The Ugly Truth About Nurse to Patient Ratios

There’s one sentence that will send chills up the spine of any nurse.

Nurse to patient ratio.

This topic has been an issue for many years and just like any other issue things have improved…….wait no they haven’t. They seem to have actually gotten worse. How is that possible?!

With the huge impact HCAHPS scores are having on facilities you would think that management would try to improve every aspect of patient satisfaction.

Yet a majority of facilities seem to be overlooking the biggest issue.

It’s not just the RNs and LPNs that are assigned to care for too many patients. Nursing Assistants, and if your state allows them Medication Aides, are also held accountable to unreal job expectations.

Issues for Registered and Licensed Practical Nurses

I’ve worked on floors where nurses are assigned anywhere from 10-40 patients during a shift. Yes 1 nurse to 40 patients……. it’s humanly impossible to provide top grade care to every patient.

Nurse to patient ratios impact RNs and LPNs in more ways than I have time to write about, so here’s just a few.  Feel free to comment below and add to this list!

  • Nurses can’t be two places at once, let alone 10+ places to take care of every patient.
  • If your facility doesn’t have Med Aides then patient care gets neglected due to the nurse rushing to pass all of their meds.
  • Due to how much documentation is required for PRNs it becomes almost impossible to get everything done on time.
  • Did somebody say documentation? Trying to chart for 10-40 patients in one shift is impractical without cutting a lot of corners.
  • One of the most talked-about issues in the healthcare industry is nurse burnout. Is there a better way to burn out nurses then assigning an unrealistic nurse to patient ratio shift after a shift?
  • Bathroom and lunch breaks don’t exist.
  • Clocking out on time? You might get started on your charting when your shift is “suppose” to end.

Issues for Med Aides

If your state or facility allows for med aides then they too need to be aware of the consequences of a poor nurse to patient ratios. Some facilities take advantage of their Med Aides.

In most occupations the better you get at your job the easier it gets because you can do it faster and more efficiently. That statement is not true for Med Aides.

Most states across the country don’t set a maximum number of patients a Med Aide is responsible for and trust me some facilities take advantage of that. Here’s a little break down of what it’s like to be a Med Aide:

  • Your first day you’re wide-eyed and nervous when you’re in charge of meds for 10-12 patients. But you get better and all of a sudden you have some extra time at the end of your shift.
  • Once you get the hang of things most facilities will bump up your ratio to pass meds for 13-21 patients. You struggle at first and but eventually find a way to handle it.
  • Then one day you clock in and check your assignment sheet. The facility is trying to save some extra money and have less Med Aides and have assigned you anywhere from 22-35 patients.

I think by now you understand the point I’m trying to make. Setting unrealistic expectations for Med Aides hurts the patient’s care and highly increases the number of med errors.

Issues for Nursing Assistants

Some states have capped out the maximum number of patients a nursing assistant can be in charge of. Some states say 11 while others cap it at 20. There’s plenty of ways facilities can dictate this number.

They can assign you low demanding patients that don’t require much care and are almost independent, but during a shift, the nursing assistant is ultimately responsible for that patient and we all know it only takes a matter of seconds for something to go wrong.

The more patients a nursing assistant is assigned the harder it becomes to provide the best care to each patient. Time-wise, it is impossible.

Between all of the tasks, these amazing nursing assistants provide people have to remember that they are only human just like the rest of us.

Any facility who is trying to save money by increasing the patient per Nursing Assistant needs to step into their shoes for a day and I’m sure that ratio will drop.

Enough is Enough

So now what? The healthcare industry is in high demand for nurses and nurse to patient ratios are to blame? Well, yes and no.

The nurse to patient ratio I discussed in this article is only part of the overall problem. But this is a problem that can easily be fixed!

By limiting the number of patients to realistic expectations every member of your nursing team will be able to provide the best care possible.

In return, your facility will have lower readmission rates, better HCHAPS scores, and lower nurse turnovers.

What’s the nurse to patient ratio at your facility for RNs, LPNs, Med Aides, and Nursing Assistants?