Nurses are the backbone of our healthcare system, and they should enjoy the benefits of patient ratios. It is essential to ensure that nurses have enough time to perform their critical duties without being overworked by too many patients at a time. According to studies, nurses with a patient ratio of 1:4 or less can perform their duties well. They can also spend time with patients, which results in better care and outcome for them.
To make sure hospitals meet these standards, California has passed legislation requiring them to maintain staffing ratios with newly established benchmarks from the Joint Commission (TJC). It will help protect public health by ensuring sufficient nurse staffing levels for all settings, including hospitals, nursing homes, home health agencies, and other health care facilities. But does this affect the work of a nurse?
What is the Nurse-to-Patient Ratio
Working as a nurse is one of the best jobs in the world. It can open a ton of possibilities for many nurses, and at the same time, help people. It’s also one of the reasons why many students sign up for nursing school. However, when you are working in an actual hospital setting, things can get tricky. One of the many issues nurses face these days is the increasing number of patients handled for each shift.
We defined the nurse-to-patient ratio as the number described to the number of patients assigned to individual nurses on a particular floor, unit, or ward. Nurses working in general care units have a higher patient ratio. For example, a nurse can care for five to eight patients on her shift in regular wards while nurses in the ICU can care for one or two patients at a time. Depending on how critical a patient’s condition is, ICU nurses can also work 1:1.
Why are nurse-to-patient ratios important?
Providing safe and quality care to patients is the goal of nurses. It is why assigning the correct number of patients for each nurse is crucial in achieving this goal. 
1. It’s Important to Nurses
The current problem of nursing shortages is seen in many hospitals these days. As a result of the pandemic, nurses work longer hours and with more patients. This situation can cause extreme exhaustion, injury, and even job dissatisfaction to many nurses. It can also lead to medical errors or mistakes on the nurse’s part as they start to feel overwhelmed with the workload as they deal with stress while supporting their families.
Nurses who have fewer patients under their belt are happier with their jobs. A study published by labor union AFL-CIO showed that nurses in California feel they have a reasonable workload and can provide better care to patients than their New Jersey or Pennsylvania counterparts. Nurses also reported receiving adequate support services, such as nursing assistants, have time for quick breaks on their shifts, leading them to be more productive in their areas.
2. It’s Important for Patients
Patients are the main characters in a nurse’s job and center of care for nurses. But if the nurse has too many patients under her, they can’t execute proper care to their patients. A new study published in the New England Journal of Medicine found that unsafe staffing levels were associated with increased mortality for patients.
Besides the risks to the patients, patient satisfaction is also a concern. When the ratio between nurses and patients is not balanced, patients may view the nursing staff and the facilities as performing poorly.
3. It’s Important for Hospitals
When nurses have the correct ratio of patients under their care, they use the full benefits of patient ratios. Meaning, it shortens patients’ time at hospitals. More nurses mean shorter time for patients, which can also help the hospitals to save medical costs.
The better the quality of nursing care in a hospital facility, the more likely patients will have positive perceptions about their overall experience. According to research by Kaplan-Meier, “the higher perception was associated with greater satisfaction on all assessed measures including functional status at discharge; control over activities of daily living; participation in decision making regarding treatment plans or life support decisions.”
Pros and Cons and Benefits of Patient Ratios
Nurses working with patients always have their upsides and downsides. Some nurses have no problem working with many patients, while some can’t. That said, having the proper nurse-to-patient ratio comes in handy, and here’s why. 
- It decreases fatigue and burnout among nurses. Working as a nurse can be a tiresome profession. A proper nurse-to-patient ratio reduces the chances of developing irritability, depression, insomnia, weight gain, and other health risks from exhausted nurses and stressful workplaces.
- Recruitment and retention rates improve with minimum nurse-to-patient ratios. It means nurses will most likely stay in their company, and hiring new nurses is not a problem for hospitals.
