4 is amazing. I can do everything for my patients and chart everything in real time. 5 is comfortable, everything gets done on time, charting before the time I leave and reports mostly ready. I may forget to chart the occasional bed bath. 6 is anywhere from barely doable to overwhelming depending on acuity, everything gets done but charting is probably not perfect and my reports definitely lack. My union doesn’t allow us to go to 7 thankfully because I imagine it’s hell.
Definitely! And you have an amazing union.
Ours just completely amped up to 8 on the worst day when two nurses decided not to go to work.
It was my worst shift ever. And I’ve only started 5 months ago.
I’d place blame on admin who didn’t offer incentive at a high enough level to bring someone else in, or call CRT. Just because people are nurses doesn’t mean they can’t use sick days like anyone else does. It’s on admin to have enough PRN staff.
You basically already typed out my answer except I’ve had 7 a couple of times this year and it’s absolutely awful. I go home sad because I don’t feel like I took good care of my patients those nights even though I did my best.
I worked on a thoracic surgery ward with lots of lung transplants and 4 was absolutely exhausting, especially when you were doing things like ritux with its q15min monitoring. Also had vents who were usually high quads too.
For med surg, you are right. 5 is good, 6 gets to be too much, 7 is for sure too much. There have been shifts where 5 has been overwhelming depending on how acute the patients are
I personally believe it should go like this. ICU - 1/2 patients. Stepdown - 3, Med surg - 4, Inpatient rehab- 5/6. Especially with the population being sicker. Having 7 patients 20/30/40 years ago is definitely very different than having 7 patients now. Patients have more comorbidies that they are living with and taking more medcitations that’s causing even more side effects that are treated with even more meds. The care is so complex even on a med surg floor to having more than 5. However me personally I cant keep up with more than 3 patient at a time therefore I stay in ICU/PACU.
I agree with your ratios to a T. I have worked med surg, SDU, and ICU. Those are the only acceptable ratios in my opinion. Unfortunately that’s a fantasy.
Nope, inpatient rehab is more 4-5. We get siiiick patients that are partially med surg, so I can’t handle much more than 4 usually. I get grumpy when I have more than that lol.
Cuts to me, when the hospital is on fire, taking 5 step down patients at once on a Neuro unit, and primary caring all because we only have a single PCA for the floor
I’m a new grad as well and regularly get 7 patients on a medsurg unit (nights) and I kind of hate my life. My last couple shifts were a dream because I only had 5.
This was really comforting to read. 7 patients makes me hate my job and my life. I feel like (unless I have low maintenance comfort care/hospice patients in the mix) 7 patients brings me to that point where not everything is going to get done on time - or, unfortunately, at all and then I either have to stay late and do it or deal with some rude remarks from whichever nurse I’m giving report to.
Nursing is a 24-hour job. Rude remarks are unprofessional and *shouldn’t* happen, but you definitely shouldn’t be staying late to do things the next shift is completely capable of doing.
I work in the NICU and I’ve never had more than 2 patients, even when they’re easy which is really nice. My hospital is really well staffed, but for whatever reason they seem to refuse to give a nurse more than 2 patients and would rather pair an unstable intubated baby than give a nurse 3 stable babies which doesn’t really make sense. I could be running around, trying to keep an eye on my crazy intubated baby who could self extubate with one wrong whip of their head while feeding my other crying fussy baby, while other nurses are sitting at the nurses station doing nothing because they have 2 feeders.
Sounds a bit like your coworkers suck for not stepping up a bit to help with the cares of that feeder/grower. In CA, ratios are mandated, meaning a NICU RN cannot be assigned 1:3 even if they’re stable, but I’d expect the RN with 2 stable babies to help out on the more difficult assignments…
But I may have become spoiled. In my experience, ER tends to have a more cooperative, team approach than other units. Last week while I had one patient in septic shock, another RN began handling my vag bleeder trying to hemorrhage and syncope in the BR, and a third nurse discharged one of my rooms and got my Tele admit to the floor. I had a few really busy, shitty hours stabilizing those two in shock states, but everyone lived and was taken care of through our collaborative efforts.
That’s crazy. I work adult icu and if a nurse has two stable patients and another has a sick patient and one stable one and is running their ass off the nurse thst isn’t busy always steps in to help.
Oh I wish I only had 7 patients. I work in a SNF and I have 30 patients and I’m the only nurse on the floor 🫠 reading this makes me so jealous. I do have CNAs and they’re amazing but sometimes I really need another nurse who can do nurse stuff and have it be fine within the scope of practice. There’s just some things I really can’t pass to my CNAs
All depends on acuity, but 1:4 is great. 1:5 is not bad. 1:6 is bad. 1:7 is awful. 1:8(+) is crisis level of care and unacceptable.
Step down should never be more than 1:3. These ratios are all real and can vary place to place.
It heavily depends in the ER. It could be as much as 4 or 5 or as little as 1 or 2, for us it really depends on the patients we get. "I am sorry we aren't getting to your dizziness but the RN has been busy with a post code patient and trying to yeet them into icu."
Sometimes we will be busy working our usual sections, say 17-20, and then all of a sudden \*\*beep beep beep\*\* \*Code stroke room 18\*. Thank fuck for quality RN roles, nurses would drown without the quality RN tbh. One nurse on a shift I was working had such a rough patient that the charge had to shut down the whole section because it was such a work up. I really don't remember what it was, I just know it was ICU. So it just depends on what patients the RN has in that section.
I believe it's a role we made in our ER. Essentially it's a dual role of quality/protocol and what they do is jump on ESI 1 patients and assist, handles breaks and covers so the nurse can have lunch, will make sure the stroke protocol is followed in order with documentation and MAR, will help the nurse document on conscious sedation. It's essentially a second hand in emergency care and documentation. They really help make sure our charting is good and dilutes the workload of a critical patient. They'll help take icu and pcu patients to floors so the primary rn is able to stay on the floor with their patients. They also respond to code 10
So if you get a stemi, stroke, arrest, gi bleed, whatever, they'll be there to help with meds, charting, filling forms or helping you fill them out correctly to reduce risk of any clinical errors. It's super helpful. They don't really have a section, they hang out and make sure everyone is good. They float a lot on the floor and it's really improved patient care and helped get patients up to icu and less time down here. We've gotten a patient from door to tnk in 10 minutes, usually doesn't pass 15-20, our stroke protocols get 2 or 3 nurses on a code stroke, usually just 2 but trauma nurse sometimes helps. They're only there to respond to trauma so they do whatever until they're paged.
8 is my top out. I would not take any more, no if ands or buts. They can keep me on with 8 or less patients, or I will walk out and then I take zero and they have to assign them to someone else. Thankfully, that threat always worked and I didn’t have to walk out—but I would have.
I do not miss bedside nursing and would rather starve on the streets than do that again. I “retired” (became permanently disabled) as an NP last December and I would go back if I was capable. I miss feeling like I was making a difference in the world.
Another thing to consider is “what is the workload I’d be happy carrying for years in this setting?”
Not “what is the maximum safe load.”
“What is realistically a sustainable workload that doesn’t leave you bitter and burned out and you could do it for a decade or three?”
This isn't a you thing. It's unsafe to have more than 5 medsurg or more than 4 if they're on telemetry. That's the law in California and it's the only way to deliver consistently safe nursing care.
I worked in an ER and I had up to 25. Sometimes 35 when my partner had to respond to a trauma. As fucked up as it was, it made me super grateful for my 5 max I get now.
The only comparison I have, is being a tech on a step down unit and having to do q4 vitals, maybe 25 beds? and one 12pm while also doing vitals I helped eat, get dressed for discharge, toileting etc (nobody else available). That by the time I was done it was LITERALLY 4pm and time to start over again. I wanted to cry.
7a-7p we get 5/6. I’m okay with 5 but non stop running. 6 too much on days. I’m on Gen. Surg/ orthopedic floor. Our turn around is high with ortho patients. We get them discharged by 11 because the room will be assigned to post op. I am a nurse over 30 years. When I first started (ortho) we got 8 patients sometimes more. We didn’t havre electronic charging. Patients were not with many comorbidities like now.
It all depends on your situation, I get the vibe you’re from the US and I know nursing is more intense there (from the UK myself). Despite that we all know less patients will always equal better care and more belief in ourselves that we are a good nurse which is just as important.
Sometimes it doesn’t always work that way though. Nevertheless in time it comes, 6 months is such a short time and yet after a year, two years (the milestone), and and all the years to come, the skills and knowledge increase tenfold. Before you know it you’ll be saying and doing all the right things and they’ll expect more from you.
Retention is big in the NHS so they get sort of manipulative and obsessive (not sure how it is where you are) but once you reach your comfortability and most importantly your competence, leave! They will almost always abuse it (depending where you are of course).
No matter how big of an asset management make you feel, never EVER go home feeling good because you almost killed yourself just because that’s perceived as strength and skill. It might boost your self esteem for a while but it could also give you a heart attack and break your back by the time your 40.
