[rnin02]

Wow, I would be crying still. That's an impossible shift. I think the most adult patients I have taken has been 8 (maybe, or maybe 7) with at most heparin and cardizem drips, nothing more than that. I would write a letter and send it to everyone above your manger...at my hospital we have directors and then I think above the directors is the CNO, and of course the CEO,etc. Make it known to as many people as possible what happened. And maybe look for a new job too! Good luck.

[Edith123RN]

I'm am so sorry for you I know what that prabably felt like, with my first nursing job in Florida. Except I was floated to a telemetry floor without any telemetry background we had 20 patients (1RN with 1LPN). Get out before it causes permanent damage, take it from me. You just have to beleave there's something better out there. Any hospital that puts a care provider in that kind of situation should be fined and held accountable for suffering they caused you and your patients. Putting you and your patients in danger. Our representatives in Government should also be paying more attention to how "the people" are being treated. Sound's like the hospital had no excuse as to why they didn't get help for you. I guess it would have cost too much. I hope things get better than that. What city and State are You in? Good luck. I wish you well.

[mamason]

that situation is totally unacceptable. Not only is it unfair to you, but, to your patients as well. I left my last job because of the same reason. My philosiphy was....No job is worth losing my license over and I do not want to be responsible for causing injury to a patient because I'm way overloaded with the pt assignment. If this keeps happening, then, I can only suggest that you document, notify the director of nursing, make copies, (one for yourself included) and then start looking for another facility it work at. The problem is, once we start putting up with this type of staffing, then, management will think it's ok to continue to jeapordize pt safety this way. It will only continue to get worse. The last place I worked, I was up to 8 pts . 75% of them were fresh angioplasties with and with out sheaths. It was too scary for me to continue working that way. I now have a job where I usually on get 4-5 pts. Love it!!! I now here that at my previous employer, the nurses are up to 10 pts a piece 3 x a week or more. SO, the cycle just continues, you see?

[kelliegrl]

WOW! I can only reiterate what others have already said. RUN. That is unsafe to the extreme. It puts both the patients and your license in serious danger. I would also write a letter of objection to your immediate supervisor and those above him/her describing the conditions you had to work in and outlining the dangers of it. Attached to that would be my letter of resignation. No one should be expected to work in those conditions.

[KristiePDX]

Holy crap! That sounds like what 1/2 of my load would be.

Always 5 Pt's on nights, consisting of a fair mix of the following:

1-2 post OHS with one on insulin gtt

Two confused-both bed alarms (one on dilt gtt for afib c rvr, and the other chf/pna c gunky lungs and dec O2 sats)

One "needy" dump from a medical floor with "history" of a pace maker or CP that NEVER comes back

And one admit either syncope, or unstable angina c bumped trop (on integ or hep gtt).

This is my life, no joke..........
And maybe one CNA for an entire 76 bed floor (if they are not sitting).

I have had my Noc's from hell, but you had one times two!

[pickledpepperRN]

That is NOT OK!

The people need to know how their lives are engdangered if they are admitted to your hospital until they staff safely.
Would your fellow nurses sign a statement the hospital is responsible for any harm to a patient due to managements unsafe staffing. The licensed nurses need to be able to prove they notified the hospital that this assignment is unsafe. Then the choice is whether to stay and do the best you can or to leave for your mental health.
Perhaps your cardiologist and/or other physicians will sign it too.

On our telemetry unit we use two minimum ratio numbers. Each RN is assigned to five stable patients with continuous cardiac monitoring. A certified nursing assistant is assigned to two RNs on nights for a total of ten patients. There is a monitor tech at all times. When he or she goes on a break the charge nurse or an LVN observes the monitors.
The charge nurse has no direct assignment.

Step down patients are staffed at 1:3 per RN with an LVN to assist two RNs. The LVN can suction and do trach care and such. Each LVN may have six step-down patients or 8 with 3 step-down and 5 telemetry. All patients assigned to an RN. If one patient is step-down the RN may not be assigned more than three patients per our written staffing plan.
Unstable patients include those with nasal bipap or mechanical ventilation, titrated drips, agitation or fall precautions, or potential unstable vital signs. A patient is classified as step down when the direct care RN in consultation with the charge nurse determines the patient is potentially or currently unstable.

