Originally from Canada where med surg was 1:9 on days and 1:18 on nights (1986-1996). moved to the U.S. where I thought I was in heaven…med surg 1:6, step down 1:4, ICUS 1:2…now in the ER 1:4 to start…1:whatever once the ER is up to 40 admits holding in the ER. I’m not a firm believer in ratios…we all know some patient assignments are far more challenging than others…..so those with the easier patients have a great day while others may not. Patient safety is much higher when we are allowed to use our great Nursing assessment skills and adjust for acuity….rather than play the numbers game. Ratios by the way are only observed in controlled settings, inpatient units while in Emergency Departments….the limits are endless. I’ve had shifts where our ED census has climbed over 180 patients in a single site ED….but staffing remains the same, while our inpatient partners…maintained their ratios. Since I have worked both inpatient, critical care and now ER….and with the current cuts to healthcare….Nurses need to be empowered to develop a solution (beyond just numbers or ratios) to patient safety and satisfaction….while maintaining staff satisfaction…before those 1:10 ratios are forced back on us.