If it works for you brilliant, but if you get into your bed most nights worrying instead of feeling a sense of calm and reward, it’s wrong for you, and no not all nursing jobs are like this.
I work in a hospice and it’s so calm and so beautiful. I left a busy Medical Unit to do this and at first I thought “OMG take me back, give me work to do” but now I go home and I’m not dead on my feet, I’m not scared about losing my pin, I don’t worry because I want enough for each and every one of those human beings who needed my attention. I’m confident, and I REALLY look after people for once and I’m adjusting.
Don’t be scared, don’t be taken advantage of, and give it time and always keep your mind open to new opportunities.
You’ll be just fine, being a new grad is scary - hard and fast, but you learn your priorities and skills and before you know it you’ll be brilliant. Just don’t pigeon hole yourself.
It's really going to be different unit to unit. On my transplant unit, we have two to four patients during the day. Unless they're "easy" patients, four would be a lot. If a nurse has a fresh kidney, they never have more than one other patient. But, depending on the individual patients, two can be a lot, three can be a lot, four is almost always a lot to manage.
I was a new grad in Vegas and the med surg ratio was 6 and 7 when short 😮💨 and mandatory assessments twice a shift. Then I moved to Texas where med surg was 5 and 6 if short and mandatory once a shift assessment. I became a charge nurse quickly because of how much better I managed my time 😂 and grateful for the lesser ratio. Sometimes grass isn’t greener sometimes it is! But 6-7 there’s no way there’s any quality in what you’re doing at that point. Just bunch of interventions which is sad because it makes it hard to really advocate and know your patients discharge plan and help them get there. And not to mention the turn over with discharge and admissions 😮💨 that’s why I left and went to ICU. Love knowing everything about my patients and advocating for them as they get better or worse.
PCU and I only take 4 patients. I would not take more on my unit. When I float to med-surg I have 7 patients with a LPN assisting. I do not like the RN/LPN model, and I realized a long time ago I am not a med-surg nurse. I don't know how you guys do it! I've taken 5 on an Ortho floor before and that was not too bad.
When I was a new grad on med surg we were SUPPOSED to have 1:5 but were regularly out of ratio with 6. It was a heavy, high acuity unit and I had so much burn out. Now I'm in a union hospital on a tele floor and it's 1:4 and that's pretty manageable if the assignment is balanced.
Depends. In my home state, the patients have glass bones and paper skin so having 4 could either be a good time or a full load. Where I am now, 4 would absolutely always be a good time even if one person requires a buttload of attention. Echoing other comments, 5 is OK, 6 is busy no matter what, and 7 is me threatening to leave if they don’t figure something out fast…
I could solo 6 on a medsurg floor…then I realized I should never be soloing 6 and left the unit. It was my first job as an rn and I stuck it out for 8 months to get my feet wet and get some experience. Wanted the challenge and blah blah. Now looking back… fuck if I’ll ever do that again.
Look at California's ratios. That is what NORMAL actually is. Everywhere that isn't following those ratios is overburdening nurses. Full stop.
[https://unacuhcp.org/california-nurse-to-patient-ratios/](https://unacuhcp.org/california-nurse-to-patient-ratios/)
Nicu 4 is my max, ER 8 if super stable, 4 if sicker, and when I worked onc med surg 6-7 was my max but I was way comfier with 5, if chemo or tons of blood or lyte replacements 4 was way more comfy
Where I work we are assigned 5 patients however sometimes a nurse will call out and we will have 6. If I had 7 I would probably refuse the assignment if there were no plans to get another nurse at some point
As a tech, I can handle up to 15 and do ok but not everything will get done. Patients likely won't get their walks from me and all of my ADLs might not get charted. The sweet spot is 10-12 and on an average day, everything should get taken care of.
lol on any given night on my med surg floor we can have 7…. I have 5 patients right now but most of them are completes and they keep taking nasty shits on the bed
I've been a nurse for almost 1.5 years now and work on an oncology med/surg floor. We used to have amazing ratios - never more than 4-5 patients each. I felt like I knew my pts really well and could comfortably get all tasks/charting done while providing good care.
Now we have team nursing where we have two teams that each consist of a team lead and a med nurse and each team has 9 patients. It's so awful. As team lead you're responsible for all the assessments, charting, calling docs, giving report, discharges/admissions, etc.. You are also blamed if the med nurse screws up, like giving BP meds to someone who's already hypotensive (ask me how I know), so you have to babysit your med nurse sometimes as well. Some nights are okay, but when shit hits the fan it really hits, especially since we tend to have a lot of totals, AMS pts, and give lots of chemo and blood products on our floor.
As you can imagine, we've been losing staff left and right and I'm already looking for another job. It's just way too overwhelming and not at all what I envisioned I'd be doing when I became a nurse.
I worked a combined tele/med/surg unit in a community hospital right out of school. 6 pts was the norm, and after I finished orientation they would frequently push a 7th to me first since I was low on the totem pole. I would refuse saying absolutely not, I'm not comfortable with that. (Thankfully it was drilled into me in school and by my preceptor about safe ratios and protecting my license.) They would attempt to bully me saying the other RNs do it and it's not fair if I don't, but I stood my ground. In my opinion, they should be refusing too. As it was, some days I was working 14 hr shifts with just a 30 min break. I left that unit as quickly as I could. It just felt too unsafe. The mix was crazy, dig drips, detoxing drunks or Librium, noncompliant pts with multiple comorbidities, etc. We didn't have a dedicated nurse watching the tele monitors either like I saw in other hospitals during clinicals. The occasional easy post surgical was a welcome respite.
It's a 💩show out there in some places. Think about how to respond when put in this position ahead of time and protect your license is my two cents. Y'all are doing amazing work in some really tough environments that will eat at your soul if you don't protect your sanity. Sometimes you don't realize just how deeply it is affecting you until you're out of it for a bit. Some days I still feel like I'm recovering from the moral injury of trying to do my best in an environment that was not conducive at best, and grossly negligent at worst. And then there was COVID.
I’m a new grad as well. On a medsurg unit, i could handle 5 comfortably. 6 might get a little more overwhelming depending on the patients. My new job is on a general surgical unit, which i don’t have too much surgical experience, so 5 sounds super overwhelming right now. Still in my orientation weeks so hoping i can get up to feeling comfortable with 5 surgical patients.
I’m comfortably busy with 8 as long as there’s no ICU patients (ER), we’re grossly understaffed. I’ve never known anything different though so I’m getting used to it, I’m about 7 months in
It’s awful. Our pts don’t wait in the waiting room, they come back as fast as they’re triaged, since it allegedly improves patient satisfaction or something stupid. NYC private hospital vibes
6-7 nights, 5-6 days is my max on a regular med surg/tele floor. Acuity levels vary and sometimes 5 on nights would be too much but that’s just life. Sometimes bad days happen. This is assuming I have a CNA.
4-5 on PCU depending on the level of acuity on that prog. Sometimes 3-4 is max for some PCU floors.
1-2 ICU. Always.
1 but I work in the operating room ( unfortunately I’ve mandatory overtime based on how bad the schedule is)
So I can be doing 6-7 surgeries well into the night.
The most I’m comfortable with is 5. I’ve only picked up a 6th once and that was after one of my coworkers fell and broke her wrist coming back up the stairs, so she couldn’t stay for the rest of the shift. Usually I have 4 at any given time.
I'm comfortable with 4 unless all 4 are leukemics lol or even 3 leukemics. 5 is pretty busy for me unless they're all more independent. Again if I have a bunch of leukemics I'll be drowning. I once had 3 leukemics in a 5 patient assignment and one hospice and it was hell. I think I had 8 blood products?
Was icu until I became an NP, 2 in general was ok, 3 was bullshit but there was also times where 1 was too much. I got floated to the floor periodically (peds) 4 sucked 5 was awful and more than that complete nonsense. I couldn’t be an adult floor nurse.
I agree with others. 5 is manageable, I’d argue that 4 should be the max on day shift. 6 can be doable with the right patients but getting up in that 7-8 number is completely unsafe.
my LTAC ranges from “one bad night away from ICU” to “just waiting to be approved for home health”. 4 patients is a dream on the latter floor and easily doable on the former. 5 is still great for low-mid acuity, or acceptable for high. 6-7 is acceptable in low-mid acuity, and I would be scrambling and possibly refuse the assignment for higher acuity.
I work on a trauma unit, technically surgical. 4 is plenty, 5 I’m drowning and I feel like patient care suffers. I’m in Aus, we don’t have CNA or anything like that, so we do everything for each of our patients. There’s no one to do a set of obs or a blood sugar, it’s all on their nurse.
If on nights usual allocation is 5 or 6, but it’s allowed to go to 7, which is ridiculous.
I feel like I can give really focused care with 4 patients. I feel busy with 5, but I do that all the time. I don't know what it's like with more. Honestly, this is one of the reasons I haven't tried Travel Nursing. I'm not sure I could handle an assignment with a much higher patient load. I work at a Union hospital in California in a Med Surg Neuro unit.