We had to use ratio numbers because our management does not understand flexible staffing accirding to the acuity of individual patients.

[KristiePDX]

Spacenurse,

Would my typical assignment be in accordance with the acuity based staffing laws? My facility has yet to comply.

[vamedic4]

Originally Posted by Angie O'Plasty, RN

10 patients on a day shift????

Run, Forrest, RUUUUUUUUUUUUUUUUUUUUUUUNNNNNN!!!

I'm with Angie on this one...find other employment...FAST!!

What you describe is nothing short of criminal on the part of your NM and staffing coordinators. I'm sure it happens to nurses all the time, though...and that's just pathetic.

Kudos to you for not going crazy when everything around you was!!

vamedic4

[pickledpepperRN]

Originally Posted by KristiePDX

Spacenurse,

Would my typical assignment be in accordance with the acuity based staffing laws? My facility has yet to comply.

I think your acuity is high even for a step-down unit. You certainly are not caring for stable telemetry patients! You should never have more than four patients, a momnitor observer, and nursing assistants as needed for each individual patient.

Department of Health Services. Click "Regulations effective January 1, 2004:
http://www.dhs.ca.gov/lnc/NTP/default.htm

OR type in title 22
section 70217

Also title 22
section 70215

http://ccr.oal.ca.gov/linkedslice/de...Action=Welcome

Hospitals shall provide staffing by licensed nurses, within the scope of their licensure in accordance with the following nurse-to-patient ratios. Licensed nurse means a registered nurse, licensed vocational nurse and, in psychiatric units only, a licensed psychiatric technician. Staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system.

No hospital shall assign a licensed nurse to a nursing unit or clinical area unless that hospital determines that the licensed nurse has demonstrated current competence in providing care in that area, and has also received orientation to that hospital's clinical area sufficient to provide competent care to patients in that area. The policies and procedures of the hospital shall contain the hospital's criteria for making this determination.

Licensed nurse-to-patient ratios represent the maximum number of patients that shall be assigned to one licensed nurse at any one time. “Assigned” means the licensed nurse has responsibility for the provision of care to a particular patient within his/her scope of practice. There shall be no averaging of the number of patients and the total number of licensed nurses on the unit during any one shift nor over any period of time. Only licensed nurses providing direct patient care shall be included in the ratios.

Nurse Administrators, Nurse Supervisors, Nurse Managers, and Charge Nurses, and other licensed nurses shall be included in the calculation of the licensed nurse-to-patient ratio only when those licensed nurses are engaged in providing direct patient care. When a Nurse Administrator, Nurse Supervisor, Nurse Manager, Charge Nurse or other licensed nurse is engaged in activities other than direct patient care, that nurse shall not be included in the ratio. Nurse Administrators, Nurse Supervisors, Nurse Managers, and Charge Nurses who have demonstrated current competence to the hospital in providing care on a particular unit may relieve licensed nurses during breaks, meals, and other routine, expected absences from the unit.

The licensed nurse-to-patient ratio in a step-down unit shall be 1:4 or fewer at all times. Commencing January 1, 2008, the licensed nurse-to-patient ratio in a step-down unit shall be 1:3 or fewer at all times. A “step down unit” is defined as a unit which is organized, operated, and maintained to provide for the monitoring and care of patients with moderate or potentially severe physiologic instability requiring technical support but not necessarily artificial life support. Step-down patients are those patients who require less care than intensive care, but more than that which is available from medical/surgical care. “Artificial life support” is defined as a system that uses medical technology to aid, support, or replace a vital function of the body that has been seriously damaged. “Technical support” is defined as specialized equipment and/or personnel providing for invasive monitoring, telemetry, or mechanical ventilation, for the immediate amelioration or remediation of severe pathology.

