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Am I incompetent or is it a staffing vs. pt acuity issue?



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Nov 03, 2009 11:30 AM

Am I incompetent or is it a staffing vs. pt acuity issue?


Sorry this is long, but I would appreciate any input...........Please!

I work in a rural hospital on the general medical floor and there are nurses, mostly RN's, with differing years of experience from <1 yr to >20 years. The majority probably have an average of 1-7 years experience. I know I am a new nurse, just passsed my 1 yr anniversary, but I question my competency a lot. I work nights because I had trouble leaving on time doing 3-11 shifts and I occasionally still leave late when I do 12 hr night shifts. We do our staffing according to the census and not pt acuity. At times I feel the pt load is too much and/or the assignments are unsafe due to numbers &/or acuity. I am afraid to say something to the NM because I don't see others struggling like I sometimes do.....so it makes me think that it's just me & if I'm a 'squeeky wheel' I won't 'get the oil' but rather get replaced. I put my pt's needs first and usually have to finish charting after giving report. I still ask a lot of questions and ask for help when I'm falling behind, but I don't want to burden my co-workers. I DON'T like staying late or when people say "You're still here!" and the hospital is really watching overtime due to budget issues. I worry about the liability of being an RN, missing something in my assessment, not doing the right intervention, not calling the Dr. when needed or calling when it's not necessary (I had a Dr. get upset with me once for this) etc. and think my charting takes too long & is too detailed because of these worries.....how do you get past that? Does anyone staff according to the pt's acuity? And if so what kind of rating system do you use? I was told my facility used to staff by acuity, but that they found the nurses rating most of the pts high acuity so they could have smaller pt loads.


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3 Comments
No. 1
Old Nov 04, 2009, 12:16 AM

Default Re: Am I incompetent or is it a staffing vs. pt acuity issue?
I would ask some of the other nurses on your floor how they organize their work and incorporate some of these suggestions into yours. I'm sure that some of the other nurses have time saving techniques that do not compromise pt care. Try to chart as you go. You will be find that it will be a lot easier to go back and assess/reassess things that you forgot or that needed more attention (and you won't have to wake a pt to do it). At the end of your shift you will just have to a short final note which should cut down on the OT.
As for calling Drs. you will always find a couple that don't like to be "bothered" for any reason. When this happens you can either grin and bear it or ask the doctor what changes in assessment they would like to be called for.
Please don't think your incompetent. Staffing by acuity is a thing of the past. I'm sorry if I seem bitter but staffing by census is nothing more than a way to save a buck and has nothing to do with patient care. In these hard economic times the workload for Nurses is only getting heavier. Please find the time to look up safe nurse to patient ratios for your state, see if legislation is being worked on and get involved. Get out and vote for people who support safe staffing, write letters to congressmen, let others you work with know about it and try to get others involved. I live in PA and as of July 1 we are now mandation free . Yes, we can make a change!
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No. 2
Old Nov 05, 2009, 12:15 PM

Default Re: Am I incompetent or is it a staffing vs. pt acuity issue?
Thanks for the input nurselori001...I'll keep in mind what you said.
A recent shift went better....and I try to chart as I go but currently we have so many heavy care pts and/or unstable pts that I couldn't chart until after 0130. I guess that's the chance you take in nursing...I was just having a looooong stretch of bad shifts and still being somewhat new it did nothing for my self-esteem!!
I like what you said about contacting congressmen & voting.....I'm not into politics but I think I need to be now! This might be a dumb question but what do you mean when you say you're mandation free?
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No. 3
from MBARN08
Old Nov 07, 2009, 08:28 PM

Default Re: Am I incompetent or is it a staffing vs. pt acuity issue?
earned_RN_2008. Do not assume that the other nurses are doing their job. I used to work late on Med Surg and think there was something wrong with me too. I found out after observing my co-workers and talking to a few gossipy ones that many of the nurses on my former Med Surg floor cut corners so they could go home on time. For example, some nurses do not actually complete patient care, finish paper work (I have known some who say they will chart on their next shift..), and some who just pretend that something did not happen so they do not have to accept responsibility (Ever had a patient’s IV fall out at change of shift or an order of blood not get hanged because the doctor mysteriously just wrote the order that is listed 2 hours ago???). In other words, you are working hard to keep up with a load and acuity that is not humanly possible to do by yourself!!! So ask for help and show no shame.

Plus, gain a reputation for being a nurse that will go home on time! The other nurses are getting away with murder because you are being too nice. Nursing is 24-7 in the hospital so the next shift has to work. Sorry... but that is what they are paid to do. As for your charge nurses who think that pilling more on you is going to be OK, stop them! Let them know you are going home on time or that they will be staying late with you... They will find another nurse to pick on once you stop letting them dump on you.

If none of what I say actually works or you are still fed up with your current employer, then find another employer as soon as you can outside of Med Surg.... I did!!! Good luck!
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