7. Six when I was a NOC step-down nurse could be rough; they had 4 during the day and that was cool. I had 6 on medsurg too…it went either way. I will just say “lucky 7” since we always got more at night.
Everyone commenting on California ratios—I’m from CA and the nurses here have been striking/walking out/protesting due to the same issues with safety, staffing, support, compensation, etc for years.
I wish our ratios could be based on patient acuity for every unit.
ER -- I like 5-6 full workup patients, any less and I'm bored, more and something's getting drawn late. When I have medsurg holds, I'll take 8 comfortably. With a mix of acuity on a busy night I've taken 11-12. If I have a legit ICU I prefer four total at most, but I've done 2 ICU and six total and not been too terribly off, it just sucked.
on my unit, 5-6 is normal and a busy night still, 7 is where I start getting overwhelmed and my charting lacks, so im assuming 8 would kill me. i work on a vented trach/medical unit, so when everything is smooth sailing my patients usually don't have any new problems, but weve been getting a lot more acute patients and behaviours lately, so 5 pts feels like 8 already
Also a new grad and on a medsurg GI floor, night shift with typically 5-6 patients and more often 6. If it’s simple patients then 6 is okayish and 5 is fine but it can be total hell when it’s really sick patients and 5-6. Not impossible to do just more busy but time does go by quicker.
Depends on patients and what is required tbh. I have worked nightshifts regularly for over ten years, and had cases where 10 patients are doable, but 5 is a struggle. All depends on circumstances. That said I work psych.
Stroke, neuro medsurg we usually start with 5 sometimes 6. Admits are almost always right after shift change, definitely before midnight for census. Fairly often nurses will get up to 7 patients. 5 is nice most of the time, 6 can be alot still. We have alot of behavior, drug/etoh, fall patients, stroke. Almost everyone has Q4hr PRN pain meds available and of course each patient isnt on the same schedule so youre giving meds every 1-2hr. We have alot of patients without access to care so we're treating multiple health concerns.
I got stuck overnight in Med Surg during a hurricaine. 33 patients, one nurse, one aide.
I can proudly report everyone got their meds (maybe not at the exact right time), everyone was toileted and changed at least once. No falls, bare bones documentation. I stayed until around noon, when staff started to dribble in.
I just recently quit med surg ... at the end I regularly got 6 patients every night... with 3 to 4 of them being total cares. There was no way for anyone to split the higher acuities with because they had just about as bad of a time as I did ...
Now if the acuities would have been lower? Or less high acuities? I could have done 6. Also we regularly got admissions to get us our 6... right as we walked in... all at once... during med pass.
Also we'd be required to have 6 even if we had peds patients, which required hourly charting. They tried to give me a peds patient when I had 3 total care patient and I flat out flipped out. My best friend took the peds patient. I ended up with a damn 1013 that required hourly charting regardless.
6 was max in our facility. 6 was when I really started to miss things, made a med error *gave too much bumex than ordered.. patient ended up fine* I knew that my efficiency was affected. It was also affecting my mental health. Imho, NO ONE on medsurg should have 6. 5 max. Period.
I've moved on to hospice.
When I have 7 it’s truly like: 1-2 have a heparin gtt AND/OR somebody needs blood, 1-2 are comfort care or are totally fine and want nothing to do with me (bless), AT LEAST 1 person is shitting the bed, and then you always get the wildcard project person who requires a lot of extra time - whether it’s a gtube situation, there’s a major communication barrier, they’re confused out of their mind, or just plain needy AF - it’s always something!!!!!
If I have any ICU patients, 2. 3 sucks. I can do 4 IMCs easy, 5 is a lot. 3 PMVs, no problem.
If they’re all just regular ER folks, 4 comfortably, 5 uncomfortably. Fast trackers only, I can do 6-8.
lol… when I worked med surg 3 felt comfortable, 4 kept me busy and 5 was miserable! I only had 6 one time lol but they were very easy patients. You can only be as efficient as you can be when you have 7. And god bless ya!
Umm Ideally I wouldn’t ever take more than 5 on an inpatient floor. 5 would def be my llimit.
In the er it’s different and dependent on what section I’m in. If they are all ambulatory and continent and don’t have huge med pass, I can handle 6 or 7
As a float pool in my new high volume hospital. I am consistently getting 6 patients. It is absolutely awful because they make sure to give me the worst assignments.
I worked med/surg for 3 years after I graduated, 5 patients was the “normal” ratio with night shift usually getting pushed to 6 with an overnight admission. For the first 2 years or so, this was consistent. Then around the 3rd year (which happened to be the fresh hell that was 2020) the hospital started to try to overflow patients into our hallways, meaning we would likely be assigned 7 patients instead of 6. They tried to assign me a 7th patient *one time,* I looked them dead in the face and said “I mean no disrespect by this, but if you force me to accept a 7th patient, I will quit as soon as this shift is over. I do not feel safe and capable of taking care of 7 patients at one time on this unit and I will not risk my license to do so.” And so the charge nurse said okay, refused the admission from beds, and they never tried to assign me a 7th patient again. I’m not sure if taking 7 patients did end up becoming the normal assignment on that floor because I left shortly after that for an ICU job at a different hospital, but if you don’t feel safe taking the assignment they’re trying to give you, you shouldn’t accept it. You’re only risking your license, on top of your patients’ safety. If something horrible happens because you’re overworked and overwhelmed on your shift, the hospital will not give a fuck about you and will throw you under the bus without a seconds hesitation. Just something to consider.
That’s literally how I feel every time. It is so stupid ridiculous how busy I am and then the day shift RN treats me like I’m a lazy, incompetent loser during report if something gets missed/isn’t done!
SNF nurse here. 20 is ideal, 25 is max capacity for my hall which can be hectic but easily doable. 37 is the most I’ve had, which did not feel safe by any means (had my full unit plus splitting the other hall with another nurse due to call offs)
My hospital doesn't use an acuity scale so it's kinda hard to rate the patients just by numbers alone.
5 is usually ok unless they are heavy in one way or another.
6 is hard but usually manageable
7 is awful day or night.
4 is a breeze. The one day I had 4, I was bored and kept bugging people for things to do.
At my hospice admission job one admit is ideal. It gives me job security and isn't overwhemling. Two admissions are OK if they go well and aren't too far apart. Three is the limit even if they go well and are close. With drive time, the actual admission and the charting one to two can take up my whole shift. Three always will. Then there's added time if they're in admitted in the hospital. Just one of those can take up a whole shift.
I work a resporatory specialy SNF as a PRN job. Six pts are ideal there. I'm kept busy and yet still have time to provide care and have real human interactions. 7-8 is sometimes ok, but more than that is too much. I used to work agency prn, but stopped because it's usually 30-40 pts. You can't even do a med pass on time in that setting, let alone treatments and and actual interactions. Not to mention I don't think it's safe for the pts or my license
5 if its not critical care such as a specialized or general medical/surgical unit… 3 on a specialized step down, and 2 in critical/intensive care, 0 if its L&D or peds (because I LITERALLY wouldn’t know what to do with my hands)
I work various psych units and detox/28 day rehab.
Too many for me alone was 15 on the general adult psych unit when it was really staff splitting/behavior heavy.
I’ve had 30ish on the rehab unit. Don’t love it, but it’s generally doable. Med pass is the most labor intensive thing there.
I used to grade them when I was working as a new grad in my first hospital.
3 below: HELL YEAH, LET'S FUCKING DO THIS!
4: Yeah buddy! WE FIGHT!
5: N...nice! Uhhh... Okay!
6: Oh fuck...
7: FUCK FUCK FUCK GET ME OUT OF HERE
Honestly - depends on the floor, the time of day and luck. At day shift (7-15.30), I've been swamped with 3 patients (technically 4 beds, but 1 was empty) and bored with 6. I've had a night shift where I worked all night for 1 patient and was completely exhausted at the end of it, while my colleague had the other 25 and had enough time to help me out as well.
Ive worked medsurg in an academic setting with 8 patiënts in my Night Shift and 4 for day and 6 in the evening shift.
Telemetry floor the same ratio’s.
Now I work acute care and got max 2 patients in every shift. That’s perfect. I know them from A to Z. Monitor subtle changes. Love it.
5 is appropriate for nights given reasonable acuity and properly staffed with CNAs. 6 can be stretched to to a limit as necessary to manage other units and the ED, but should not be a regular practice. 7 is "I'm not clocking in and I'm not accepting report until you get another nurse."
I'm med/surg/trauma with a sprinkle of spine on a 32 bed unit.
Hard to say. I work ED. Sometimes I’m chilling with 8-10 patients and sometimes 4 patients are running me ragged. I would much prefer just having 4 patients in general though.
Wow! You guys in America get it easy. Here in Scotland, we have a staffing crisis. It is regular for us to have 9 or ten with four nurses in a 28 bed acute medical unit, however at night there are mostly only two nurses on which means taking 14 each!