(10) The licensed nurse-to-patient ratio in a telemetry unit shall be 1:5 or fewer at all times. Commencing January 1, 2008, the licensed nurse-to-patient ratio in a telemetry unit shall be 1:4 or fewer at all times. “Telemetry unit” is defined as a unit organized, operated, and maintained to provide care for and continuous cardiac monitoring of patients in a stable condition, having or suspected of having a cardiac condition or a disease requiring the electronic monitoring, recording, retrieval, and display of cardiac electrical signals. “Telemetry unit” as defined in these regulations does not include fetal monitoring nor fetal surveillance.

n addition to the requirements of subsection (a), the hospital shall implement a patient classification system as defined in Section 70053.2 above for determining nursing care needs of individual patients that reflects the assessment, made by a registered nurse as specified at subsection 70215(a)(1), of patient requirements and provides for shift-by-shift staffing based on those requirements.
The ratios specified in subsection (a) shall constitute the minimum number of registered nurses, licensed vocational nurses, and in the case of psychiatric units, licensed psychiatric technicians, who shall be assigned to direct patient care.
Additional staff in excess of these prescribed ratios, including non-licensed staff, shall be assigned in accordance with the hospital's documented patient classification system for determining nursing care requirements, considering factors that include the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan, the ability for self-care, and the licensure of the personnel required for care. The system developed by the hospital shall include, but not be limited to, the following elements:
(1) Individual patient care requirements.
(2) The patient care delivery system.
(3) Generally accepted standards of nursing practice, as well as elements reflective of the unique nature of the hospital's patient population.

(c) A written staffing plan shall be developed by the administrator of nursing service or a designee, based on patient care needs determined by the patient classification system. The staffing plan shall be developed and implemented for each patient care unit and shall specify patient care requirements and the staffing levels for registered nurses and other licensed and unlicensed personnel. In no case shall the staffing level for licensed nurses fall below the requirements of subsection (a). The plan shall include the following:

(1) Staffing requirements as determined by the patient classification system for each unit, documented on a day-to-day, shift-by-shift basis.

(2) The actual staff and staff mix provided, documented on a day-to-day, shift-by-shift basis.

(3) The variance between required and actual staffing patterns, documented on a day-to-day, shift-by-shift basis.

(d) In addition to the documentation required in subsections (c)(1) through (3) above, the hospital shall keep a record of the actual registered nurse, licensed vocational nurse and licensed psychiatric technician assignments to individual patients by licensure category, documented on a day-to-day, shift-by-shift basis. The hospital shall retain:

(1) The staffing plan required in subsections (c)(1) through (3) for the* time period between licensing surveys, which includes the Consolidated Accreditation and Licensing Survey process, and

(2) The record of the actual registered nurse, licensed vocational nurse and licensed psychiatric technician assignments by licensure category for a minimum of one year.

(e) The reliability of the patient classification system for validating staffing requirements shall be reviewed at least annually by a committee appointed by the nursing administrator to determine whether or not the system accurately measures patient care needs.

(f) At least half of the members of the review committee shall be registered nurses who provide direct patient care.

(g) If the review reveals that adjustments are necessary in the patient classification system in order to assure accuracy in measuring patient care needs, such adjustments must be implemented within thirty (30) days of that determination.

(h) Hospitals shall develop and document a process by which all interested staff may provide input about the patient classification system, the system's required revisions, and the overall staffing plan.

(i) The administrator of nursing services shall not be designated to serve as a charge nurse or to have direct patient care responsibility, except as described in subsection (a) above.

(j) Registered nursing personnel shall:

(1) Assist the administrator of nursing service so that supervision of nursing care occurs on a 24-hour basis.
(2) Provide direct patient care.
(3) Provide clinical supervision and coordination of the care given by licensed vocational nurses and unlicensed nursing personnel.

(k) Each patient care unit shall have a registered nurse assigned, present and responsible for the patient care in the unit on each shift.

[/quote]

[laurenjarrod]

Thank you everyone for your advice. I want to let you know an update on what has happened since then. A few nurses and I went to our CNO's office and told her what happened. We also attended a forum we have quarterly with the president of the hospital. Our CNO was shocked and wanted to "walk in our shoes for a day". I am not sure what will happen when she comes to work with me but I am chosing a day when we have 3 nurses so she can see how it really is. She told us that our nurse to patient ratio should be 5-1, and not 6, 7 or 10-1! Just wanted to give an update. I will post again after she comes to the floor. As far as the president of the hospital he was useless.