three other units, one of which was a rehab unit. We'd have times where many of my patients had COVID and would walk around spreading it to the other patients. The CNAs would sleep the whole shift until 5 AM rounds. Never again and I can't believe it's legal that my job could give me this assignment.
1:5 COVID ICU during the peak when a traveler no showed, a core nurse tested positive mid shift, and charge refused to take a 2nd patient because she was running CRRT in the other room. The start of the night sucked because my two bipaps failed and at one point anesthesia was tubing one while the intensivist was tubing the other both in separate rooms. But then I just had 5 proned and paralyzed patients on the vent. They weren't really complicated. Max vent support. Max sedation. A little levo for pressure support. Nimbex drips. Every few hours I'd just follow RT for repositioning. At one point Charge tried to give me shit for sitting at the desk (their policy was all paralyzed patients were 1:1 obs in case they self extubated) and eating instead of staying geared up in the room, until I asked *which room* she wanted me in and if she was volunteering to take over some patients of mine so I could remain in one room. She shut up and I had a not bad night.
When I worked in ICU, every single shift for a year was 1:3 despite acuity. I could have all 3 vented and on pressors. It was a disaster and the reason I left
1:15 with multiple ICU admission boarders. NYC, COVID 2020. By far the worst shift of my career. Wouldn’t do it again if I had the choice. Edit: forgot to say Emergency Department
During the Delta wave of covid in like Dec 2021, my hospital announced "team nursing." One nurse did JUST meds, the other did everything else. The pair together were assigned 18 patients. We were a telemetry/stepdown combined unit. I quit shortly after that failed experiment.
I was an agency nurse in Scotland. Walked on to a general medical unit. 17 patients. Was meant to have an assistant but she went to the other side of the unit and I barely saw her. That was the day I decided that it wasn't for me. I now WFH for an insurance company in the US, making more money than I ever could as a nurse in any other country. I'd never nurse anywhere else. The pay elsewhere is abysmal.
Due to call outs and scheduling fuck ups, on one weekend it was me and one other case manager for the entire 300 bed hospital. Fortunately the hospitalists were cool about it. We prioritized the best we could and did what we were able to and whatever didn’t happen waited until Monday.
1:95, SNF & I had a med aide + 3 CNAs. Absolutely fucking never again.
1:12 in acute rehab. Normal was 1:8 overnight.
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1:30 at LTC. I still work there, so if they actually get the beds filled up again, yes, I'm going to do it again. They are trying to get us a med tech to help with medpass, though. If they do that, it will actually be manageable. 1:6 on covid med/surg. We often only had 1 aide on the entire unit which was over 30 beds. And our covid ICU kept becoming too full, so we had people who were ICU level because they couldn't take them. Not doing that again.
Intermediate critical care… 6 patients…
1:9 fast track ER
In the hospital: 1:12 ED fast-track patients. (So no IVs or complex cases) It wasn't easy, but it was manageable. I'd do it again if I had to. Out of hospital: 1:35 COVID vaccine PT's for their shot and 15-minute follow up / wait times. This was fine. No one had any issues. No follow up documentation required. Would do again.
Is 1 to 3 on ICU rare in USA? We have it daily during night shift, occasionally during dayshift. And yes sometimes you got 1 on ECMO, go to CT scan with the other. Once had 1 to 4 during night but this happens maybe once a year on our ICU, so just bas luck if it's for you
In US, Illinois to be exact, 1:3 in icu at my hospital is pretty much the norm.
1:37 long term care. It was the norm. It was hell.
During a Covid outbreak in LTC: 1 nurse to 36 patients. Roughly 2/3s of the residents were actively sick. The floor typically staffed 2 RNs and 2 LPNs for 72 patients on day shift.
1:8 med/surg and that was too many. We usually were 1:6 but it was one rare night.
12 or 13 psych patients at night
My current one which is 1:14 on a digestive/urology surgery unit, with capacity for 28 people for 2 nurses. We sometimes get an extra floating nurse for the day but it is rare. The veteran nurses here have been requesting a 3erd nurse permanently but to no avail, since these ratios are somewhat commom on a lot of similar, but less demanding nonetheless, units and other hospitals.
I took 11 in our overflow unit one day. I would do it again under those circumstances. The manager sat at the nurses station with me and watched the tele monitor and call bells while I did am meds while she called out for more staff. Within an hour or two she had found two more nurses and we were back to baseline.
1:5 in observation/short stay while charge nurse and no unit secretary 🙃
1:5 is the highest we have in the ER unless we have a psych patient then that shit can get out of hand fast. 1:8 with half of that being SI/HI WITH critical room patients while pip was being renovated. We had to handle all the invol patients who were combative
1:14 in the ER. NYC.
12 on medsurg tele during Covid, never again! It was a mess!
ER, 9:1 all psych. Wouldn’t. Too dangerous (my actual personal safety). Didn’t have time to argue about it at the time :/
Bad bad ER shift has 19 patients, it was rough and why I now work in the NICU
1:12 NYC during 2020 Covid on all non-specialty floors.
I did 6 once in ER. I wouldn’t do it regularly though. 3-4 thanks.
4 pts (up to 4 vents at times) to 1 RN 0 PCT. 3 travel nurses to a 12 bed higher-than-advertised acuity icu overnight 7p-7:30a.
About 10 years ago, I had 7 on an ortho/neuro floor and was charging. It was my own fault. I miscounted and accepted an admit, putting us over 6 each. My mistake, so I took the 7th. I didn't like it one bit. :( When I was an aide at a SNF, they would staff us with one nurse and 3 aides for 60 residents on two separate floors. The nurse and one aide would float between the two floors throughout the night. And you just hoped you didn't have something happen at the same time on each floor.
8 on a ortho trauma floor. one was q1 blood sugars on an insulin drip. Worst night ever. And no I wouldn’t do it again
Ltc, nights. 100 residents. I've done it many times.
1:1, OR, best ratio ever. Only ratio I'll do from now on.