- The number of preventable mistakes, including patient falls and pressure ulcers, are proven to decrease if the nurse-to-patient ratios are correct. Patient mortality also decreases as a result of nurses that can do their job accordingly. It means more patient recoveries, fewer sick patients, and fewer patients suffer from post-treatment infections.
- Under the proposed plan, hospitals would have to expand their nursing staff and pay them more. It will be a challenge for some hospitals with limited funding or strict budgets that restrict hiring new employees who don’t already work there.
- Nurses will not be able to give proper care for patients all at once. Patients will have to wait longer even if there are available beds for admission.
- Can cause nurses to burn out, develop anxieties, depression, sleep deprivation, and may even quit jobs.
Should Nurses Have Patient Ratios?
The question now is, should nurses have more patients than they can handle? The debate about whether or not to turn nursing-to-patient ratios into law will never go away. Since healthcare practices are constantly changing, finding ways to provide better care for nurses and patients will always be relevant. This way, both can use the benefits of patient ratios. Giving nurses the minimum ratio of patients under their care can make a difference in their work performance and general well-being.
The benefits of a reduced nurse ratio play a vital role in a nurse’s career and constantly changing positions. With a significant increase in nurse-to-patient ratios across the United States in the past ten years, nurses’ quality of time with their patients improves patient satisfaction and comfort.
So why is it important to practice the correct nurse ratio?
Benefits of Reduced Nurse Ratio to Patients
The patients will always be the nurses’ priority. They are also the reason why practicing the proper nurse ratio must be done . How can patients benefit from this?
- Quality care is given to patients when nurses have the correct number of patients under their supervision. All patients under their care receive the attention needed. No one is left out or forgotten.
- The chances of writing the wrong information in the patient’s chart are small. When a nurse is too busy taking care of other patients, it is possible to write the incorrect information given to all of their patients. No matter how experienced a nurse is, errors happen if they take care of too many patients. The proper nurse ratio can help avoid these situations.
- Readmission is less when nurses take care of the patients correctly. According to studies, nurses in a good work environment versus nurses in a poor working environment (ex., too many patients under their care) have fewer readmitted patients than many patients under them.
- Meeting patient satisfaction is easy when nurses have a reduced number of patients under their supervision. Patients are happier with the quality of care they deliver.
Benefits of Reduced Nurse Ratio to Nurses and Hospitals
Studies show that nurses can benefit significantly if healthcare facilities follow the proper nurse ratio. Not only will it affect their patients, but the quality of health care they deliver as well .
- The benefits of reduced nurse ratio help in decreasing the chances of nursing burnout. It also relieves insomnia, fatigue, depression, irritability, weight gain, and other health risks from being overworked and stressed. Studies of nurses in California say that they experience more burnout and dissatisfaction with their jobs than nurses working with minimum nurse ratios in other states. That said, regulated nurse-to-patient ratios allow nurses to perform better while also maintaining their health.
- Work retention and recruitment of nurses improve when there are minimum nurse ratios. Nurses will stay with their job when stress is less at work. Recruiting new nurses is more accessible when the hospital’s minimum nurse ratios reflect quality care towards their patients.
- Patient mortality and preventable mistakes like patient falls, ulcerations and hospital-related infections decrease to a minimum when there are higher nurse-to-patient ratios. Some fewer patients get sick while in recovery, and post-operation treatment complications are lesser. Medical errors, as well as patient and family complaints, are also avoided in this situation.
- The performance of nurses reflects their work environment. Nurses work better with their co-nurses and doctors. They also participate actively in improving patient care and making decisions in their workplace. In short, nurses become better members of the entire healthcare facility in quality patient care programs.
Why Should Reduced Nursing Ratio Be Applied to all HealthCare Facilities?
Nurses are amazing people! They work hard to help the sick and dying, especially now that we are experiencing the pandemic. And with the increasing number of ill patients, many nurses are caught between taking care of their patients and maintaining their health.
