7 Patients Feels like Too Many

  1. 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. So, the problem is that I usually have 6 patients which is managable most nights, but sometimes I'm assigned 7. On those nights I have 7, I feel like I am so busy that I am on the verge of being unsafe. I am worried that I am going to miss something (I am not able to check on all 7 patients every hour) or that I'll make a med error. This week when I had 7, I literally had no time to check for critical labs on anyone. What if something important had come in?? I am just moving so fast, trying to get it all done. And of course, I am never done on time, I usually work at least an hour OT in the morning charting. Sometimes 2 hours, on a really bad night.

    So what I am looking for (besides venting of course) is tips on what I can do on these super busy nights when I feel overloaded. What do you do?
  2. 19 Comments

  3. by   DolphinRN84
    Funny how I came across this thread. At my hospital, I work on a med/surg- vascular surgical floor, which can be a pretty hectic and heavy floor, and I work permanent nights. When we are adequately staffed (4 nurses on a 22 bed unit) we have a max of 5-6 which I can easily manage ok. I'm on tonight and there are only 3 of us on...and the floor is full, so currently I have 8 patients right now....I've had 7 patients before and it can be quite busy, but really depends on the patients. I know how you feel about feeling unsafe, because it is! The only advice I can give is to take your time and don't rush things- minimizes making mistakes. You've only been off orientation for 6 weeks and you are just learning how to manage your time better. That will come in time. I hate having more than 6 patients, but sometimes it happens. Like tonight I have 8 patients! But it's not too bad at the moment- pretty steady. Also if you feel overwhelmed, maybe some of the nurses can also pitch in and help if they are not too busy. Hope this somewhat helps. I definitely know how you feel.
  4. by   RNDave
    I'm new, too, working on a medsurg floor. I usually have 6 patients on afternoons. Our midnight nurses take at least 8. The few times I've had 7 patients, I also had an LPN working with me. I agree with you that 7 isn't safe for anybody, especially a new grad.

    DolphinRN84 wrote:
    The only advice I can give is to take your time and don't rush things- minimizes making mistakes.

    This is good advice. I've stopped running around the unit at top speed trying to get things done. I am learning that charting when things happen is preferable to coming back later and filling things in. I know that isn't always possible, though. I haven't mastered this yet, but I want to develop a 'system' of goals where certain things are done by certain times to help in getting out on time. The fine line is to keep focused on critical thinking and patient assessment and not get focused on tasks only.

    Last edit by RNDave on Jan 13, '08
  5. by   wannabeagreatnurse
    Hi RNDave,
    I've been a nurse now for 7 months and I'm just beginning to feel like I'm not a danger to my patients. I work on a busy Med/Surg floor and switch between days and evenings because I'm PRN. I have five patients at a time, and some shifts depending on their needs, that's too many. Rarely do I have the same patients, so I have to learn quickly about my patients every shift. There are some evenings, still, when I work an hour or two over my shift to get documentation done.

    If you're really feeling overwhelmed and unsafe in caring for your patients, talk to your nurse manager. It's your license and you have the right to defend it. Ask if you can back down to five or six patients until you're more sure of yourself. Confide in your charge nurse about those things that you still need help with. Perhaps you have specific things that you still don't quite get. Check back with your preceptor or mentor and review those items. Review how you're doing your work. Try your best to work smarter, not harder. Chart as you go, whenever possible. Use your aides and tell them about those patients that will need the most attention, and tell them what you expect of them. (Hard to do, but a way to help you get your work done.)

    Make sure you're getting as much rest as possible on your days off, get exercise, eat well and stay hydrated while you're working. Praise and thank the people that help you, and foster good relationships with those around you. Rarely where you can find good teamwork will you find individuals who are disgruntled. (Suround yourself with good people...) When you do find people who are disgruntled, stay away from them, you don't need the negative vibes.

    Hope these suggestions help. It will get better, and remember, you will learn something new every day of your nursing career. Don't be so hard on yourself...you're just a baby in the grand scheme of nursing. Take care.
  6. by   november17
    Quote from DolphinRN84
    the floor is full, so currently I have 8 patients right now....
    Amazing that you have time to post. Keep up the good work.