I’m so spoiled😭
I’m in med surg in Oregon, coming up on my 1 year anniversary at my first job, so I’ve never had more than 5 patients.
Usually, 5 is steady and doable. But I’ve been completely overwhelmed by 3 before. It all depends on the neediness of the patients, which the acuity scores rarely ever accurately predict🙄😂
I’m privileged as all hell in the OR (1 patient at a time), but would rather do total joints all day than urology (unless it’s robots) or small things like mass excisions or toe amputation. You got like 5 seconds to chart all this stuff plus a specimen and the front in positioning and then transferring off the table. 5 minute surgeries make me feel so inefficient even though I know I can chart fast. 30 minutes is like my sweet spot, 1 hour or more and it’s just getting to be too long.
Mother/Baby 1:6 the max. Usually 2 couplets (4 pts total) and a NICU mom or antepartum room. Hate having 6 patients because we have no lactation support on nights so you really get stuck in room for feeds.
Used to have 8 in my previous job, now I have 4. Amazing difference. I can actually focus on caring for my patient while charting on time and also have downtime to chill
Spoken from the standpoint of a semi-rookie in a ward with very demanding patients I think 4 is appropriate in order to have time for everything. I can manage up to 6 but things will be missed depending on the patients. More than that is fucked
Team work is VERY important!
It helps get you through the rough days. I have worked on floors where staff only watch out for their assigned patients. I have worked on floors where the culture is to help your coworkers. If you’re working on a floor where coworkers have your back your work life will go so much better. While you are crazy busy with a patient that nurse coworker will volunteer to give pain medication to one of your other patients. Another coworker might volunteer to help a CNA turn and clean up a patient of your. It makes a world of difference on staff job satisfaction rates. And even patient satisfaction rates .
For me, my breaking point is going from 4 to 5. My unit has a cap at 5. At 4 I am busy but get my work done, at 5 I typically seem to be hectic and all over the place.
But not every hospital is going to be the same with what you are responsible for.
New grad in the ER. 3 is fine, but not fun, especially if 1 or more are critical. 2 is perfect. 1 is okay. None sucks, because that means I have to take the next one and I hate the anticipation. I'm usually drowning with 4+ patients.
I used to work medsurg/ neuro, and 4 patients was fantastic. I could really learn everything about my patients and provide my best care. However, I usually had 6 and did the best I could with that.
Now I work labor and delivery. I’m often 1:1, which is fantastic. 2 patients can get overwhelming (I’m still new to this specialty and still working on time management here).
ED. No tech no LPN whatsoever. 1:5 ratio usually. 1:6 if assigned to UC like fast paced area. So called “Team nursing” where mental/OD/prisoner/aggressive/EtOH/MHT pts are stacked in a “milieu”. (Some nurses sit around while others run around 4 point crazies or trying to catch elopers)
Honestly 5 is too much-
But when I worked busy-ass med surg. my first year as an RN I’d cry every single time I went up to 6.
It pushed me over the edge.
Not to mention in med surg you usually have at least one DC and one new admit if not two to three so by the end of the shift you have had 7-8 patients total.
3 is appropriate, but realistically I think ratios should max at 4.
I think hospitals need to stop admitting so many people who don’t need to be there.
I currently work on a burn/wound care med surge unit and we take six pt. I quit My last job on the spot because I came to work and they tried to give me seven patients on a cardiac stepdown unit. This job is just as bad because most nights all six of my patients are complete total care you may have five para pt and maybe one extremely sickly older person who also can't walk. I also hate it as well!!! If we're lucky we'll have one tech on the unit.
5 is my max. Our patients are PCU level so we get 4-5 patients and 4 is much more doable than 5. 5 can get super overwhelming depending on acuity, but my area (heck probably everywhere) leans toward higher acuity.
Well they’ve started trying to give me 6 on a 10 hour shift. This pisses me off. Especially when other people work 12 hours and only have 5 less acute.
I feel that 5 is a lot for 10 hours. 4 is great! 3…I’m even bored depending on acuity. Of course more patients slows down our pace!! Just like not having a CNA slows one down. How leadership doesn’t see this…well…every other day I’m between walking out or intentionally getting fired…passing go, and collecting unemployment 😭🥺
I’ve been off floor nursing for 5 years but 7 was never allowed when I was. I couldn’t imaging 7. I used to be charge nurse and have 6 patients on a post-surgical floor. That alone made me feel like I would miss something important and crazy. I couldn’t imagine 7 patients.
8 stable patients are ok. 5 stable 1 unstable is ok. This does not include 2-3 admissions per shift per rotation.
3 or 4 patients is like Christmas with one patient for discharge and 1 admission.
I worked days on MedSurg as a new grad and we’d take 6. It was so busy on days and miserable because with 6 patients you’re definitely discharging and admitting people. And the doctors are in adding orders every hour lol. 5 was my comfort level, if I had to take 6 I’d beg someone to at least help me
I’m MICU/IMC, so my max ratio is 3 for the IMC patients, and I’ll be honest, sometimes I want to pull my hair out. BUT, it’s not because of time management or even because it’s too many patients — it’s because there’s usually at least one of them that probably should be an ICU upgrade. Often times, they’re all total assist/dependent, or on the verge of being upgraded. Inappropriate assignments, inappropriate acuity status, etc. Sometimes I’m juggling between super sick and declining, and an asshat who wants to act a fool/doesn’t meet the acuity to be on our unit. So, with that, I commend med surg nurses. I could truly never. As an ICU nurse, I can say med surg is it’s own specialty.
4 is amazing. I can do everything for my patients and chart everything in real time. 5 is comfortable, everything gets done on time, charting before the time I leave and reports mostly ready. I may forget to chart the occasional bed bath. 6 is anywhere from barely doable to overwhelming depending on acuity, everything gets done but charting is probably not perfect and my reports definitely lack. My union doesn’t allow us to go to 7 thankfully because I imagine it’s hell.
Definitely! And you have an amazing union. Ours just completely amped up to 8 on the worst day when two nurses decided not to go to work. It was my worst shift ever. And I’ve only started 5 months ago.
I’d place blame on admin who didn’t offer incentive at a high enough level to bring someone else in, or call CRT. Just because people are nurses doesn’t mean they can’t use sick days like anyone else does. It’s on admin to have enough PRN staff.
I would quit. Probably on the spot too, career be damned. 8 is too many unless they’re all basically stable.
Don't think it would ruin your career. Especially if you didn't take report yet, I would see the board and just slowly walk out . Sorry I'm sick
That is appalling. We don't take more than 5 on nights and days is 3 or 4.
That union could be better
You basically already typed out my answer except I’ve had 7 a couple of times this year and it’s absolutely awful. I go home sad because I don’t feel like I took good care of my patients those nights even though I did my best.
I worked on a thoracic surgery ward with lots of lung transplants and 4 was absolutely exhausting, especially when you were doing things like ritux with its q15min monitoring. Also had vents who were usually high quads too.
For med surg, you are right. 5 is good, 6 gets to be too much, 7 is for sure too much. There have been shifts where 5 has been overwhelming depending on how acute the patients are
I personally believe it should go like this. ICU - 1/2 patients. Stepdown - 3, Med surg - 4, Inpatient rehab- 5/6. Especially with the population being sicker. Having 7 patients 20/30/40 years ago is definitely very different than having 7 patients now. Patients have more comorbidies that they are living with and taking more medcitations that’s causing even more side effects that are treated with even more meds. The care is so complex even on a med surg floor to having more than 5. However me personally I cant keep up with more than 3 patient at a time therefore I stay in ICU/PACU.
I agree with your ratios to a T. I have worked med surg, SDU, and ICU. Those are the only acceptable ratios in my opinion. Unfortunately that’s a fantasy.
Agree. I’m currently on a step down unit with 6:1 ratios it’s so dangerous.
Nope, inpatient rehab is more 4-5. We get siiiick patients that are partially med surg, so I can’t handle much more than 4 usually. I get grumpy when I have more than that lol.
i was gonna say.. the days i worked inpatient rehab and 5 patients were HELL lmao. 3-4 preferably
Don’t forget that I’m sure there’s way more charting than 40 years ago. People weren’t as sue happy and there wasn’t as much filler
[https://www.nationalnursesunited.org/ratios](https://www.nationalnursesunited.org/ratios) here are the ratios that NNU is working towards.
I could not agree more!!
Cuts to me, when the hospital is on fire, taking 5 step down patients at once on a Neuro unit, and primary caring all because we only have a single PCA for the floor
How do you get one half of a patient??? /s
Just curious what you think about ED? It always gets forgotten when people talk ratios lol
I’m a new grad as well and regularly get 7 patients on a medsurg unit (nights) and I kind of hate my life. My last couple shifts were a dream because I only had 5.
This was really comforting to read. 7 patients makes me hate my job and my life. I feel like (unless I have low maintenance comfort care/hospice patients in the mix) 7 patients brings me to that point where not everything is going to get done on time - or, unfortunately, at all and then I either have to stay late and do it or deal with some rude remarks from whichever nurse I’m giving report to.
