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

  1. 0
    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????

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  2. 25 Comments...

  3. 1
    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
    WildcatFanRN likes this.
  4. 1
    Congratulations! on your RN!

    I know as you enter the world of nursing it is intimidating and overwhelming. You won't be thrown to the wolves on the first day. Do you have a new grad orientation? This is where they will get you up to speed. Unfortunately, nursing school doesn't prepare you for the real world when classes are on line, in a lab or limited to one maybe two patients. While overwhelming at first.....actually for at least the first year, you will get better on your organizational skills. Even experienced RN's can be over whelmed with 6 patients depending on their acuity. What shift will you be working once off orientation? How long is your orientation?

    Just take a deep breath and remember that the way to get to the next step is to take the first one and then the next, one step at a time until you get to your destination. Nursing is a hard profession. It may "pay well" but you earn every cent. .

    Good luck!
    gaylarn4 likes this.
  5. 1
    There is a difference in staffing between day and night shifts, so is this on night shift?? If so I would say that is not far out of the range of what is normal. Did they say that is the max, 6 pt per RN? Because that may mean the majority of the time you have 4-5 but have to be capable of carrying 6 in the event they are short staffed or at full capasity. The number of tech/aids/LPNs they have matters too, some hospitals train support staff to do a lot more than VS and baths/toileting.

    As stupid as this may sound to you right now, I think new grads are at an advantage to work an a challenging environment at first. Because in learning you are capable of handling that, you then have confidence you can handle anything. I have been an LPN for nearly 3 year in a very nice skilled nursing facility, but as a new grad RN I have decided to start at a very fast paced acute rehab hospital, just because I know I will not fully delevelop my nursing skills if I work in a cushy, suburban ltc facility for the next five years. And god forbid, I lose that job or if my family relocates and I have to work at a 'real' nursing home, not sure I could manage. I love it where I work now, but it is not expanding my horizons. Just keep in mind that there are lots of other nurses who do it and manage just fine. Nursing is definitely a tough job. You have to start orientation without such ideas in your mind and all those pre-concieved notions that you have and just be open to learning and taking in the experience.

    Even I start 'class' orientation tomorrow, and am nervous. Hearing older nurses talk about the old days of nursing is even scarier. Relax, breath, and be confident; You can do this!
    gaylarn4 likes this.
  6. 1
    Just remember to take your time, (not toooooo slow but in a safe manner) and remember to prioritize your patients. For me, I use my report sheet as my "main brain sheet'. I have a clear clipboard so when I turn it over I have all of my med times and labs due (and their specific times as well), and other important things that matter on that sheet. If I can learn how to do it with 9 patients, you can do it with 6. Remember it will take time to get comfortable with this. It will not be overnight, not in a week, maybe not even in a month. And as soon as you think you have a routine, you're back at square one, but that's ok though. You'll get there!
    gaylarn4 likes this.
  7. 3
    6 is the norm where I work. You can do it.It takes time management and that gets easier with practice.
    fashionistaRN, Aurora77, and gaylarn4 like this.
  8. 1
    The med/surg units in my hospital have 1:6 ratios, used to be 1:7 until recently. Luckily I work in peds where we have 1:5. On occasion though we have been short staffed and I've had 6 patients. Unfortunately I don't think it's that uncommon for med/surg units to have 1:6 ratios. Like other posters said, just take your time. Do your best and prioritize. For example, if you have someone who is in respiratory distress and going down hill then it's okay if your q24 hour antibiotic is half an hour late to one of your stable patients. There's only one of you and you can't be everywhere doing everything at once, and it's okay to ask for help. Do things ahead of time as much as possible. If I didn't have mountains of paperwork to do, I think 5-6 patients would be much more manageable. You'll see that paperwork can take up a good part of your day. Because you never know what will happen later on, try to get as much of your paperwork done as early as possible. Over time you'll get used to it a little bit and it won't seem as overwhelming. But it's still not easy. And you'll leave some days feeling awful because you can't give your patients the attention they deserve no matter how hard you try. But you'll do your best, and at the end of the day that's all you can do.
    gaylarn4 likes this.
  9. 3
    where i work we have 6 patients each when we have normal staffing and a full house, on day shift. if we're short staffed we could have 7 patients! and we are a busy med-surg floor.

    it's a matter of organizing, prioritizing, working quickly, multi-tasking, etc. it's also a matter of getting the hang of it, so don't feel bad if you're overwhelmed at first!!! we all are.

    when i get organized for the day, i make a cover sheet and put lines on it to make six boxes. usually i make them small enough that i have some room on the bottom of the page for random stuff. i put the name and room number at the top of each of the six boxes, and on the side i put four check boxes for looking at vital signs, doing my assessment/flow sheet, vital signs again, and a note. then in the middle of the boxes i put the med times, combining 8's and 10's as one box because i generally give them together (if you're not willing to give QD meds early, you're going to end up giving them late). i usually put 12/14 together (we use military time) and 16/18's together, though i usually jump ahead of myself and give the 16's separately from the 18's if i have a chance (that's 4pm and 6pm)... and if the patient has finger sticks or dressing changes i put check boxes for that too.

    the face sheet on the front of my paperwork helps me see the big picture, so i can decide who to go to first, and i try to keep in mind what i can bring with me. running late on 10am meds and now it's 11am? bring in the 12's if they don't have to be after lunch, and bring the glucometer in there with you.

    we have computer work stations on wheels with med drawers in them so i'm able to chart as i go along for the most part. but you can take down little notes on your paper to remind you to do stuff later.

    if you have spare moments, think what you can do during them. (waiting for a page to be returned? you can chart something or pour some meds). know that you'll get the hang of multi tasking and of the tasks themselves, and you'll adjust to the fast pace. just be careful and know that it's ok to peek at your papers and/or the computer because it's hard to keep 6 people straight!
    sekishin, snuggles49, and gaylarn4 like this.
  10. 0
    It's on DAY SHIFT!!!
  11. 1
    1:6 sounds pretty great to me!! The last time I did med-surg I had 7-8 patients and was the charge nurse.....on day shift. It is totally doable. Organization and prioritization are key. You will run all day, probably not pee, and scarf down a bag of chips for your meal, but hey, isn't that what nursing is all about these days??
    WTXgrl likes this.

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