Nurse to Patient Ratio: How to Cope with High Numbers

Staffing is one of the major challenges in healthcare today. There is no universal recommendation for the ideal nurse to patient ratio, even from the WHO. Countries and regions have been left to determine this for themselves. California in the US is the only state to have a law on the required nurse to patient ratio of 1:5 in medical surgical units.

This only means that as a nurse, you will often find yourself caring for many patients at any given time. The global shortage of healthcare providers against a growing population is an indicator that this problem is here to stay. Even well staffed facilities find themselves with a shortage of staff from time to time due to absence as a result of sickness or other life events.

In my few years of work, the highest number of patients I've cared for in a shift was about 40. On that particular day, I managed a medical ward alone. I don't need to tell you that things went really bad. Currently, I care for at least 8 patients with the maximum being 14 when there is an acute shortage.

Often times I found myself struggling at work and feeling overwhelmed. I may have shed tears here and there. The long working hours compound the toll. Time is truly a teacher. I still struggle during my shifts but the good news is, I am coping better. Here is how:

1. Having a Routine

Each workplace has its own routine. Administration of medication, the primary role of nurses, usually takes the first place in most wards. This is followed by a mix of different activities like ward rounds, monitoring vitals, collecting specimen, doing bed baths, feeding patients, taking patients for scans or other procedures, updating relatives and so on.

In addition to our ward routine, I have come up with my own work routine. For a day shift I usually; give the morning treatment, go for break, do my observations, do other charts, give midday treatment, have lunch, write my notes, do procedures like dressing, give evening treatment and finally prepare to handover.

The above is just a skeleton of my day. Several things (as mentioned above) usually happen in between. Having a routine means I have a point of reference. My night routine has a slightly different structure. Both have helped me complete most of my work before end of shift.

2. Prioritizing Care and Having a To-Do List

When taking handover, its good to know which of your patients are very sick. These patients are likely to be the ones who need more attention from you. Therefore, prioritize their care. Give them timely treatment, monitor their observations closely and follow up on any pending procedure. Also prioritize tasks that were not done during the previous shift.

When I started using a To-Do list, it felt corny. It is my go-to nowadays. The list usually helps me to remember what I need to do. Through the shift I will glance on and update the list, striking out any jobs that I have completed. I also use sticky notes a lot, especially to remind me of medications that need review, or drug charts that need re-writing.

3. Ask for help

Asking for help was a challenge before finding my voice in the new workplace. Still, you must always seek help. Ask for help anytime you need it. Identify people in the shift who are willing to help and are available to help, most times usually the charge nurse. Be willing to help yourself. This way you are building currency for when you need help.

4. Handover Appropriately

Despite having a routine, prioritizing care and asking for help, you will still find yourself not completing everything that needed to be done. Sometimes it is because you were overwhelmed. Other times the doctors will change some treatment and you will find out when it is too late. Other times you will have simply forgotten.

Handing over appropriately and honestly is the way to go. This way, the nurse taking over can complete the task, ensuring continuity of care. It will also help them to prioritize their care.

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Overall, team work is the best way to deal with large patient numbers. As such being a team player is fundamental. Finally, make sure you relax during your off days so that you are energized to care for all your patients when you return to work.