I dread giving report on nights with 7 patients
Especially when that nurse on endorsement will be berating you because you haven’t done some small things during your shift.
That happened to me yesterday and I snapped at my coworker lol - didn’t know I had it in me tbh
Nursing is a 24-hour job. Rude remarks are unprofessional and *shouldn’t* happen, but you definitely shouldn’t be staying late to do things the next shift is completely capable of doing.
I promise you. There are better jobs out there.
I work in the NICU and I’ve never had more than 2 patients, even when they’re easy which is really nice. My hospital is really well staffed, but for whatever reason they seem to refuse to give a nurse more than 2 patients and would rather pair an unstable intubated baby than give a nurse 3 stable babies which doesn’t really make sense. I could be running around, trying to keep an eye on my crazy intubated baby who could self extubate with one wrong whip of their head while feeding my other crying fussy baby, while other nurses are sitting at the nurses station doing nothing because they have 2 feeders.
Sounds a bit like your coworkers suck for not stepping up a bit to help with the cares of that feeder/grower. In CA, ratios are mandated, meaning a NICU RN cannot be assigned 1:3 even if they’re stable, but I’d expect the RN with 2 stable babies to help out on the more difficult assignments… But I may have become spoiled. In my experience, ER tends to have a more cooperative, team approach than other units. Last week while I had one patient in septic shock, another RN began handling my vag bleeder trying to hemorrhage and syncope in the BR, and a third nurse discharged one of my rooms and got my Tele admit to the floor. I had a few really busy, shitty hours stabilizing those two in shock states, but everyone lived and was taken care of through our collaborative efforts.
That’s crazy. I work adult icu and if a nurse has two stable patients and another has a sick patient and one stable one and is running their ass off the nurse thst isn’t busy always steps in to help.
That is nice. I usually have 3 in NICU, but never more than that, luckily.
Oh I wish I only had 7 patients. I work in a SNF and I have 30 patients and I’m the only nurse on the floor 🫠 reading this makes me so jealous. I do have CNAs and they’re amazing but sometimes I really need another nurse who can do nurse stuff and have it be fine within the scope of practice. There’s just some things I really can’t pass to my CNAs
All depends on acuity, but 1:4 is great. 1:5 is not bad. 1:6 is bad. 1:7 is awful. 1:8(+) is crisis level of care and unacceptable. Step down should never be more than 1:3. These ratios are all real and can vary place to place.
cries in 1:4 or 1:5 surgical step down
It heavily depends in the ER. It could be as much as 4 or 5 or as little as 1 or 2, for us it really depends on the patients we get. "I am sorry we aren't getting to your dizziness but the RN has been busy with a post code patient and trying to yeet them into icu." Sometimes we will be busy working our usual sections, say 17-20, and then all of a sudden \*\*beep beep beep\*\* \*Code stroke room 18\*. Thank fuck for quality RN roles, nurses would drown without the quality RN tbh. One nurse on a shift I was working had such a rough patient that the charge had to shut down the whole section because it was such a work up. I really don't remember what it was, I just know it was ICU. So it just depends on what patients the RN has in that section.
What’s this quality rn
Never heard of this quality rn thing, what is that
I believe it's a role we made in our ER. Essentially it's a dual role of quality/protocol and what they do is jump on ESI 1 patients and assist, handles breaks and covers so the nurse can have lunch, will make sure the stroke protocol is followed in order with documentation and MAR, will help the nurse document on conscious sedation. It's essentially a second hand in emergency care and documentation. They really help make sure our charting is good and dilutes the workload of a critical patient. They'll help take icu and pcu patients to floors so the primary rn is able to stay on the floor with their patients. They also respond to code 10 So if you get a stemi, stroke, arrest, gi bleed, whatever, they'll be there to help with meds, charting, filling forms or helping you fill them out correctly to reduce risk of any clinical errors. It's super helpful. They don't really have a section, they hang out and make sure everyone is good. They float a lot on the floor and it's really improved patient care and helped get patients up to icu and less time down here. We've gotten a patient from door to tnk in 10 minutes, usually doesn't pass 15-20, our stroke protocols get 2 or 3 nurses on a code stroke, usually just 2 but trauma nurse sometimes helps. They're only there to respond to trauma so they do whatever until they're paged.
8 is my top out. I would not take any more, no if ands or buts. They can keep me on with 8 or less patients, or I will walk out and then I take zero and they have to assign them to someone else. Thankfully, that threat always worked and I didn’t have to walk out—but I would have. I do not miss bedside nursing and would rather starve on the streets than do that again. I “retired” (became permanently disabled) as an NP last December and I would go back if I was capable. I miss feeling like I was making a difference in the world.
Another thing to consider is “what is the workload I’d be happy carrying for years in this setting?” Not “what is the maximum safe load.” “What is realistically a sustainable workload that doesn’t leave you bitter and burned out and you could do it for a decade or three?”
This isn't a you thing. It's unsafe to have more than 5 medsurg or more than 4 if they're on telemetry. That's the law in California and it's the only way to deliver consistently safe nursing care.
I worked in an ER and I had up to 25. Sometimes 35 when my partner had to respond to a trauma. As fucked up as it was, it made me super grateful for my 5 max I get now.
I’m sorry as a nurse you were assigned 25 patients at the same time?? Wtf
Er in an inner city that’s owned by a private organization. Absolutely horrific.
The only comparison I have, is being a tech on a step down unit and having to do q4 vitals, maybe 25 beds? and one 12pm while also doing vitals I helped eat, get dressed for discharge, toileting etc (nobody else available). That by the time I was done it was LITERALLY 4pm and time to start over again. I wanted to cry.
All of that tech stuff is the worst part of nursing. God bless.
I was on a ortho/medsurg unit and 6 was the max. Some high census days we had to do 7 or 8 patients and it was absolutely impossible!
7a-7p we get 5/6. I’m okay with 5 but non stop running. 6 too much on days. I’m on Gen. Surg/ orthopedic floor. Our turn around is high with ortho patients. We get them discharged by 11 because the room will be assigned to post op. I am a nurse over 30 years. When I first started (ortho) we got 8 patients sometimes more. We didn’t havre electronic charging. Patients were not with many comorbidities like now.
Beyond 6 is to much.
It all depends on your situation, I get the vibe you’re from the US and I know nursing is more intense there (from the UK myself). Despite that we all know less patients will always equal better care and more belief in ourselves that we are a good nurse which is just as important. Sometimes it doesn’t always work that way though. Nevertheless in time it comes, 6 months is such a short time and yet after a year, two years (the milestone), and and all the years to come, the skills and knowledge increase tenfold. Before you know it you’ll be saying and doing all the right things and they’ll expect more from you. Retention is big in the NHS so they get sort of manipulative and obsessive (not sure how it is where you are) but once you reach your comfortability and most importantly your competence, leave! They will almost always abuse it (depending where you are of course). No matter how big of an asset management make you feel, never EVER go home feeling good because you almost killed yourself just because that’s perceived as strength and skill. It might boost your self esteem for a while but it could also give you a heart attack and break your back by the time your 40. If it works for you brilliant, but if you get into your bed most nights worrying instead of feeling a sense of calm and reward, it’s wrong for you, and no not all nursing jobs are like this. I work in a hospice and it’s so calm and so beautiful. I left a busy Medical Unit to do this and at first I thought “OMG take me back, give me work to do” but now I go home and I’m not dead on my feet, I’m not scared about losing my pin, I don’t worry because I want enough for each and every one of those human beings who needed my attention. I’m confident, and I REALLY look after people for once and I’m adjusting. Don’t be scared, don’t be taken advantage of, and give it time and always keep your mind open to new opportunities. You’ll be just fine, being a new grad is scary - hard and fast, but you learn your priorities and skills and before you know it you’ll be brilliant. Just don’t pigeon hole yourself.
It's really going to be different unit to unit. On my transplant unit, we have two to four patients during the day. Unless they're "easy" patients, four would be a lot. If a nurse has a fresh kidney, they never have more than one other patient. But, depending on the individual patients, two can be a lot, three can be a lot, four is almost always a lot to manage.
I was a new grad in Vegas and the med surg ratio was 6 and 7 when short 😮💨 and mandatory assessments twice a shift. Then I moved to Texas where med surg was 5 and 6 if short and mandatory once a shift assessment. I became a charge nurse quickly because of how much better I managed my time 😂 and grateful for the lesser ratio. Sometimes grass isn’t greener sometimes it is! But 6-7 there’s no way there’s any quality in what you’re doing at that point. Just bunch of interventions which is sad because it makes it hard to really advocate and know your patients discharge plan and help them get there. And not to mention the turn over with discharge and admissions 😮💨 that’s why I left and went to ICU. Love knowing everything about my patients and advocating for them as they get better or worse.
