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The Real Story Behind Nursing Ratios -
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The Real Story Behind Nursing Ratios

I support mandated nurse-patient ratios


Jake reaches in his pocket and pulls out a crumpled scrap of paper scribbled with “101.2 temp Room 2112” and hands it to Ashley, the registered nurse.  Ashley nods and says nothing but is inwardly alarmed because she knows a temperature plus a source of infection can be a sign of deadly sepsis. She once saw a deadly case from a

spider bite.  This patient has a deep red streak running up his painfully swollen forearm from an untreated cat scratch.

She grabs a computer to check 2112’s labs and antibiotics, but out of the corner of her eye spots the confused elderly man in 2118 pulling out his IV. She sprints to stop him but is too late. He was in the middle of a blood transfusion and now there is blood everywhere.

Simultaneously a surgery nurse in green is pushing a gurney towards  Room 2114. The patient is Mrs. Brown, a post-op knee replacement patient who is groggy and moaning in pain. There’s an emesis basin on the pillow by her head. A sign she’s nauseated.

Mrs. Brown will immediately need a patient controlled analgesia (PCA) machine that allows her to self-administer morphine injections to control her knee pain. PCA machines are complex to program and require full and mindful attention during set-up to avoid narcotic overdose. Ashley will have to closely monitor her patient for signs of respiratory depression while on the PCA. Ashley makes a mental note to make sure to get Mrs. Brown up before the end of her shift to ambulate for early mobility.

The daughter of the patient in Room 2116 is standing in the hall, coffee cup in hand, glaring at Ashley because her mother asked for more coffee earlier. Ashley will have to make a fresh pot of coffee herself in the cramped food room. Sometimes she feels like a waitress.  Stressed, Ashley feels guilty and avoids eye contact. Ashley knows the family doesn’t understand that she really wants to bring their mom a nice fresh steaming cup of coffee.

Ashley feels the phone in her scrubs pocket vibrate. It’s the Lab. “Your patient in 2120 has a critically low potassium level.” Low potassium levels cause erratic and dangerous heart beats. While calling the doctor, Ashley rushes to Room 2120 to apply a telemetry monitor to monitor her patient’s heart rhythm, essential with a low potassium. It’s an isolation room so first she must laboriously gown, mask and glove before entering the room. Stepping in the room, Ashley realizes her patient has soiled herself.  The patient is a 74-year-old woman, weak, and embarrassed. Ashley senses her discomfort and expends energy trying to make her comfortable by calmly making small talk, and trying not to appear rushed.

Ashley has only  five patients but even with five patients, things can spin out of control. Luckily, Ashley is in California, where staffing levels are mandated and Ashley cannot be assigned more than five patients on a medical surgical nursing unit. In most states, there are no set ratios.

That same day, in similar units across the nation, a nurse who works at a world-renowned hospital in the mideast has seven patients. Another nurse in Florida is just glad he doesn’t have eight patients like the day before. Yet a third nurse in Tennessee has six patients.

None of these nurses have yet had time to read the recent report in BMJ revealing that medical errors are the third leading cause of death in the United States, but they would not be surprised. Each of them is doing their best to keep their patients safe, sometimes against the odds.

Mandated nurse patient ratios are needed to ensure safe staffing levels. Patients deserve the attention of a nurse who is not too busy to safely oversee their care. Nurses need and deserve manageable patient loads and improved working conditions.

Thousands of nurses are gathered in Washington, DC in May to raise awareness around safe staffing and the efforts need to continue. Nurses must call for legislators to support safe staffing ratios and hold hospitals accountable to ensuring patient safety.

It’s time to speak up and support safe nurse patient ratios across the nation. #NursesTakeDC  Find out about Nurse-Patient Ratios: A Biased View here

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Until next time friend,

Nurse Beth

AuthorYour Last Nursing Class: How to Land Your First Nursing Job..and your next!” 

Come visit me at Ask Nurse Beth career column at for all kinds of  entertaining and informative career questions and answers, and to submit your own question :)


About Beth Hawkes (141 Articles)
Nice to meet you! I'm a Nursing Professional Development Specialist in acute care, a writer, speaker and career columnist.
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