The influx of patients with the new Covid variant had nurses working for long hours with few rest periods. Because of this, nurses give less quality care to patients. They are also exhausted from the different roles they carry out. Among these roles include acquiring knowledge from non-nursing disciples to treat patients.
If hospitals want their nurses to stay in their jobs and hire new ones, they must find a way to implement minimum nurse-to-patient ratios. Nurses are not robots; they feel exhausted too, and we cannot replace them with robots either!
As exhausting as their jobs can be, nurses will continue to give their best. Providing them with better options and opportunities will surely change their perspective. Hopefully, healthcare facilities will consider the benefits of a reduced nurse ratio. It will be helpful to their nurses and the patients, and the entire hospital as well.
Nurses and Code Blues
Code blues are one of the scariest situations to be in as a nurse. Every nurse should know the basics of code blue because they can happen at any time. Many times a nurse is the first one to witness a patient going into cardiac or respiratory arrest. There is a lot to know about how to run a good code blue.
The best way to deal with a code blue is to prevent a code blue. As a nurse you need to try and round on your patients at appropriate times, even the more stable ones can turn on you. It is understandable that in certain situations hourly rounding is impossible but rounding should never be neglected on purpose. Labs are important and should be one of the first things to look into during your shift and throughout.
What to do during a code blue
It is very important to stay calm and professional during a code blue. The nurse in charge of the situation should delegate tasks accordingly. This includes making sure that when there are nurses available, they are doing what they can for their assigned patient while not forgetting about the other patients on the floor space as well.
During a code blue, nurses should first assess the situation. They need to check for signs of life, and then start CPR if needed. There are times when you can visually see that the patient is not breathing even by the way they look. If you enter the room and are not sure of what is going on with your patient always assess. Call their name, touch or shake them, and feel for a pulse. If there are no signs of life call a code!
According to ACLS guidelines, the adult cardiac arrest algorithm is:
For Shockable Rhythms
- Start CPR (100 compressions/min), attach to monitor and defibrillation pads, and give Oxygen.
- Check the rhythm: is it shockable? Ventricular Fibrillation and Pulseless Ventricular Tachycardia are shockable.
- Shock 120 – 360J
- Continue CPR for 2 min and establish IV access.
- Rhythm and pulse check, shockable? VF/pVT
- Shock 120 – 360J
- CPR: 2 min, Epinepherine every 3-5 min
- Rhythm and pulse check, shockable? VF/pVT
- Shock 120 – 360J
- CPR: 2 min, Amiodarone, lidocaine, treat reversible causes.
- Back to step 5
For Nonshockable Rhythms
- Start CPR (100 compressions/min), attach to monitor and defibrillation pads, and give Oxygen.
- Check the rhythm: is it shockable? Asystole and Pulseless Electrical Activity are not shockable.
- CPR every 2 min and IV access
- Epinephrine ASAP every 3-5 min
- Treat Reversible cause
- Back to step 3 until ROSC or termination
What are the nurses’ roles during a code blue?
There are a few nursing roles to play in a code blue situation and each has its own responsibility. The first thing to understand is that it is not your fault.
The first nurse role is the “lead” aka the nurse who is in charge of running the code. This nurse is responsible for dictating and delegating certain tasks. This should be the primary nurse or a charge nurse because the primary nurse is the one that knows the patient the best and the charge usually has a higher knowledge base and skill set. The primary nurse or a charge nurse are the best people to assess the situation because they have been managing the patient’s care and are our best hope in figuring out what happened.
The lead can then change when a physician comes or another nurse takes over.
The dos and don’ts of a lead
- Don’t take on other tasks or leave the room.
- If you are the lead, you are running the show so know the cardiac arrest algorithm.
- Speak loudly so everyone knows what is going on, make sure people know you are the one running the code.
- If you are the primary hand this role over to the physical and critically think of what could have happened (harder than you think).