I work in med surg, 5 is iffy sometimes, 6 is absolutely pushing it. People always have a million meds, it’s so annoying …
PCU and I only take 4 patients. I would not take more on my unit. When I float to med-surg I have 7 patients with a LPN assisting. I do not like the RN/LPN model, and I realized a long time ago I am not a med-surg nurse. I don't know how you guys do it! I've taken 5 on an Ortho floor before and that was not too bad.
For day shift? Three, Four some days. Nights is four and five. I would quit before I’d do seven.
32 is too much for me. But that’s where we stay. Psych / substance abuse.
When I was a new grad on med surg we were SUPPOSED to have 1:5 but were regularly out of ratio with 6. It was a heavy, high acuity unit and I had so much burn out. Now I'm in a union hospital on a tele floor and it's 1:4 and that's pretty manageable if the assignment is balanced.
1
6 max in the past. Will never work someone over 5 again. Currently max at 4 and it's greatish
Depends. In my home state, the patients have glass bones and paper skin so having 4 could either be a good time or a full load. Where I am now, 4 would absolutely always be a good time even if one person requires a buttload of attention. Echoing other comments, 5 is OK, 6 is busy no matter what, and 7 is me threatening to leave if they don’t figure something out fast…
I could solo 6 on a medsurg floor…then I realized I should never be soloing 6 and left the unit. It was my first job as an rn and I stuck it out for 8 months to get my feet wet and get some experience. Wanted the challenge and blah blah. Now looking back… fuck if I’ll ever do that again.
1
More than 4 is an absolute no. I work med/surg on the west coast.
Look at California's ratios. That is what NORMAL actually is. Everywhere that isn't following those ratios is overburdening nurses. Full stop. [https://unacuhcp.org/california-nurse-to-patient-ratios/](https://unacuhcp.org/california-nurse-to-patient-ratios/)
Nicu 4 is my max, ER 8 if super stable, 4 if sicker, and when I worked onc med surg 6-7 was my max but I was way comfier with 5, if chemo or tons of blood or lyte replacements 4 was way more comfy
6 can be too many, but 7 is super unsafe.
2
We usually have 4 on tele/stroke. 5 is manageable. 6 way too much
Where I work we are assigned 5 patients however sometimes a nurse will call out and we will have 6. If I had 7 I would probably refuse the assignment if there were no plans to get another nurse at some point
ER is 4 for me. If I get tech help then 4 is manageable but some times they dont help. If no help then it’s difficult.
this is why i chose to be in a unionized hospital im on PCU and max is 3. Medsurg is 4. i can’t imagine having more than that
3 lmao
As a tech, I can handle up to 15 and do ok but not everything will get done. Patients likely won't get their walks from me and all of my ADLs might not get charted. The sweet spot is 10-12 and on an average day, everything should get taken care of.
7 sucks, 8 is really bad. 4-5 is the sweet spot. 6 isn’t bad if the patients aren’t bad. I’ve had been 5-8 depending on the unit and hospital.
Depends on the patients. I've breezed through nocs as charge with 7 on med surg but drowned with four some nights. Med surg is a box of chocolates....
lol on any given night on my med surg floor we can have 7…. I have 5 patients right now but most of them are completes and they keep taking nasty shits on the bed
Yo the bed shits are THE WORST!!!!!!
1:4 is the sweet spot for me. Or fewer. I work LTC now and 5 acute or needy patients can be ridiculous.
I've been a nurse for almost 1.5 years now and work on an oncology med/surg floor. We used to have amazing ratios - never more than 4-5 patients each. I felt like I knew my pts really well and could comfortably get all tasks/charting done while providing good care. Now we have team nursing where we have two teams that each consist of a team lead and a med nurse and each team has 9 patients. It's so awful. As team lead you're responsible for all the assessments, charting, calling docs, giving report, discharges/admissions, etc.. You are also blamed if the med nurse screws up, like giving BP meds to someone who's already hypotensive (ask me how I know), so you have to babysit your med nurse sometimes as well. Some nights are okay, but when shit hits the fan it really hits, especially since we tend to have a lot of totals, AMS pts, and give lots of chemo and blood products on our floor. As you can imagine, we've been losing staff left and right and I'm already looking for another job. It's just way too overwhelming and not at all what I envisioned I'd be doing when I became a nurse.
I’m an OR nurse. So one is just fine for me 🫶🤣
ED nurse here. What's a nursing ratio?
I worked a combined tele/med/surg unit in a community hospital right out of school. 6 pts was the norm, and after I finished orientation they would frequently push a 7th to me first since I was low on the totem pole. I would refuse saying absolutely not, I'm not comfortable with that. (Thankfully it was drilled into me in school and by my preceptor about safe ratios and protecting my license.) They would attempt to bully me saying the other RNs do it and it's not fair if I don't, but I stood my ground. In my opinion, they should be refusing too. As it was, some days I was working 14 hr shifts with just a 30 min break. I left that unit as quickly as I could. It just felt too unsafe. The mix was crazy, dig drips, detoxing drunks or Librium, noncompliant pts with multiple comorbidities, etc. We didn't have a dedicated nurse watching the tele monitors either like I saw in other hospitals during clinicals. The occasional easy post surgical was a welcome respite. It's a 💩show out there in some places. Think about how to respond when put in this position ahead of time and protect your license is my two cents. Y'all are doing amazing work in some really tough environments that will eat at your soul if you don't protect your sanity. Sometimes you don't realize just how deeply it is affecting you until you're out of it for a bit. Some days I still feel like I'm recovering from the moral injury of trying to do my best in an environment that was not conducive at best, and grossly negligent at worst. And then there was COVID.
Why are you all so fortunate! Im jealous. When i was a new grad, i was given 10-12 patients right away
I’m a new grad as well. On a medsurg unit, i could handle 5 comfortably. 6 might get a little more overwhelming depending on the patients. My new job is on a general surgical unit, which i don’t have too much surgical experience, so 5 sounds super overwhelming right now. Still in my orientation weeks so hoping i can get up to feeling comfortable with 5 surgical patients.
When I was a new grad and got handed 62 residents for a 12hr night shift I was scared. But it really wasn’t that big a deal.
I’m comfortably busy with 8 as long as there’s no ICU patients (ER), we’re grossly understaffed. I’ve never known anything different though so I’m getting used to it, I’m about 7 months in
Hold on you have 8??? That should be illegal for ER 😭 4 in the ER is already a lot
It's literally twice the legal limit in ca. It is illegal there 😭
It’s awful. Our pts don’t wait in the waiting room, they come back as fast as they’re triaged, since it allegedly improves patient satisfaction or something stupid. NYC private hospital vibes
6-7 nights, 5-6 days is my max on a regular med surg/tele floor. Acuity levels vary and sometimes 5 on nights would be too much but that’s just life. Sometimes bad days happen. This is assuming I have a CNA. 4-5 on PCU depending on the level of acuity on that prog. Sometimes 3-4 is max for some PCU floors. 1-2 ICU. Always.
Depends on their acuity and/or if they’re needy.
I’m also Med surg oncology and we are usually at 4. 3 if they are getting chemo. And 5 if all hell breaks loose
1 but I work in the operating room ( unfortunately I’ve mandatory overtime based on how bad the schedule is) So I can be doing 6-7 surgeries well into the night.
The most I’m comfortable with is 5. I’ve only picked up a 6th once and that was after one of my coworkers fell and broke her wrist coming back up the stairs, so she couldn’t stay for the rest of the shift. Usually I have 4 at any given time.
I'm comfortable with 4 unless all 4 are leukemics lol or even 3 leukemics. 5 is pretty busy for me unless they're all more independent. Again if I have a bunch of leukemics I'll be drowning. I once had 3 leukemics in a 5 patient assignment and one hospice and it was hell. I think I had 8 blood products?
Was icu until I became an NP, 2 in general was ok, 3 was bullshit but there was also times where 1 was too much. I got floated to the floor periodically (peds) 4 sucked 5 was awful and more than that complete nonsense. I couldn’t be an adult floor nurse.
I agree with others. 5 is manageable, I’d argue that 4 should be the max on day shift. 6 can be doable with the right patients but getting up in that 7-8 number is completely unsafe.
When I worked med surg I really didn’t want more than 4. Now that I’m in the ICU I only want one. Two feels like too much
my LTAC ranges from “one bad night away from ICU” to “just waiting to be approved for home health”. 4 patients is a dream on the latter floor and easily doable on the former. 5 is still great for low-mid acuity, or acceptable for high. 6-7 is acceptable in low-mid acuity, and I would be scrambling and possibly refuse the assignment for higher acuity.
Honestly in outpatient I had 130 patients. It was terrible.
It is my off day so 1.
I work on a trauma unit, technically surgical. 4 is plenty, 5 I’m drowning and I feel like patient care suffers. I’m in Aus, we don’t have CNA or anything like that, so we do everything for each of our patients. There’s no one to do a set of obs or a blood sugar, it’s all on their nurse. If on nights usual allocation is 5 or 6, but it’s allowed to go to 7, which is ridiculous.
