Barely managing 2 patients...and they want me to manage 5???!!!???

  1. OMG--my panties are in a bunch just thinking about eventually I will be expected to take 5 patients on the oncology/med floor. I can barely manage 2!! :uhoh21:

    Last night I had a very needy patient who required most of my time -- thank goodness my other patient was peacefully sleeping most of the night. There are just sooooo many little things I have to remember to do (I keep an organization sheet with me to stay on track, but still...!) -- mainly charting which much of seems very redundant. Don't ya just love JCAHO?

    I've only been actually on the floor less than a week total and I'm pretty much left on my own unless I have questions. My preceptor is so busy herself I feel like I'm bothering her with my questions.

    Actually I found out they just changed the nurse/patient ratio from 3 pt. to 1 RN, to 5 pt. to 1 RN within the last few days (when I first got there the ratio was 3 patients to 1 nurse and it seemed much more doable). I'm supposed to be up to 5 patients by October 19th -- yeah...right...

    Anyone else out there in oncology? What is your nurse to patient ratio? This nurse/patient ratio seems so unsafe to me on a high acuity floor. Any advice on how to handle this expectation? I just don't see how I'll be ready to take on 5 patients by October 19th -- if I was on med/surg I think I could do it, but not on this floor!

    Thanks for your input and thanks for letting me vent before I go crash for the day. Gotta go back tonight.
    P.S. I forgot to mention we also have tele patients...
    Last edit by blaaveispiken on Sep 30, '06
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  2. 7 Comments

  3. by   RNKay31
    OMG! So sorry to hear how you are feeling, but I cannot answer your questions, because I am not in your shoes, hoping the best for you.
  4. by   traumaRUs
    Okay now. First congrats on getting through with school and passing NCLEX. How long is your orientation? Is it possible to get it extended? With a little more experience you will be able to stay more organized and make a single trip into a room do for several tasks. As to needy patients, setting limits helps. For instance, you NEVER ignore pain or distress. However, grouping patient care tasks will eliminate the multiple trips. For instance, you go into a room, you assess the patient, ask if they need water or a trip to the bathroom or if they need pain meds. Then...as you get done, you ask if there is anything else you need? At that point, you have addressed all the important concerns. Do you have CNA's, techs? Some tasks can be delegated.

    I would talk with your preceptor and let her know you need more help with organizational skills.
  5. by   HMP83
    Hello,
    I'm also a new grad RN working on an oncology floor...also feeling very overwhelmed. I work night shift and am responsible for usually 4 patients (could be up to 5) plus cover 1-2 LPN's patients, basically sign off their orders, write orders, call docs, sign off assessments etc). Just trying to get time management down is difficult but when you have such complex pts that need blood products, their labs always seem to be all out of whack, managing their symptoms from chemo/rad, and of course the whole psychosocial component of cancer is just overwhelming. Also my floor is a hematology floor that has hemophiliacs and sickle cell crisis pts, that have horrible pain and need their narcotic pushes and phenergan and benadryl every chance they can have it (usually q 2 hrs). I feel like i'm just tryin to stay afloat all night and am exhausted. I'm still trying to figure out how to juggle it all, but sadly it is already starting to burn me out and i've only been in it a few months. I'll let you know if it gets any better for me, just know that you aren't alone!!! good luck!
  6. by   blaaveispiken
    I'm also a new grad RN working on an oncology floor...also feeling very overwhelmed. I work night shift and am responsible for usually 4 patients (could be up to 5) plus cover 1-2 LPN's patients, basically sign off their orders, write orders, call docs, sign off assessments etc). Just trying to get time management down is difficult but when you have such complex pts that need blood products, their labs always seem to be all out of whack, managing their symptoms from chemo/rad, and of course the whole psychosocial component of cancer is just overwhelming. Also my floor is a hematology floor that has hemophiliacs and sickle cell crisis pts, that have horrible pain and need their narcotic pushes and phenergan and benadryl every chance they can have it (usually q 2 hrs). I feel like i'm just tryin to stay afloat all night and am exhausted. I'm still trying to figure out how to juggle it all, but sadly it is already starting to burn me out and i've only been in it a few months. I'll let you know if it gets any better for me, just know that you aren't alone!!! good luck!
    Thank you!!! That's really all I needed to hear was "I know what it's like to be in your shoes"! How long have you been working on the floor? How long was your preceptorship? Did you feel like you were getting what you needed during your preceptorship?