IV access and medication
This role can be filled by one or two nurses because getting IV access and maintaining IV access can be a tough job. It is better to have 2 nurses on this job until good IV access is maintained then one nurse can step away and take on another task. You will be administering medications per the cardiac arrest protocol but also some paralytics and sedatives like etomidate, propofol, versed, fentanyl, etc…
Dos and Don’ts
- Don’t stop after the first attempt, keep trying.
- If you are struggling ask for help and keep trying
- Try not to forget the labs
- If pushing med keep the vials so you don’t forget what you gave.
- Push the correct medication.
- Let people know what you’re pushing and when.
the recorder’s role is exactly what its title is, you record. Many nurses don’t like this role because it usually requires you to chart after the code. As the recorder, you write down everything that is going on into time slots. A code blue sheet looks like a spreadsheet. It is your job to also manage time so everyone knows when it is time for a shock, pulse check, and medication.
Dos and Don’ts
- Don’t think you will remember something, always write it down.
- Maintain this role, don’t do other tasks
- Keep your eyes on the clock.
- Know the Cardiac arrest algorithm.
- Speak loudly.
This is usually when the boys come in. Every guy likes doing compressions but just like other things, not every guy is good at them. Always remember 100 – 120 compressions a minute is a way to go. This is also not a one-man job. There should be a person or two ready to hop on the chest. Compression gets tiring so try and switch every 2 min.
Dos and Don’ts
- Don’t be a hero, ask for help, and switch!
- Give good compressions, 2 inches, and push down hard and fast.
- If no one is in line, delegate to someone that isn’t doing anything.
This role can be plated by a few people. Your job is to chase down and meds or equipment. You can also be the one putting in orders for labs, making phone calls to radiology, or getting ahold of anesthesia or a physician.
Dos and Don’ts
- If there are a lot of you, then it is better to stay away
- Try and recognize when the situation is under control and you might not be needed. Sometimes the more bodies the harder it is to run a code.
- Check on the other patients.
- Let people know what you are getting or where you’re going.
- The better you get at this the more efficient you will be inputting in orders or grabbing meds.
Speaking with family
This is a very important role and will usually be the responsibility of the primary nurse. It is always hard letting the family know that their loved one is in cardiac arrest or has passed away. This is a skill that gets better with practice.
Dos and Don’ts
- If you are not sure how to approach a family ask someone.
- Be honest and don’t speak on things you aren’t sure of.
- Ask the family to come in.
- You can always defer some concepts to the physician and say the Doctor will better explain the situation once you arrive.
- Don’t give false hope.
As the primary nurse, try to figure out the underlying causes of cardiac arrest. Look at lab values and prior issues. It’s easier said than done but try to stay calm. If this is not your patient make sure you have a role not just standing by and interfering. If it is your patient make sure to stay in or near the room because you will have to maintain the report. Remember to speak to the family and explain what has happened. Always try your best, brush up on your knowledge, and remember that it was not your fault.
Moving Out After Nursing School
How soon did you move out after nursing school?
There is no ideal time frame. Some nurses do it a few weeks after landing their first job, some wait a few years and build up their finances, while others have already been living on their own. Moving out is a big part of your life, so make sure to think it through. Why do you want to move out? Is it because everyone is doing it, you want more space, you want more freedom, etc… You may think; what are the benefits of moving out after nursing school.
Things to consider before moving out
Finally getting to move out of your parents’ home is one of the greatest and most accomplishing things you will do in your lifetime. It puts you in a point of optimal growth, you’re going to experience life on a different level. These are some steps to take before you move out.
- Figure out your financial situation
- If you want to move out you first have to make sure you have enough money. There’s a thing called rent or mortgage for everyone still living at their parents’ home. You’re going to be paying for the place you are living in and it is going to be your most costly expense. The average cost of rent in the US is a little over $1,000 a month, depending on the location you will most likely be paying more. For example, a 2 BR condo in LA will run you around $3,000 – $5,000, in Chicago $1,800 – $3,000.
- You also need to incorporate groceries, utilities, Netflix, phone bills, and personal expenses. It all adds up and it’s usually a lot more expensive than you initially thought.
