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Our staff RNs work 12-hour shifts with no relief nurse.When we cover for each other, is that violating state law for patient-to-nurse ratio and is it safe?

Wednesday October 31, 2012
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Dear Nancy,

I'm employed in a hospital on the med/surg telemetry unit and assigned four to five patients. The staff RNs work 12-hour shifts with no relief nurse. Instead, we are supposed to cover each other during meal breaks. Is this against the state law for the patient-to-nurse ratio, and is this considered safe patient care?


Nancy Brent replies:

Dear Margaret,

You can check what your state says about nurse-to-patient ratios by going to your state legislative website and putting "nurse patient ratio law" in the search bar. This will give you some idea as to what the ratio on a med/surg telemetry unit should be. You might not get a direct answer however, so a second option is to check with your risk management department. Because risk management is concerned with controlling risks to the facility, it could be a second resource for you.

Twelve-hour shifts have been in existence for some time, but your question of no relief nurse being available while you take your meal breaks bears review. Although theoretically, everyone would get a meal break, and would have to cover for another nurse while on his or her break, it may not be the most ideal coverage model. As you questioned, it may not meet your state's nurse-to-patient ratio if you only have four to five patients, but when covering for another, you care for double that number.

Also of concern is your state's labor laws concerning meal and rest breaks. How much time are you allowed for either or both? Is this practice consistent with those mandates?

You always have the option of having your concerns reviewed in detail by a nurse attorney or attorney in your state. You may want to see if your board of nursing provides guidance to you on the matters relating to nursing practice. Check their home page on the Web to see if any opinions or guidance have been issued on these areas of practice.


Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.