7 Patients Feels like Too Many - page 2
by luv2yoga 1,968 Views | 19 Comments
I am a new nurse - I've been off orientation only about 6 weeks. I am working nights on a busy med-surg unit. For the most part, I have great co-workers who are helpful and really know their stuff. I feel like I'm learning a lot.... Read More
- 0Jan 17, '08 by socalpcaWow!! Reading this string really made me feel lucky. I only have a max of 5 patients on our floor. As a new nurse (7 months), I have a hard enough time getting out on time with the 5 patients I deal with. I could not possibly fathom taking care of 7 or even eight patients. To me, that's absoultely unsafe and completely criminal.
- 2Jan 17, '08 by Zookeeper3ok, when floated (I don't do this regularly(((disclaimer))), when I give 'em a quick I'm so and so... I'll be in shortly I ask them if they need anything. I write it down on my assignment sheet I make. I check vs. pull my meds and grap the requests.. pain meds, snacks.. look up labs.
So I then hit each room with the vs known, do the assessment, pass the meds.. a bit of teaching as I fluff and puff being friendly but always moving.. checking IV dates, tubbing dates, dressings....talk, teach and do all at once. BEFORE I leave the room, I explain I'm moving on to the other patients and ask what else I can do to make them comfortable.
(seems crazy when you're busy... have 6 more to see.. but I swear... settle them in now why you're there and get it done so you can move on and be interrupted as little as possible).
family grabs you in the hall during med pass. Smile and let them know that you will be busy for a bit providing meds and treatments and want to give their concerns you full attention AFTER your meds have been passed. (Yep some are angry and have been put off all day... here you can try for a few moments and then say... let me bring my charge nurse in to help address your complaints. Now I will finish my med pass and then check back in to make sure your needs have been addressed.
yeah I know, ideal... but when it works 60% or more with these problem people... usually more... you're back on track... family is at least listened to. Usually family just needs TIME with SOMEONE as the docs stop in so briefly.
lastly... take that deep breath in and out before you enter each room and pass meds. The patient needs you to be calm, not in hurry and needs their meds correctly... even though you want to scream "shut up I have to go to the next room"... exude... calm.... it's catchy.
Not meant to be preachy at all, just a few suggestions that may help at least some of the time.
thats a LOT of patients. I swear, if you slow down you will be more efficient. best of luck... it will get easier, promise.
- 0Jan 19, '08 by luv2yogaThanks for all the specific suggestions. I am learning to group tasks together, for example, bring the midnight meds in with me when I do assessment. Thank goodness 7 patients is not our norm, it is usually 5 or 6. When I interviewed at 4 hospitals in this area, I specifically chose this one because it had the lowest ratios. The other places I looked at said 8 patients at night--I can't even imagine. Well, I guess I can, things just go undone. They have to.
- 0Feb 17, '08 by IpaqWOW! i feel so jealous, envious with everyone posting here that they only get 7 patients at night...meredithT, which hospital do you work? i am also a new grad and just got off orientation and started on my own last january, 2008. I ALWAYS have 11 patients on a very heavy medsurg floor with 2 admissions and one transfer from other unit that just got stable. isnt that nice!??? i thought that was always the norm on night shift. but then again when i read this post, i feel so bad now....:scrm:
- 0Feb 17, '08 by sharona97Brings back memories of working telemetry (thank God for that invention), having ICU send up patients left and right as there unit(s) were getting flooded. Only my 10 patients had walls between them, and 4 with chest pain all at once. But of course that was 20 years ago, with a severe nursing shortage where you were given 3 sick days a year, period.
Welcome all new nurses!!!! You are needed, no lie!
- 0Feb 20, '08 by CareBayerI am precepting on a Stroke Step-Down unit where it is the norm to have 6 patients on day and afternoon shifts. Sometimes we don't even have an aide to help. It's crazy and I don't know if I'll ever feel that I can deliever safe nursing care to this many people at one time!
- 0Feb 22, '08 by RiverNurseDon't get me started! LOL...
I am a new nurse as well - three weeks out of orientation. I, too, work on a busy tele/med-surg unit. I've been assigned 6 patient at my own insistence and sometimes 7 - with the occasional admit patient.
I have found that I can simply roll with the punches and try my best to get my meds passed and assessments done in a timely manner (easier said than done...) and/or try to change the system so that there are more reasonable nurse :: patient ratios. That will require nurses working together for real change in the workplace.
Here's an example of the patient load I had the other night:
Six patients, 1 had low O2 sats all day, requiring constant monitoring, she had a rebreather mask that she refused to keep on. Patient two had a stroke, right side hemiparesis and was non verbal, on restraints. Patient 3 was suffering from chest pain and ETOH abuse - was having DTs, dr had prescribed ativan every hour on the hour and assessments. Patient 4 was in a veil bed, wouldn't remain clothed, dementia and required bed changes through the night - CNAs weren't always responsive, saying, "I just won't change him again." I changed him several times - wanting to prevent skin breakdown. Patient 5 had a Hx of stroke - care on this patient was easier. Pt 6 returned post-op, requiring an assessment, vitals q 15 min, then 30 then hourly for the first three hours, and corresponding assessments of the dressings.
Whew! Busy night.
I feel that five patients are completely manageable by a nurse, six is more hectic depending on the acuity - 7 is nearly too many.
Anyone have any ideas on how we can improve the nurse :: patient ratios?