6 patients at once? How do you do that?? Any advice?

[RN0302]

I'm a new grad RN and just got my first job working days on a M/S floor. I will start in two weeks and was informed that you carry 6 pts per RN on this floor. In all my years of working in healthcare I've never, ever seen a 1:6 RN/patient ratio. I know it's out there but I've never seen it. How is that even possible?

I'm absolutely terrified of my new job after hearing this and now don't even want to do it. To me it just sounds wildly unsafe. I don't even know how you can keep up with the assessments, meds, and many needs of 6 M/S patients. I'm already anticipiating how horrible this new job will be and dreading it so much that I've developed stomach pain.

Any advice on how to manage 6 patients at once????

[sistasoul]

Hey girl :) Congrats on graduating! I myself am not yet an RN, I'm a tech (CNA) working on RN liscense... at the hospital that I work at here in IL (Medical/Oncology unit) I am on night shift, and often times the night RNs (who work 7p-7a or 11p-7a) have 6 patients when we are at full census. Unfortunately this can be extremely taxing for the nurses, I know from observation and their words. Some people (incorrectly) assume that just because a nurse works nights means that she has it easier and can handle a bunch more patients- and it's not always true. There are nights when things are easy breezy, and nights when we all wanna pull our hair out and cry! Sometimes there will be a group of patient(s) with: one on dialysis, one with a PCA, highly unstable sugars, a patient getting aggressive chemo, a combative person, and a super confused one that wants to crawl out of bed or get naked every 10 minutes. Yes, it happens, but not every day. All I can say is I hope you have good nurses to partner with, and take FULL advantage of your techs! The only way that the nurses survive having 6 high acuity is utilizing the techs, helping each other out (the RNs) and if you have a good charge nurse, using him/her too. Where I work at least it's totally acceptable, and even encouraged, that the nurses ask the charge for help when they are swamped. If you work there for a while, and feel that it's just too much, talk to your manager! Our staffing model was recently updated because we all banded together and brought our greivances to the manager, and had meetings, and things were resolved. Maybe you'll get there and find out that the other nurses feel overworked too...Or, maybe they'll have some good tips for you as to how to handle 6 patients- talk to them!

Good luck :)

Our poor charge nurses also have a full patient load plus charge dutues and are already pulled too thin.

[DixieRedHead, ASN, RN]

Am I in some kind of alternate universe? 6:1 on Med- Surg is great staffing.

[PetsToPeople]

I am still in RN school and from what I have heard, I am expecting to have to care for atleast 6 if not more pts after graduation. This is from what I have seen the staff nurses do during clinicals and from what I heard from AN.

[loriangel14, RN]

It's on DAY SHIFT!!!

Yeah 6 patients on day shift. What were you expecting? That's usually the minimum where I work.

[yeng_27]

Here in my country nurse patient ratio in government hospitals are 1:15 and trust me its hell..:))

[Ahhphoey]

1:6 is pretty normal for med-surg. I used to take between 5-8 patients on day shift when I worked med-surg and that was about 5 years ago, so a max of 6 is pretty sweet.

[anotherone, BSN, RN]

6 on days sounds rough depending on the patients. NOT ALL MED SURG patients are the same. not at all. This may be 6 patients per RN , NO AIDES OR LPNS. or 6 patients per RN with an aide working with you. It all depends. I work med surg and there are shifts were 4 seems barely doable because half of those should be in the ICU and shifts were I have had 6 on days and am sitting around because 4/6 of those are walkie talkies waiting for tests or super easy post ops .

[That Guy, BSN, RN, EMT-B]

Expect to drown the first few weeks. It happens. You will feel behind, you will feel like you failed, its ok. Its the norm. You are a newbie and learning your ropes so its to be expected.

[FLmomof5]

I would say how you handle it will be based on your orientation. I had 12 weeks and worked up to a 5 pt load on days and 6 on nights. When I got off orientation I had the occasion to take 7. I would recommend check boxes for each patient. I would always mark their med times (2100, 0000, 0200, 0400, 0600, etc.), one box I labled NN (nursing notes....aka: assessment), MAR (checking tomorrow's MAR), 24 (24 hour chart check) and for those on a PCA I would have a box for each of the 2 hours to record PCA data.

[evolvingrn, BSN, RN]

If you have a CNA dedicated to you then i think it will be doable. We have 3 to 4 pts but we do a fair amount of our own cares ect.

[loquero]

6 patients would be a dream come true- of course i'm not med/surg. I'm a psych nurse and usually have 8-12 patients. Lately we have been dangerously understaffed and I worked a 7p-7a recently where I was the only nurse with 19 patients between 2 units-- the 2 most medically unstable units in the hospital: Geriatrics and Detox. Impossible. I am not far from reporting them to... well, who do you report it to. Will probably post a separate thread for that. But you will get used to managing your time and getting things done at your own pace and routine. But understaffing is the only thing that makes me dread going to work. Hospital and nursing admin needs to wake up! There needs to be a federal mandate on N-P ratios. AND STAFF TO ACUITY!

Good Luck! (and as someone already said, you can only do so much. So prioritize and if you can't get everything done, document it and keep it to yourself should anything come up about it later as to why something was not done)

[Lauryen828]

I to am a new Grad. I graduated in December and I work on a Med Surg Unit. I started my new position in February and I can easily have a 7 patient assignment during day shift. If I work nights 7-8 patients sometimes 9 if we are short. It is HARD!!! I am so overwhelmed and I want to cry everyday before I go in. I am on orientation for another week, and the Nurses that have been my preceptors all seem to get things done no problem. I haven't seen anything Unsafe happen (thank God) however I still feel that it is unsafe, and I firmly believe you can not give patients the "BEST" care as my job always pride themselves in. Organization is the key. It can be done, Im just trying stay positive and pray that I make it out alive.