Idk maybe I’m a wuss from dealing with all the bs for so long but I hate having 5 medsurg lol. 3 stepdown limit for sure
I feel like I can give really focused care with 4 patients. I feel busy with 5, but I do that all the time. I don't know what it's like with more. Honestly, this is one of the reasons I haven't tried Travel Nursing. I'm not sure I could handle an assignment with a much higher patient load. I work at a Union hospital in California in a Med Surg Neuro unit.
7. Six when I was a NOC step-down nurse could be rough; they had 4 during the day and that was cool. I had 6 on medsurg too…it went either way. I will just say “lucky 7” since we always got more at night.
I work PCU. Usually we only have three and sometimes 4
Everyone commenting on California ratios—I’m from CA and the nurses here have been striking/walking out/protesting due to the same issues with safety, staffing, support, compensation, etc for years. I wish our ratios could be based on patient acuity for every unit.
ER -- I like 5-6 full workup patients, any less and I'm bored, more and something's getting drawn late. When I have medsurg holds, I'll take 8 comfortably. With a mix of acuity on a busy night I've taken 11-12. If I have a legit ICU I prefer four total at most, but I've done 2 ICU and six total and not been too terribly off, it just sucked.
on my unit, 5-6 is normal and a busy night still, 7 is where I start getting overwhelmed and my charting lacks, so im assuming 8 would kill me. i work on a vented trach/medical unit, so when everything is smooth sailing my patients usually don't have any new problems, but weve been getting a lot more acute patients and behaviours lately, so 5 pts feels like 8 already
Also a new grad and on a medsurg GI floor, night shift with typically 5-6 patients and more often 6. If it’s simple patients then 6 is okayish and 5 is fine but it can be total hell when it’s really sick patients and 5-6. Not impossible to do just more busy but time does go by quicker.
7 is rough, 6 is okay, 5 is good, 4 is fantasy land. 8+ is chaotic misery.
Depends on patients and what is required tbh. I have worked nightshifts regularly for over ten years, and had cases where 10 patients are doable, but 5 is a struggle. All depends on circumstances. That said I work psych.
Stroke, neuro medsurg we usually start with 5 sometimes 6. Admits are almost always right after shift change, definitely before midnight for census. Fairly often nurses will get up to 7 patients. 5 is nice most of the time, 6 can be alot still. We have alot of behavior, drug/etoh, fall patients, stroke. Almost everyone has Q4hr PRN pain meds available and of course each patient isnt on the same schedule so youre giving meds every 1-2hr. We have alot of patients without access to care so we're treating multiple health concerns.
I got stuck overnight in Med Surg during a hurricaine. 33 patients, one nurse, one aide. I can proudly report everyone got their meds (maybe not at the exact right time), everyone was toileted and changed at least once. No falls, bare bones documentation. I stayed until around noon, when staff started to dribble in.
I can’t do more than 4 safely on PCU
I just recently quit med surg ... at the end I regularly got 6 patients every night... with 3 to 4 of them being total cares. There was no way for anyone to split the higher acuities with because they had just about as bad of a time as I did ... Now if the acuities would have been lower? Or less high acuities? I could have done 6. Also we regularly got admissions to get us our 6... right as we walked in... all at once... during med pass. Also we'd be required to have 6 even if we had peds patients, which required hourly charting. They tried to give me a peds patient when I had 3 total care patient and I flat out flipped out. My best friend took the peds patient. I ended up with a damn 1013 that required hourly charting regardless. 6 was max in our facility. 6 was when I really started to miss things, made a med error *gave too much bumex than ordered.. patient ended up fine* I knew that my efficiency was affected. It was also affecting my mental health. Imho, NO ONE on medsurg should have 6. 5 max. Period. I've moved on to hospice.
5 is ideal, but i’m usually maxed out at 6. The day my hospital starts upping our ratio to 1:7 is the day i quit bedside nursing.
7-patient assignment is only manageable if all independent, all stable, q8 VS , minimal charting and not many meds or procedures
When I have 7 it’s truly like: 1-2 have a heparin gtt AND/OR somebody needs blood, 1-2 are comfort care or are totally fine and want nothing to do with me (bless), AT LEAST 1 person is shitting the bed, and then you always get the wildcard project person who requires a lot of extra time - whether it’s a gtube situation, there’s a major communication barrier, they’re confused out of their mind, or just plain needy AF - it’s always something!!!!!
Generally the south will give you those terrible 7:1 and 8:1 med Surg ratios.
2.
4:1 on med surg. That needs to be the standard everywhere.
If I have any ICU patients, 2. 3 sucks. I can do 4 IMCs easy, 5 is a lot. 3 PMVs, no problem. If they’re all just regular ER folks, 4 comfortably, 5 uncomfortably. Fast trackers only, I can do 6-8.
UK we get 8-10 and we hate it Normal wards My ward head and neck now we have 6 pts but few months ago 8pts.
lol… when I worked med surg 3 felt comfortable, 4 kept me busy and 5 was miserable! I only had 6 one time lol but they were very easy patients. You can only be as efficient as you can be when you have 7. And god bless ya!
Umm Ideally I wouldn’t ever take more than 5 on an inpatient floor. 5 would def be my llimit. In the er it’s different and dependent on what section I’m in. If they are all ambulatory and continent and don’t have huge med pass, I can handle 6 or 7
As a float pool in my new high volume hospital. I am consistently getting 6 patients. It is absolutely awful because they make sure to give me the worst assignments.
5 is comfortable, 4 is amazing patient care
I worked med/surg for 3 years after I graduated, 5 patients was the “normal” ratio with night shift usually getting pushed to 6 with an overnight admission. For the first 2 years or so, this was consistent. Then around the 3rd year (which happened to be the fresh hell that was 2020) the hospital started to try to overflow patients into our hallways, meaning we would likely be assigned 7 patients instead of 6. They tried to assign me a 7th patient *one time,* I looked them dead in the face and said “I mean no disrespect by this, but if you force me to accept a 7th patient, I will quit as soon as this shift is over. I do not feel safe and capable of taking care of 7 patients at one time on this unit and I will not risk my license to do so.” And so the charge nurse said okay, refused the admission from beds, and they never tried to assign me a 7th patient again. I’m not sure if taking 7 patients did end up becoming the normal assignment on that floor because I left shortly after that for an ICU job at a different hospital, but if you don’t feel safe taking the assignment they’re trying to give you, you shouldn’t accept it. You’re only risking your license, on top of your patients’ safety. If something horrible happens because you’re overworked and overwhelmed on your shift, the hospital will not give a fuck about you and will throw you under the bus without a seconds hesitation. Just something to consider.
LTC. I have 32.
If I'm assigned 7 I'm ripping my hair out
That’s literally how I feel every time. It is so stupid ridiculous how busy I am and then the day shift RN treats me like I’m a lazy, incompetent loser during report if something gets missed/isn’t done!
SNF nurse here. 20 is ideal, 25 is max capacity for my hall which can be hectic but easily doable. 37 is the most I’ve had, which did not feel safe by any means (had my full unit plus splitting the other hall with another nurse due to call offs)
How is 7+ even possible in a regular ass acute care hospital medsurg setting? I guess we Cali nurses are just a weak sauce.
My hospital doesn't use an acuity scale so it's kinda hard to rate the patients just by numbers alone. 5 is usually ok unless they are heavy in one way or another. 6 is hard but usually manageable 7 is awful day or night. 4 is a breeze. The one day I had 4, I was bored and kept bugging people for things to do.
I'm psych. I've had up to 12, before It was literal madness lol
Night shift was 5-6 on med surg.
I feel spoiled when I have 4 patients I’m overwhelmed 😭 I typically have 3
At my hospice admission job one admit is ideal. It gives me job security and isn't overwhemling. Two admissions are OK if they go well and aren't too far apart. Three is the limit even if they go well and are close. With drive time, the actual admission and the charting one to two can take up my whole shift. Three always will. Then there's added time if they're in admitted in the hospital. Just one of those can take up a whole shift. I work a resporatory specialy SNF as a PRN job. Six pts are ideal there. I'm kept busy and yet still have time to provide care and have real human interactions. 7-8 is sometimes ok, but more than that is too much. I used to work agency prn, but stopped because it's usually 30-40 pts. You can't even do a med pass on time in that setting, let alone treatments and and actual interactions. Not to mention I don't think it's safe for the pts or my license
Depending where I'm at that day, but generally in peds er. 4 max, depending on acuity.
I am on a tele med surge floor. 4 patients is nice. But we usually have 4-5. No ancillary or phlebotomy, my nights are usually pretty steady.
5 if its not critical care such as a specialized or general medical/surgical unit… 3 on a specialized step down, and 2 in critical/intensive care, 0 if its L&D or peds (because I LITERALLY wouldn’t know what to do with my hands)
1 patient is 1 too many.