    I just don't feel like my main preceptor has time for me because she is so busy herself. We took a break together last night with the idea that we would discuss goals, debrief, etc., but another nurse came in and she and my preceptor ended up talking throughout the break. She probably needed that more than talking about work, but once again...fI'm eeling very frustrated. I've only been with my other preceptor once, but honestly I learned more from her in one night than I have with my main preceptor. Don't get me wrong, she is very nice and very likeable, she is just not as good of a preceptor.

    Our floor also takes sickle cell crisis patients and I had one earlier this week, so I know about the q 2 hours pain management.

    I really thought I belonged in oncology, but I'm already starting to wonder about my decision to take this position. I have heard that most of the new grads who start out on this floor leave after a short period of time. I'm beginning to understand why.

    Should be sleeping, but after only 3 hours of sleep I'm wide awake. I am really upset about this. Will try to go back to sleep and hope tonight will be better. Thanks again for letting me vent...!
  7. by   HMP83
    Yeah, I know how working night shift makes you like an insomniac. Orientation is about 2 months, but I asked for an extra few days (so i'll be on my own next week), even though my preceptor doesn't share any of the load (i do it all) but it is nice to know she is there if I need her. Yeah, the first month of my orientation was on day shift, so i was happy to go to nights, it gives me a little more time to get organized. So I've had 2 different preceptors: one for days and one for nights, they both have been very helpful, one more than the other but I guess i can't complain too much. I just wish i would have gotten more education and inservices on working with cancer pts and chemo and the blood disorders instead of just assuming I know it all. I thought i belonged in oncology also, but I think it more that I am interested in hospice, I guess a yr in onc will make me more marketable in hospice if that is what I decide to do. I know it is a bit early to decide but i dont see myself doing oncology for more than a yr. I'm already getting burned out and that's not a good sign. Oncology pts have a lot of psychosocial needs but d/t to the stress and the overwhelming pt to nurse ratio I feel like the needs are ignored many times, esp since i'm a new grad and this is a lot to handle. I'm hoping this all gets better but until then i guess i'll just keep at it and get this experience under my belt. Atleast look at it this way we will come out with great IV starting experience, pain management, death/dying experience, chemo/rad knowledge, port-a-cath and central line exposure, etc. Let me know if you ever need to just vent, it feels better to know someone else is feeling the same anxiety and doubt. Good luck to u!!
  8. by   JustJen
    First, take a deep breath.....seriously...take a deep breath.

    I have been a RN for less than a year and work a Med/Surg Ortho/Oncology floor where it is quite common to have 7 patients at night. My defense when I am feeling overwhelmed (it happens often) is to take a deep breath, jot down the tasks that must be done, assess who is available to you for support, and ASK FOR HELP. I found if I didnt take that approach, coworkers would see it all over my face that I was stressed, they would be willing to help, but I would at that point be so behind that I would have no idea what they could help me with.

    It gets easier, you just have to learn a few good lessons. Two of them are:

    1) Always, always, ALWAYS help when you are somewhat caught up because if you are caught up, 99% of the time at least one co-worker is not.

    2) Ask for help when you need it. I know few good nurses that can get through a shift without getting help from someone.

    People are very willing to help the one who helps them.

    Just my 2 cents.
  9. by   paalam
    redundancy is a big problem in nursing. it has become nothing but papers. lazy nurses love redundancy it gives them an excuse to make cna's do their jobs. first year out of n school i got 10-15 patients a day.10 in the day for sure and guarantee more than 12 at nite.

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