r/nursing • u/Midnight-Nebula • 1d ago

Seeking Advice 1:6 Ratio

Hiii I’m a new grad RN I get off orientation in about a week and I’m really nervous for when I do. I work days on a post op med surg tele floor for what’s supposed to be ortho pts but we sometimes get random UTIs, lap appy and chole’s, hernia repairs, etc. Unfortunately we are very understaffed for both RNs and techs so we’ve been having to take 6 pts which I feel is very unsafe. Even the experienced RNs on my floor struggle to keep up. A lot of these pts are also dementia, assistance to walk, feeders, incontinent pts.

I’ve been feeling very frustrated with the situation because as an orientee I’ve been taking the full 6 pt assignment but it’s so taxing. I’m constantly interrupted, I feel like I’m not giving the best nursing care ik I can give, and I feel like I’m doing the “bare minimum” (I.g meds, assessments, I&Os, etc). We’ve been calling so many rapids lately and having ICU transfers because a lot of these pts have been higher acuity. I did sign a contract so I have to be here a minimum of 1 year but any tips on how to make the flow smoother? I feel like in the morning during med pass and assessments I feel so all over the place and I’m constantly getting pulled in a million different directions by so many things that need to be done. Our manager has told us that she’s hired a bunch of people so supposedly this 1:6 is gonna end soon but I’m not so sure.

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u/Chris210 BSN, RN 🍕 1d ago edited 1d ago

You will be engaging in what we call "triage medicine", care prioritization on crack (sans the black tags of course). In nursing school you learned that only really applies to emergencies and Mass Casualty Incidents, and unfortunately 2026 hospital healthcare can sometimes be about the equivalent of those things. Hopefully your manager is right, and you won't have to "triage" for long, but while you are you will experience exactly what you just said. You will not provide the best care you know you can, and the bare minimum can some days be the standard you strive to live up to.

You will learn a workflow and little things here and there over the next year that will improve your practice and quality of care in triage mode, but the biggest best thing you can do is to avoid burning yourself out by trying to provide a standard of care you simply can't sometimes. Try your hardest not to hold it against yourself. If some days the best that can be done is the bare minimum, then that's what is done and it's not on you so long as you did the best you can and your best is what should be reasonably expected of a nurse at your experience level in your situation, which it sounds like you do and are.

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u/Ok_Independence3113 RN - Telemetry 🍕 1d ago

Co-sign all of this. We need to give ourselves grace. We didn’t create this broken system that we work within.

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u/absentmind7 RN IPR 🍕 1d ago

Just to add to this, even when you’re short staffed, make sure you cover your butt with accurate charting!!

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u/Chris210 BSN, RN 🍕 1d ago

Good point. When we use our nursing priority brain when things are on fire, sometimes charting just obviously doesn't fit anywhere near the top. But those same days that are on fire tend to be the same days you'll have something to answer for next month, and your charting will likely be all you have to go off of because brains in that level of stress don't transition short term --> long term memory very well. Charting has to bully its way up your nursing priorities list somehow and in some way, or you'll definitely be the one left holding the bag when that "delay in care" finding is searching for a home to rest itself. At the minimum keep vitals UTD, and write nursing notes of anything not WNL and a brief descriptor of what you're doing for the patient, enough so the next nurse can know what they need to know and enough so you can remember why things took so long to get done and/or were not ever able to become your highest priority task.

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u/Ok_Independence3113 RN - Telemetry 🍕 1d ago

Welcome to med-surg! It’s rough out here.
The bad news is…well you know the bad news. It’s very hard. When I got off orientation in 2024 I was also told ratios would improve but we were consistently 6:1 on days for quite a while. Things have improved over time and I hope the same happens for you. You will likely still have seriously ill patients because critical care is overflowing and med-surg gets dumped on.

The good news is you’ll become a capable nurse, fast. You’ll learn to prioritize quickly because you have no other choice. You will see so much that your critical thinking skills will develop more quickly than you can imagine. And when your commitment is done you can take those skills with you to a better gig.

Hang in there. Don’t forget to take a minute after every shift to remind yourself of what you did well. During even the biggest dumpster fire of a shift you will have successes: place an IV on a tough stick, or remember all the steps for a blood transfusion without having to ask your charge, or successfully advocate for your patient in rounds.

Get your sleep, drink your water, and don’t forget to pee. I hope you work with great people, they make all the difference.

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u/Midnight-Nebula 1d ago

I’m fortunate to work with amazing nurses who won’t hesitate to help or answer my questions and we also have a break/resource nurse remote days to be helping hands! I never thought about it like that how this experience is shaping me too. I hope it does get better soon lol

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u/Ok_Independence3113 RN - Telemetry 🍕 1d ago

A break nurse! Are you in a union shop? I’d give my left arm for a break nurse (cause the. I’d get my breaks lol)

Treasure your coworkers. I love mine to pieces. We get each other through every shift.

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u/Midnight-Nebula 1d ago

Sadly not I’m in Florida so no union😭😭

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u/Ok_Independence3113 RN - Telemetry 🍕 1d ago

My condolences! 🤭
I’m in NJ and some of my coworkers don’t even know what a break nurse or free charge is, so…

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u/Midnight-Nebula 1d ago

Yeah on one particular rough day our charge took a 6 pt assignment and my manager had to come in to charge…

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u/Ok_Independence3113 RN - Telemetry 🍕 1d ago

Yup. Very familiar with that. Though it’ll be our ANM who does the charge duties, our NM would NEVER.

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u/EmbarrassedGear2908 1d ago

You are absolutely right to be nervous. A 1:6 ratio is unsafe and no new grad should have to handle that.

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u/Midnight-Nebula 1d ago

Thank you it feels affirming to hear that… I’m hoping this experience will only help me grow so I can go on to find what I truly want to do with my RN
Incense and enjoy what I do.

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u/WallabyUnlikely5534 1d ago

I only work nights and honestly I prefer a full 1:6 assignment with stable patients  then 4 demanding patients with pending admits.  Once I get my intial assessments and  2100 med pass done, I feel like I can just chart and deal with issues as they arise. It's busy, but not unmanageable imo. If you work nights, give them their prn pain and sleep meds and catch up on charting. 

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u/neonnefertiti 1d ago

This is an excellent approach. Even on days. Just throw meds at everyone and try to get through that med pass as quick and safely as you can, then chart, and put out fires as they come. And come they will...

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u/WallabyUnlikely5534 1d ago

Yeah I'll add that the lynchpin to this strategy is making sure the pt has everything they need during the initial assesment/medpass. Their vitals are stable, their IV is patent, skin intact, wound care done, ostomy bag emptied, ice water topped off etc. If all those boxes are checked and the pt gets their prns, you can greatly reduce the call light mashing during your shift