Working w/o Techs and Secretaries

[KalipsoRed]

So I'm working on a telemetry unit at a decent sized hospital. We have about 22 beds on our floor. Normally we have a 4 or 5 to 1 ratio of patients to nurse. During my entire 12 week training period we always had a secretary and a nurse aid/tech. I have been on my own for 6 weeks now and recently we have started to have low census on my floor. In about 20% of my shifts now I have not had a tech or secretary and one time I was left on the floor by myself with only one other nurse.

I find this very frightening. I can barely do my job when we have a full staff....actually I can only do about 70% of my job when we are fully staffed. I always put the patient first, but my paperwork and computer charting goes by the way side real fast when I start falling behind. On my floor we still do the majority of our charting on paper and have a might complicated DOS program to chart our medications. We also use the same DOS program to put in orders from the physician. Needless to say I am not very good at it even though I went to the 2 day class, mostly because for the last 17 or so weeks that I've worked there I have not had to put in orders due to the fact that the secretary was there to do it. I am also not familar with tech duties and how to chart them. Yes, I know how to give bed baths, take vitals, and change linens. What I don't know how to do is all of that AND pass my meds, change bandages, do assessments, answer the call lights for things like tea, coffee, and snacks, get my charting completed timely and correctly, and check orders.

How do I be a secrtary, tech, and a nurse with 4 or 5 patients?! Plus the fact that I still feel very new at this. I have a lot of questions and I don't know where all my resources are yet. Heck most of the time I don't even know that I need a certian resource until a certian issue comes up.

I've let my manager know my concerns and she explained to me why low census occurs and the book that dictates how much staff is needed for how many patients. I understand that the hospital is, above all else, a business and that those rules are put in place for a reason. She said that she felt like I was doing a great job, but if I felt like the pace was to fast for me she would help me move to a different floor. Honestly I don't think the "pace" will be any slower on a different floor and I know my whole issue about having a lack of resources to go to when staffing is short will not be fixed by moving. Am I lazy because I cannot function without a secretary and a tech at this point? I had a Nurse Practitioner tell me that she use to do total care for 4-5 patients all the time and do nursing duties. On my floor, as with most floors I'm sure, patients can range from pretty self sufficent to incapable of doing any self care at all. Usually you get stuck with a combination...like 1 that can do their own stuff, 2 that need assistance, 2 that need total care.

*Sigh* How bad should I feel about not being able to get all my charting done timely, or mostly forgetting to chart I & Os every time I go to work, or sometimes competely forgetting to do computer charting? How many of you guys out there do secrtary, tech, and nursing duties on a 12 hour day shift? How do you get all the work done? This all makes me feel like a crappy nurse.

[*ac*]

So I'm working on a telemetry unit at a decent sized hospital. We have about 22 beds on our floor. Normally we have a 4 or 5 to 1 ratio of patients to nurse. During my entire 12 week training period we always had a secretary and a nurse aid/tech. I have been on my own for 6 weeks now and recently we have started to have low census on my floor. In about 20% of my shifts now I have not had a tech or secretary and one time I was left on the floor by myself with only one other nurse.

I find this very frightening. I can barely do my job when we have a full staff....actually I can only do about 70% of my job when we are fully staffed. I always put the patient first, but my paperwork and computer charting goes by the way side real fast when I start falling behind. On my floor we still do the majority of our charting on paper and have a might complicated DOS program to chart our medications. We also use the same DOS program to put in orders from the physician. Needless to say I am not very good at it even though I went to the 2 day class, mostly because for the last 17 or so weeks that I've worked there I have not had to put in orders due to the fact that the secretary was there to do it. I am also not familar with tech duties and how to chart them. Yes, I know how to give bed baths, take vitals, and change linens. What I don't know how to do is all of that AND pass my meds, change bandages, do assessments, answer the call lights for things like tea, coffee, and snacks, get my charting completed timely and correctly, and check orders.

