Is this too much or am I crazy...what are your units like?

Your floor is crazy.

My first tele job was similiar. Extremely sick pts with patho and gtts (and 5:1 ratios) that would easily be in the ICU in many other hospitals. Later, I moved to an ICU at a different facility. At this hospital, the only drip on their tele floor was Heparin. The nurses in this ICU commented that the tele floor was not "progressive" and they remember all the things that they titrated when "they" were on tele.

When I first started out, I though it was a 'badge of honor' to tell all of my new grad nursing school friends about all the stuff I have seen (drips, meds, crashing pts, etc.). I felt that I was having such a better learning experience than they were (which, to some degree, I was).

As time passed, I began to realize how much the stress was waring on me. I was leaving work frustrated, barely getting through the orders of the day. Because many of the patients were sick enough to need ICU care, they took a great deal of time and energy to care for. Lunch was a joke and bathroom breaks were rare. Codes and transfers back to the ICU were a little more common than they should have been. All of this translates into a decrease in the quality of patient care. Was I teaching my new onset CHF pts about lifestyle changes? Nope, I was too busy titrating the 75 mcg/min of nitro that my HTN pt needed. Was I preparing my preop CABG pt for his postop recovery? Nope, I was too busy grabbing lidocaine (who still uses that? ) for my post code whose bag is running out and is throwing PVC's.

This stress that you experience at work carries over to all areas of your life, whether you realize it or not. I was gaining weight and becoming less healthy. I even think I started getting a little depressed. I know that I saw this with many of my co-workers.

Most importantly, in all this chaos mistakes will be made. If they are, no one will take into consideration that you had a crazy pt load - not administration, the pt or family, or the nursing board. Do not underestimate this last comment. Also, my friends who were working in better environments were making the same amount of money, because this area pays based on years of experience. Although they weren't stress free, I could tell that things were better.

Too often we rate our nursing abilities by how sick our patients are. Everyone wants to be the hero that saves the lives on the high-ratio, drip-giving, IV-pushing, code-having floor. It's great to be able to manage high acuity patients, but we also have to realize that if we only focus on that aspect of nursing care, we are doing much more harm than good for our patients.

When Mrs. Johnson is admitted for STEMI, it's a big deal. Do you think she would really trust you as her nurse if she knew that - because you've accepted a crazy work load - you may not have time to teach her about her labs, give her pain meds, or be there right away if she codes while another pt decompensates? What about John Smith, the new diabetic on the insulin gtt? Would he drive to another hospital if he knew that you probably didn't have time for his q1hr BS's? How could you with the ratios?

We are nurses, not super heroes. The economy is tough, I know. Unfortunately, you really need to move to another area. You aren't doing anyone any favors by working in (and, in a way, helping to maintain) an environment like this. These environments exist because we - as nurses - allow them to exist.

CrazyPremed

Hey, i was wondering after reading your post how things are going at your job. Are they any better or worse? Are you still there? I am a new nurse, have been on a cardiac floor where we mostly take pts post cabg, thoracic cases and amputations. some we get are overflow of medical like chf exbaration. the situation you described scared me to death. i felt overwhelmed just reading it. now all of our post surical pts come out on an insulin gtt and we do blood sugar checcks every hour. they also come out with several chest tubes. so those patients usually require more attention. we may have one on an amio gtt. but typically we on nights have 4 pts on and sometimes 5 when we r short with charge having up to 3. (bad nights) but usually we have one walky talky that is going home the next day. one post cabg. maybe a chest pain with a nitro gtt or doputatmine gtt. but never everything all at once what you had. i hope things are better for you know. it is interesting to hear what other nurses go through.

Last night was a pretty crummy night for me... split shift, first 4 hours on a medical floor w/varied acuity pt's 3 pt's and one admission, last 8 hours on my own tele floor with 6 new pt's.
Put my head in a spin for sure! Charting on ten pt's.. crazy!

Normal ratio on my tele unit is 1:7 on nights, days usually 1:4 or 1:5. I've also gotten 6 pt's w/two additional admissions. We get drips galore .. cardizem w/titration parameters, of course heparin drips, usually caring for 4-6 cardiac monitored pt's during the night. It's RIDICULOUS!!!!! Then I get flack about sometimes appearing disorganized during morning report... Ya think??!!!

Seems this unsafe practice is all over the place, and the more ya complain to the uppers, the more wasted air there is in the world.
It's all about budgets and justifying why an extra nurse was called in to help out vs putting pt safety first.

What can be done w/out jepoardizing our jobs? The more ya sqawk, the closer you are to being booted out the door.

That sounds like way too much. Consider moving to a less overworked position. Remember if you make a mistake the nursing administration will not stand behind you. They will try to put all the blame on you, and your license and not just your job might be in danger.

Been there, done that. Your unit sounds more like an IMC, which usually have 1:3 staffing ratios.