    Quote from RNDave
    I am learning that charting when things happen is preferable to coming back later and filling things in. I know that isn't always possible, though. I haven't mastered this yet,
    No joke. I'm getting better at it though. I've been practicing stopping and charting no matter what/how many call lights are going off. For me I've found it's helped to practice making good focused notes within a few seconds. Writing something is better than writing nothing at all.
    Last edit by november17 on Jan 17, '08
  7. by   RainDreamer
    I can't imagine taking care of 7 sick patients ...... that's too many, IMO!

    Talk with your supervisors and/or nurse manager. If you don't let them know you're overwhelmed by it, then they will continue giving you assignments like this. The thing that concerns me is that you feel like you're on the "verge of being unsafe". If you don't feel like you can safely take on the assignment, let someone know. Risking your license is not worth it ..... you worked too hard to get it!
  8. by   DolphinRN84
    Quote from november551
    Amazing that you have time to post. Keep up the good work.

    Hahaha thanks. Actually with 8 patients that night, it was steady..though Sunday night I had 8 patients again and it was hell...Then I had 7 Monday night, because we were short a nurse those past 3 days...*sigh* Yeah anything more than 6 patients is too much IMO.
  9. by   november17
    Quote from DolphinRN84
    I had 7 Monday night, because we were short a nurse those past 3 days...
    I feel you. We got 3 new graduate RNs hired onto our night shift and we're pretty happy to get the extra hands!! Can't wait till they get off orientation.
  10. by   MelBel
    I feel like 6 is my limit too! Although normally, I have 7, 8 or 9. 8 being average. This week we were "overstaffed" and I had 5 patients Mon/Tues and 6 on Wed I was happy, my manager was not!

    But anyway, from practice and watching more experienced nurses, the one thing I've learned, is TAKE YOUR TIME!

    For example: I used to want to get all my meds passed within the "legal" window. Not going to happen with 9 patients. So here is how I try to organize myself...our PCAs do our vitals at the beginning of the shift, so when I get out of report, I know that they have already made their way down the hall, and I've been alerted to any issues with those. I check all my orders, give myself a 2 minute mental break, and then hit the floor...introduce myself to my patients and check to make sure there aren't any dangers, etc. Then, for the most part I try to go down the line by room number, and do complete care on that patient...full assessment, meds, incontinent care, etc. If I have a group that really requires prioritizing, I can't always go down the line. Sometimes I see the patient with the demanding family first...decreases interruptions.

    If we are short, and I have to do my own VS, I do vitals and assessments together, then go back and do meds.

    What I've learned....it is OK if meds are 30 minutes late. (Most of the time) it is not going to hurt the patient to get it a little late. Doing everything at once saves a LOT of time...and it seems like I spend longer with the patient. I've had to get over the fear of leaving the last patient down at the end of the hall for so long without me going in....but that is why I stop in at the beginning!

    Hope this helped a little bit, not as organized as I'd like, but I'm sleepy
  11. by   madwife2002
    Gosh 7 patients is a lot of patients. The way to get through is to priortise your care and document as you go through. Decide what needs to be done immediatly and what can wait. Try not to allow the patients to manipulate you, be firm but kind.
    Focus in on certain 'tasks' ie.
    Get organised with pain meds I find if you have a pt who is frequently medicated, medicate them it takes so little time-but if they are constantly using the call light it becomes stressful for you and you will lose focus.
    Ask for help should you need it, a more experienced nurse may well have a little time to help, just because they dont offer doesnt mean they wont help, sometimes nurses dont want to step on each other's toes.

    Remember just practice safely and a smile will get you a 10 min reprive from a lot of pts.
  12. by   socalpca
    Wow!! 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.
  13. by   Zookeeper3
    ok, 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.
  14. by   marie-francoise
    The Aiken study from JAMA in 2002 is worth a look... She addresses nurse-patient ratios.

    Managed care and the way our health care system works today isn't doing nurses or patients any favors as far as staffing.