How do I be a secrtary, tech, and a nurse with 4 or 5 patients?! Plus the fact that I still feel very new at this. I have a lot of questions and I don't know where all my resources are yet. Heck most of the time I don't even know that I need a certian resource until a certian issue comes up.

I've let my manager know my concerns and she explained to me why low census occurs and the book that dictates how much staff is needed for how many patients. I understand that the hospital is, above all else, a business and that those rules are put in place for a reason. She said that she felt like I was doing a great job, but if I felt like the pace was to fast for me she would help me move to a different floor. Honestly I don't think the "pace" will be any slower on a different floor and I know my whole issue about having a lack of resources to go to when staffing is short will not be fixed by moving. Am I lazy because I cannot function without a secretary and a tech at this point? I had a Nurse Practitioner tell me that she use to do total care for 4-5 patients all the time and do nursing duties. On my floor, as with most floors I'm sure, patients can range from pretty self sufficent to incapable of doing any self care at all. Usually you get stuck with a combination...like 1 that can do their own stuff, 2 that need assistance, 2 that need total care.

*Sigh* How bad should I feel about not being able to get all my charting done timely, or mostly forgetting to chart I & Os every time I go to work, or sometimes competely forgetting to do computer charting? How many of you guys out there do secrtary, tech, and nursing duties on a 12 hour day shift? How do you get all the work done? This all makes me feel like a crappy nurse.

You know what bugs me most about this? The NP saying, "back in the day... we took care 12 patients total care, blah, blah, blah..." Yeah, right, but without half the documentation, cover-your-butt, double checks and paperwork we have to do.

Anyway, I hear ya. This whole economic downturn means we are all working shorter and shorter.

[mama_d, BSN, RN]

I also hate that "I used to do so much more with so much less" stuff. Not very helpful in fixing a flawed system in just reminiscing about the bad ole days.

I also work tele (on nights), on a 25 bed unit. Normal staffing calls for a 5:1 ratio with two techs on when we're full. However, there have been plenty of times where we've been 6:1 with one tech for the whole floor. You just grit your teeth, put the patient first, and let the paperwork slide until you can get it done, even if it means staying after report to catch up. This kind of situation is where being on floor where staff are very supportive of each other is vital. I'm very lucky in that I work with people who don't mind dropping what they're doing to jump in and help turn/clean up each other's patients.

I do have to say that the day shift on my floor would NEVER EVER EVER tolerate having no secretary and no techs...it does not matter how low the census is or what issues people are having, days gets two techs and a secretary AT ALL TIMES. Plus they have a 4:1 patient ratio. Okay, so I'm a little bitter about the fact that nights gets the shaft on my floor...

Don't beat yourself up about getting behind on the charting. When it comes down to it, having a little charting left to do at the end of the shift is not going to hurt the patient, whereas not passing meds on time etc. b/c you're doing your charting instead can.

Is there a way that you can exchange services with the other nurses in regards to putting in orders when you're super busy? Like, "I'll gladly hang your piggyback for you if you'll throw this order in the computer for me since you're so much faster at it"? Not in any way saying to push it off all the time, since you need to learn the system, but maybe in times of urgent need?

Now is the time to let people know what kind of nurse you are; volunteer to help others out without being asked on a consistent basis, even with the little stuff, and you'll be amazed at how much they'll give in return.

As far as forgetting to chart stuff... When I was a fairly new nurse, I had a Word document that I made up with all the things that had to be done before I left at the end of the shift, and ran off several copies of it and checked it off as I went along.

Also, start working hard on those time management skills! I have found that the more stuff I do with my first rounds, the better the rest of my shift goes...you may want to check out my post in this thread describing my routine each shift, it's all the little tricks I've learned to maximize my time management:

https://allnurses.com/forums/f8/new-nurses-considering-quiting-332429-3.html

Hope I was able to help a little, good luck!