[belfry]

I work on a med-surg tele floor, ratios 5:1 days, 6:1 nights, with 3 CNA's if we are lucky. We have patients with insulin drips occasionally, and no change in ratio to go along with...

As for the CNA getting the accucheck, why bother as she will just have to hunt down the nurse to tell her what it is and then the nurse has to go adjust the drip, may as well do "one stop shopping" and get it done by myself!

[allele]

I've worked on a step down cardiac surgery unit for a little over 5 years now...we've always taken insulin gtts. It's protocol for them to stay on the gtt for a minimum of three days and post op hearts come out of the CVICU at 24 hours, if not the same day of surgery. It wasn't easy for me at first, but I found my rhythm with them. We also have good CNA staffing and they do ALL blood glucose levels and document them on the insulin gtt flow sheet. I rarely forget to look (although it does happen occasionally) but if a patient is below 100 (we shut off the insulin if <100) or critically low the CNA WILL find me!! Now, looking at your ratios, things may be a little difficult. I'm lucky, 1:3 ratios on days and 1:4 on eves (I work 12 hour days) and 1:5 on nights....whether we have a titratable gtt or not. I'm sure you can handle the insulin gtts, but they really should do something about your ratios....and NOT give you more than one insulin gtt!! I've had to take two gtts a couple of times and even with only three patients it's NOT an easy shift!! Good luck! )

[jackieRN03]

Hi Allele

Thanks for the info. You ratios are better than ours. If we had a 3:1 ratio an insulin gtt would be a piece of cake. What part of the country are you in?

My biggest problem with this whole situation is that the people who decide what the bedside nurse can "handle" does not work at the bedside and probably hasn't in many years. There is no accounting for acuity of patients or for the type of surgery/disease process. They use these formulas to calculate how many nurses needed per shift that are totally inadequate because of the above factors. Administration throws extra money or high differentials at nurses and thinks this will keep patients safer.

[allele]

Originally Posted by jackieRN03

Hi Allele

Thanks for the info. You ratios are better than ours. If we had a 3:1 ratio an insulin gtt would be a piece of cake. What part of the country are you in?

My biggest problem with this whole situation is that the people who decide what the bedside nurse can "handle" does not work at the bedside and probably hasn't in many years. There is no accounting for acuity of patients or for the type of surgery/disease process. They use these formulas to calculate how many nurses needed per shift that are totally inadequate because of the above factors. Administration throws extra money or high differentials at nurses and thinks this will keep patients safer.

I have to agree with you. The people who get to decide how many patients we can take care of are pretty far removed from reality sometimes. I know I'm lucky where I am...I've worked in a few hospitals through some agency work I did and my full time job certainly has the best ratios I've seen. I'm in the Northeast, if you'd like more specific information I can PM you if you'd like. Good luck with your situation!

[papersacknurse]

I recently left a telemetry floor and the nurse patient ration on a good day usually was 1-6, there were days when I had 7 and sometimes I might get 8 patients. Our floor never counted insulin drips as 2. If a patient was on a cardiac drip the most patient a nurse could have was five. And thats not counting the accuity level. It was constant stress on that floor. And to me I still consider myself a new nurse just having passed the state board last year. So I have only been a nurse for one year and came out of orientation with 6 patients and have been charge nurse at least 3 times. Last month a patient died in my care. His blood pressure was low but had been low doing his stay. I didn't remember the BP being low and I didn't recheck it. I only had five patients that day but their accuity was high. One of my patients the physcian had wrote orders for comfort measures only and to be put on a Demerol drip and another patient had a trach that needed constant suctioning and was on tube feeding and when I went to check the residuals I pulled back stool colored contents. So did I lose focus on the low blood pressure prehaps so. The patient died not as result of the low blood pressure, when his history was reviewed the physcian discovered he had a mass on his heart. Do I feel bad, yes because maybe he would have not died that day if I had rechecked his blood pressure and got him to the unit so that he could be stablized. I just know that some hospitals are taking risks when there are too many patients for one nurse to handle. Now I am looking for a new area to work in so that I can feel that I can deliver safe care to patients.

[Nightrn16]

The floor I work on, I've taken care of insulin drips before with a 9 patient load. I work night shift (and I don't care what anyone says, no one sleeps at night) and on the telemetry floor I work on, we titrate cardiziem, heparin, nitro, dopamine, dobutamine, insulin drips, argantroban, amniodarone, ect. I gotta say that it's annoying to just finally sit down from doing like 5 things and then realize it's time for your hourly blood glucose test.

So I get up, go do it, on the way back to the desk, 2 other people call out wanting stuff, or I gotta fix someone else's heparin, or someone is having chest pain that I gotta take care of. I get them fixed, sit down, write all of 2 words then realize that it's time to check the blood sugar again.

On the floor I work on, the patient care people can't take the blood glucoses, only the extern II's can, and at night we only have 1 of those working occasionally. Most of the time we don't even get an aide, so even if the girl is working that can do them, she's not on the hallway I work on.

I think since I've been there (almost 2 yrs .. still a fairly new nurse) I've taken care of about 5 or 6 insulin drips, all in this situation. Insulin drips sadly do not count as two people in our classification system.

I'd give anything to just have a 4 or 5 patient load with an insulin drip lol.

[grace90]

Two nights ago I floated to the cardiac/telemetry floor and had a patient on an insulin drip. This patient's sugar just kept going higher and the drip kept getting titrated higher according to the protocol until he was at 40 units/hour and his sugar was 318. I called the doc at that point, had him made npo, and got the drip rate decreased to 20 units/hour. I also discovered at that point someone had been bringing him Sprite. He was a patient I was covering for an LPN, and had taken over midshift at 7 pm. He was getting hourly fingersticks and I was having to hunt down the PCA each time to make sure it was done and find out what it was. The LPN, rightly so, wasn't having anything to do with the drip. But I had 4 primary patients of my own, 3 of which I barely saw because the 4th one was having some issues of her own. I was almost literally running between those two rooms. Any wonder I was in tears by 9 pm. Oh, and they don't decrease our patient load at all when we have an insulin drip.

[Dieselmota]

Originally Posted by telehead

We do insulin drips on our tele floor and I believe the plan is to move to the tight controls in the near future, but that's not why I called.

We had a situation about a month or so ago. she found a puddle of insulin on the floor be the bed... The nurse never connected the drip to the patient...

HAHA Telehead! That is a very literal "Insulin drips on the Floor!"

[tinderbox]

On the tele floor that I work on, we have patients on insulin drips ALL the time. OUr max patient load is 4. It can be very time-consuming sometimes but if the blood sugars stay consistent, sometimes it's not that bad cuz then you end up checking every other hour instead of every hour. These patients are definitely taken into consideration when charge nurse is figuring out assignments/acuities/pt load.

[lmnurse]

I agree I have worked on a step down telemetry unit and they have attempted to send us patients on insulin gtts and if you have 6 patient and only 2 techs per 22 patients doing hourly FSBS is not very feasible especially if you recieve a new admit or if someone else on the floor is not doing well with BP or anything else for that matter. I think the patients on insulin gtts should be kept where the nurse to patient ratio is lower. Also I know that in one of the hospitals that I work in they have started the new insulin protocols where they want the BS to be less than 130 and anything above that they recieve insulin where before they did not recieve insulin unless the BS was below 150 and maybe 200.