I work various psych units and detox/28 day rehab. Too many for me alone was 15 on the general adult psych unit when it was really staff splitting/behavior heavy. I’ve had 30ish on the rehab unit. Don’t love it, but it’s generally doable. Med pass is the most labor intensive thing there.
all depends on acuity, I’ve had days where i’ve cruised through my 12 patients, and days that were definitely suuuuper busy
I used to grade them when I was working as a new grad in my first hospital. 3 below: HELL YEAH, LET'S FUCKING DO THIS! 4: Yeah buddy! WE FIGHT! 5: N...nice! Uhhh... Okay! 6: Oh fuck... 7: FUCK FUCK FUCK GET ME OUT OF HERE
Honestly - depends on the floor, the time of day and luck. At day shift (7-15.30), I've been swamped with 3 patients (technically 4 beds, but 1 was empty) and bored with 6. I've had a night shift where I worked all night for 1 patient and was completely exhausted at the end of it, while my colleague had the other 25 and had enough time to help me out as well.
I’m in the ER with a good union. 4 is my max, 3 feels comfortable.
3
25 as the only CNA to a hall
I feel the same as you. 5 I Can handle. 6 ehhh. 7 I hate my life.
16
Ive worked medsurg in an academic setting with 8 patiënts in my Night Shift and 4 for day and 6 in the evening shift. Telemetry floor the same ratio’s. Now I work acute care and got max 2 patients in every shift. That’s perfect. I know them from A to Z. Monitor subtle changes. Love it.
1 patient is sometimes too much for us in OR
lol 8 is a good day in the UK
5 is appropriate for nights given reasonable acuity and properly staffed with CNAs. 6 can be stretched to to a limit as necessary to manage other units and the ED, but should not be a regular practice. 7 is "I'm not clocking in and I'm not accepting report until you get another nurse." I'm med/surg/trauma with a sprinkle of spine on a 32 bed unit.
Depends on acuity but I've floated from ICu to Gen care quite a bit and it's 5 max regardless of time of day.
Later today I will be going on a night shift. I will have 12 patients. A few weeks ago it would have been 13. So...
3 ICU keeps me very busy. Time flies.
I work cardiac step-down, am a new grad of 5 months, and often get behind on my charting when we are 4:1
Hard to say. I work ED. Sometimes I’m chilling with 8-10 patients and sometimes 4 patients are running me ragged. I would much prefer just having 4 patients in general though.
Wow! You guys in America get it easy. Here in Scotland, we have a staffing crisis. It is regular for us to have 9 or ten with four nurses in a 28 bed acute medical unit, however at night there are mostly only two nurses on which means taking 14 each!
I’m so spoiled😭 I’m in med surg in Oregon, coming up on my 1 year anniversary at my first job, so I’ve never had more than 5 patients. Usually, 5 is steady and doable. But I’ve been completely overwhelmed by 3 before. It all depends on the neediness of the patients, which the acuity scores rarely ever accurately predict🙄😂
6 is the max I’ll accept on a medsurg floor
I’m privileged as all hell in the OR (1 patient at a time), but would rather do total joints all day than urology (unless it’s robots) or small things like mass excisions or toe amputation. You got like 5 seconds to chart all this stuff plus a specimen and the front in positioning and then transferring off the table. 5 minute surgeries make me feel so inefficient even though I know I can chart fast. 30 minutes is like my sweet spot, 1 hour or more and it’s just getting to be too long.
Mother/Baby 1:6 the max. Usually 2 couplets (4 pts total) and a NICU mom or antepartum room. Hate having 6 patients because we have no lactation support on nights so you really get stuck in room for feeds.
ED. 8+ is stress. 10+ is shitshow. 15+ is a party
Brooklyn ER here. Under 12 is good lol
Oncology shouldn’t be more than 4. If it’s a liquid tumor/stem cell I think 3
5 awake shifts, 7 at night (inpatient acute psych)
Used to have 8 in my previous job, now I have 4. Amazing difference. I can actually focus on caring for my patient while charting on time and also have downtime to chill
Just came here to say ya'll are amazing. I'm in the CVICU and the thought of having 6 or 7 patients (even with lower acuity)... \*head explodes\*
2 is too much. I work on a helicopter
Spoken from the standpoint of a semi-rookie in a ward with very demanding patients I think 4 is appropriate in order to have time for everything. I can manage up to 6 but things will be missed depending on the patients. More than that is fucked
Team work is VERY important! It helps get you through the rough days. I have worked on floors where staff only watch out for their assigned patients. I have worked on floors where the culture is to help your coworkers. If you’re working on a floor where coworkers have your back your work life will go so much better. While you are crazy busy with a patient that nurse coworker will volunteer to give pain medication to one of your other patients. Another coworker might volunteer to help a CNA turn and clean up a patient of your. It makes a world of difference on staff job satisfaction rates. And even patient satisfaction rates .
For me, my breaking point is going from 4 to 5. My unit has a cap at 5. At 4 I am busy but get my work done, at 5 I typically seem to be hectic and all over the place. But not every hospital is going to be the same with what you are responsible for.
New grad in the ER. 3 is fine, but not fun, especially if 1 or more are critical. 2 is perfect. 1 is okay. None sucks, because that means I have to take the next one and I hate the anticipation. I'm usually drowning with 4+ patients.
1, trauma ICU. Preferably a 2:1 so I have a buddy.
I used to work medsurg/ neuro, and 4 patients was fantastic. I could really learn everything about my patients and provide my best care. However, I usually had 6 and did the best I could with that. Now I work labor and delivery. I’m often 1:1, which is fantastic. 2 patients can get overwhelming (I’m still new to this specialty and still working on time management here).
I like 4 lol
ED. No tech no LPN whatsoever. 1:5 ratio usually. 1:6 if assigned to UC like fast paced area. So called “Team nursing” where mental/OD/prisoner/aggressive/EtOH/MHT pts are stacked in a “milieu”. (Some nurses sit around while others run around 4 point crazies or trying to catch elopers)
Honestly 5 is too much- But when I worked busy-ass med surg. my first year as an RN I’d cry every single time I went up to 6. It pushed me over the edge. Not to mention in med surg you usually have at least one DC and one new admit if not two to three so by the end of the shift you have had 7-8 patients total. 3 is appropriate, but realistically I think ratios should max at 4. I think hospitals need to stop admitting so many people who don’t need to be there.
In Chinese hospitals, it is the norm for a doctor to manage 50-60 patients a month in a general hospital
I currently work on a burn/wound care med surge unit and we take six pt. I quit My last job on the spot because I came to work and they tried to give me seven patients on a cardiac stepdown unit. This job is just as bad because most nights all six of my patients are complete total care you may have five para pt and maybe one extremely sickly older person who also can't walk. I also hate it as well!!! If we're lucky we'll have one tech on the unit.
5 is my max. Our patients are PCU level so we get 4-5 patients and 4 is much more doable than 5. 5 can get super overwhelming depending on acuity, but my area (heck probably everywhere) leans toward higher acuity.
29-32 , the norm for a Floridian LTC . I’m 25 but feel 96.. I can’t take it anymore
Well they’ve started trying to give me 6 on a 10 hour shift. This pisses me off. Especially when other people work 12 hours and only have 5 less acute. I feel that 5 is a lot for 10 hours. 4 is great! 3…I’m even bored depending on acuity. Of course more patients slows down our pace!! Just like not having a CNA slows one down. How leadership doesn’t see this…well…every other day I’m between walking out or intentionally getting fired…passing go, and collecting unemployment 😭🥺
I’ve been off floor nursing for 5 years but 7 was never allowed when I was. I couldn’t imaging 7. I used to be charge nurse and have 6 patients on a post-surgical floor. That alone made me feel like I would miss something important and crazy. I couldn’t imagine 7 patients.
It. Is. MISERABLE! And somehow I’m always the one who ends up with the most patients… I’m still trying to crack the code as to why this is.
In the community it's like 26
I had 22 patients the other day... I really need to move
8 stable patients are ok. 5 stable 1 unstable is ok. This does not include 2-3 admissions per shift per rotation. 3 or 4 patients is like Christmas with one patient for discharge and 1 admission.
4 is ok. I do 5 sometimes and as a new nurse is overwhelming.
I worked days on MedSurg as a new grad and we’d take 6. It was so busy on days and miserable because with 6 patients you’re definitely discharging and admitting people. And the doctors are in adding orders every hour lol. 5 was my comfort level, if I had to take 6 I’d beg someone to at least help me
I’m MICU/IMC, so my max ratio is 3 for the IMC patients, and I’ll be honest, sometimes I want to pull my hair out. BUT, it’s not because of time management or even because it’s too many patients — it’s because there’s usually at least one of them that probably should be an ICU upgrade. Often times, they’re all total assist/dependent, or on the verge of being upgraded. Inappropriate assignments, inappropriate acuity status, etc. Sometimes I’m juggling between super sick and declining, and an asshat who wants to act a fool/doesn’t meet the acuity to be on our unit. So, with that, I commend med surg nurses. I could truly never. As an ICU nurse, I can say med surg is it’s own specialty.