Question: In your postpartum unit, what is the usual staffing ratio? We try not to staff more than 1:6, sometimes with a tech, sometimes without. We also put in all our own orders and juggle the phone as well (no secretary). It's usually not too much of a problem...
Until lately. I am a fairly new nurse, a little over a year out of school, and *I believe* I prioritize my time quite well. I combine trips to the supply room and such like that, but I still spend much of my time running from room to room b/c I've got this one asking for something and I'll sit down and chart all of two words and here's somebody else wanting something. So after I've done that then say that there's this patient in L&D that they're about to section (hopefully not stat...) and they need a circulator b/c there's umpteen other patients on the back that need watching. So somebody (sometimes the house nursing supervisor) listens for my call bell while I'm in the OR and then recovering my patient (all together a 2 hour distraction, more often than not). Or, I'll be on the code team and get called away to a code while I've got six patients on the floor and I'm the only nurse out there -- our unit is designed so that L&D, PP, and Nsy are all huddled together so we can float back and forth, but still! I was in a code the other day for nearly an hour and a half!!
My BP goes up just after reading that.
**And then I think: My God, what if one of my patients (who I'm ultimately responsible for) had started to PPH on me? Or a PIH'er starts seizing? Or if something really bad comes in and we have to crash section?**
Then I get back to *my* patients (and I don't really like terms like that b/c they're supposed to be *our* patients, like a team, but I don't often end up on the receiving end of our unit's "teamwork" -- we pull together in a true crisis and function well, but that's almost the only time it happens) and they're all wanting this that or the other. I try to make "pain rounds" twice a shift (8 hr shift) when I'm making rounds for assessments and vital signs (if I don't have a tech.) so that I can get everybody medicated so that I can sit and chart in relative peace for two consecutive minutes.
And some days it takes two hours after my relief comes in to finish my charting - and it's not *just* me -- there are other nurses who have been there far longer than I have that have problems like mine.
And often, the nurse that relieves me comes in griping about this and that that she finds hasn't been done, simply b/c I did not have the help or the time or I've prioritized it so low that it just didn't get done (like taking trash out of the rooms for instance -- I don't like rooms full of trash and I usually go around with a trash bag and collect, but some days it's just not realistic.) But at the same time, I *know* I've done my very best to get what I've got done, and my patients are all alive and comfortable (the *most* important thing, right??)
And then my nurse manager will target me for having so much overtime. I like a big check as much as anyone, but most days after running around like I do, I'm *ready* to be out the door as soon as I can possibly get out. And I tell her so. She's even followed me around for a shift to see what *I'm* doing wrong.
And wouldn't you know it, that day turned out to be an easy day, with a low census and nothing going on in L&D (we deliver around 600/year btw..we're rural) and she basically had no suggestions for me. And ever since then, it's this major stressor for me, trying to get out semi-on-time. My immediate supervisor can be very inflexible at times; she's a control freak...common knowledge at my facility.
And, my DON seems to be one of those people that doesn't want to hear about -- or recognize -- problems, they only want to hear how wonderful everything is. I don't know her all that well, but this is the opinion I've formed in the few dealings I've had with her (she's fairly new.)
So, I determined that one of the medications I'm on (an antidepressant) was not working for me anymore, and I've gotten that changed and we've all noticed a change in my general demeanor. I started taking better care of myself -- I had lost about twenty pounds w/o trying and while I can definitely stand to lose the weight, it just seems like a lot to lose w/o trying. My best friend (also an RN) says I need to quit and find another hospital with "adequate" staffing.
So, what is adequate?
The worst part of all is I *like* my job. I like most of the patients (hey, you can't love everybody), the doctors are fabulous (with the exception of one that none of us like), it's a very short drive from my home, and the pay is decent. I really like most of the people I work with, and sometimes stay over (off the clock, of course) just to chat when there's nothing going on.
Please, I welcome any suggestions (and criticism) for my problem. Like I said, I'm taking better care of myself than I had been and we got my medication straightened out, so it doesn't seem completely hopeless (as it did at one point and I was very, *very* depressed), but I am always trying to improve my -- and my patients' -- situation. And, thanks for letting a frustrated nurse vent.
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