- Consider your loans. What are your monthly loan payments? You might be better off living at home for a few months or years longer to get them paid off quicker.
- Where do you want to live
- Location, location, location, one of the biggest real estate owners is McDonald. You need to think about where you want to live, city, suburb, local, or out of state. Is there a particular spot you always go to or really like? Do you want some views, or maybe live close to your parents.
- Why do you want to move out
- Moving out is a lot of work and increases your responsibility. Are you moving out for the right reasons or are you mindlessly doing it because everyone else is?
Benefits of moving out
- More freedom: You will not have a room anymore, the whole place will be your temple. You can do whatever whenever walking naked from your bedroom to the kitchen kind of freedom.
- More responsibility: You will now be a fully functioning adult with complete control of your life and future. You are going to learn all the things associated with living at your own place; decorating, cleaning, fixing, maintaining, etc… It is a new sense of being.
Nursing School vs Actual Nursing
We are going to be discussing the difference between nursing school and actual nursing. Nurses always say to their students or orientees “ Nursing is a lot different than clinical.” We even say it quite often. Nursing school and nursing are 2 separate things.
G-tubes, catheters, and IV pushes
Remember how we were told to check placement and patiency then flush. Our clinical testing consisted of our instructors observing us put each medication in a separate small cup, add a little flush in between each ned. Then you let it all go in by gravity?
There is no time for that.
Mix the meds together, dilute with water, and push it in. Everything’s going into one place anyways: the stomach. However, remember to always check for placement.
Foley catheters can be some of the hardest things to insert. In clinical you were taught to find a landmark. Spread this labia. Locate this, half-a-finger length up, insert, and you’re golden! Smooth and easy.
It’s a bit harder than that.
The best advice is to get some experience. Walk in with a determined attitude, get some help, put on the lights, and always bring 2 kits and extra gloves. Try to minimize distractions but there’s usually something going on.
IV pushes in nursing school and clinical was a long process. You standing there in front of the patient and instructor pushing the med for 5 minutes. It’s your first time and the patient’s because no one pushes meds that slow.
Don’t get us wrong we still push meds like Lasix slowly but not 5 min.
Physician’s orders and patient compliance
As nursing students, nurses were strictly never to change or discontinue a physician’s order without express over the phone, verbally, or written consent from the doctor physician. Another one was to call and notify the doctor of the refusal of medication by the patient.
In the real world, we do not call the doctor and say a patient refused a med unless it’s something serious like a pressor or inotrope. We use our judgment, if you aren’t sure then ask around first.
In a theoretical textbook scenario, the patient always seems to be compliant. Mr. Thomas have you been adhering to your heart-healthy diet, yes and I’ve never felt better. That’s too perfect of a world, you are going to see the frequent fliers that come for the same thing over and over again.
Double gloving and wet to dry dressing
We were never allowed to double glove in nursing school. If I remember it correctly we were strictly not allowed to do it and had to always re-apply new gloves.
In the real world, some situations call for double gloving. In attempts to clean up c diff and before changing a betadine dressing are good times to double glove.
Wet to dry dressing changes
How many times did you do a sterile wet to dry dressing change at home, before lab, during class, and at your lab practical?
In the real setting, we do not do as much as the nursing school made you think you would. We have better ways to properly clean and heal a wound.
Short staffing and there’s no black and white
Short staffing and nurse-to-patient ratios have never been fully enforced in the US, California comes first on the list with the best nurse-to-patient ratios.
In the textbook world, you always have enough staff, equipment, and medication. You learn nothing about short staffing and how it will affect you physically and mentally. Due to staffing mistakes are unfortunately made. Medications are late, labs take longer than expected, and patients become agitated. It isn’t a perfect world with perfect staffing.
Nursing isn’t black or white
Nothing in nursing is black and white–not even lab results. Everything is gray. Textbooks make it seem simple, but it isn’t. The human body and mind are very complex, nursing and medicine are too. Keep an open mind and learn to think critically.