Nurses Share Their Worst Nurse-Patient Ratios

The number of patients assigned to each nurse varies from hospital to hospital, but nurses say they are being asked to care for more patients than they can handle. If the nurse-patient ratio is too high, nurses might not have time to do everything that’s required of them in a day. They may end up working overtime or forgo breaks just to get it all done, which can lead to burnout and higher turnover rates that leave the remaining nurses short staffed.

High ratios also put patients at risk. Nurses won’t have as much time to monitor their patients for issues or double-check their work when administering medication, which increases the chances of crucial errors that can elongate their stay. Patients with comorbidities and highly complex conditions require even more time and attention. That’s why high acuity floors and departments usually have lower ratios than other units, but that’s not always the case.

Experts say the ideal nurse-patient ratio in non-acuity settings is one nurse for every four patients. But there are currently no federal mandates that regulate the number of patients registered nurses (RNs) can care for simultaneously. Nurses would like to see the U.S. impose a standard nurse-patient ratio to prevent hospitals from increasing their workload.

Hospital earnings are based on the number of patients treated. Facilities often try to maximize the number of patients to increase their earnings without increasing the number of nurses.

But high nurse-patient ratios cost lives. Studies show increasing the nurse-patient ratio beyond the 4:1 standard leads to a 7% increase in hospital mortality for every patient that’s added. This is due to patient infections, bedsores, pneumonia, cardiac arrest, and accidental death. Many nurses experience PTSD after watching their patients die of mistakes and neglect that could’ve been prevented if lower ratios had been in place.

So, how many patients are being assigned to nurses across the U.S.? (responses have not been edited for grammar and spelling)

11:1 rehab (inpatient not ECF) and I was a charge nurse.

Faye

24:1. Eleven of them were covid positive psych unit. 😒

Benedicta

My first nursing job in LTC: 40:1. Including all meds, assessments, treatments, etc. If anything, I did learn to prioritize. I would never think to ask a nurse to do that now.

Sara

I routinely have 30:1 but I have had 58:1. This is with one med tech also and two aids.

Melissa

It was the ICU and there were 4 of us… charge had 3 years of experience, I had 2, other 2 nurses were just out of school and maybe just off orientation. We had 8 to start the 12-hour shift, but admitted 2. One was on continuous dialysis. 4 vents. I think we lost 2 by the morning. I have PTSD from that night.

Mandy

250:1. Yes. Every night in a retirement home, 30 of them are in a transitional bed care unit waiting for long term care. It wasn’t easy.

Athena

70:1 with 1 CNA and 1 housekeeper during a snowstorm. No one else could get there. We were there for 3 days, and we all did everything. Long term care facility my first year out of school 30 years ago

Valerie

1 nurse 1 aide 150 residents in the building of memory care, nursing home. And AL residents overnight.

Rosana

In med/surg, I had 15 pts and I worked with a great LPN who had 15 also.

Suzanne

60:1, overnight nurse at a nursing home.

Kandace

One night in NICU— we started out with 3 of us taking care of 8 babies, but by dinnertime two of the babies had coded, so I ended up having to take care of 6 babies by myself— and only one was what we called a “feed and grow” (a baby that just needed to gain enough weight to go home)— the others were either on vents or O2 hoods, TPN or blood transfusions, central lines, etc.

Joyce

For me the worst I ever had was 24:1 working as a hospice nurse. That same job I worked Monday-Friday and then was expected to be on call overnight from 7pm-7am both Saturday and Sunday. There were supposed to be other on-call nurses but sometimes it would just be 1 nurse on call to a census of over 400 patients in at least 4 different counties. I would end up working 14 days in a row the weekends I was on call, out all night long and driving hundreds of miles. It feels bad when you can’t give the care you know patients deserve.

I’m back at the hospital now and it’s much better here!

Abbi

I had 18:1 in med/surg with 4 unstable cardiacs 🙃 It was a rural hospital.

Jessica

As a CNA I once had 31 full care patients in a skilled unit. (2 CNAs to 60 patients) It was the second shift, and it was Halloween and over 60% of the staff called out. It was insane. The only nurse with (60) patients was in tears by the end of the shift. I was just dumbfounded. I gave my notice the next day. Management should have come in.

Melissa