Frustrated with the floor

anotherone, BSN, RN · Mar 17, 2012

Did you have all ten patients? I would never go back for that a second time. Not every place is THAT bad!

amarilla, RN · Mar 17, 2012

Yes - we start with 7 or 8 and can go to 10+. I started with seven, discharged one, picked up one from another nurse and admitted three. My previous floor started at 5/6 and went to 8+ with only two techs for the whole floor, (hence my departure), but since the patients were much sicker, I'd felt the trade was worth it at the time to get out of there.

Tell me more about these better (or not so bad) places?

SandraCVRN · Mar 17, 2012

Cardiac IMC...4 pts, day or night

sapphire18 · Mar 17, 2012

My first unit, a step-down, would be 2-4 pts on days and 4-5 on nights (6 ONLY if someone called out and it couldn't get covered). ICU- 1-2 day or night.

At my first job, if a pt was sick enough to need a nurse with them to go for a test, then they needed to be in the ICU. If they needed a nurse with them for agitation reasons, we had a centralized nursing team that would send someone with them. If you have 9 other patients, I can't understand them making you travel off the floor with a pt for a test. So that means another nurse is responsible for 18-19 surgical patients while you are gone? What??

DookieMeisterRN · Mar 17, 2012

We never have more than 4 on days and 5 on nights. 10 is just dangerous. I'd invite the wizards who came up with these ratios to come work on the floor with you for a shift.

NeoPediRN · Mar 17, 2012

I'd file with Safe Harbor for that kind of ratio...many post op patients end up needing a close eye for 24 hours because of I/O balance, pain management, and complications...no way you can be effective with 10 patients. Nothing will happen if people don't speak up, and I love my license wayyyy to much to put it at risk night in and night out...so, Safe Harbor it would be for me.

wooh, BSN, RN · Mar 17, 2012

Safe Harbor isn't available in most places. It's do it and risk killing or failing to rescue someone, or don't do it and get fired.

NeoPediRN · Mar 17, 2012

In that case Wooh...oh hi unemployment, it's so nice to see you. And HI intact nursing license, I was worried I wouldn't see you again there for a minute...

wooh, BSN, RN · Mar 17, 2012

It's great when we have the option. For our brothers and sisters that are the sole income for their household with hungry mouths to feed and not a lot of other employment options nearby, it's do it and say a prayer.

NeoPediRN · Mar 17, 2012

Truly, I'm very thankful to have worked in places with (for the most part) appropriate staffing ratios. I honestly don't know what I'd do if it came down to a choice between putting my nursing license in danger day after day risking my future income altogether or keeping my family fed, clothed, and warm for the moment but always having to worry.

RNsRWe, ASN, RN · Mar 17, 2012

Well, thing is, every floor everywhere has its bad nights. Even the ones that are supposed to be lighter loads, lower ratios will still have nights when they're screwed. It's the nature of the beast in nursing, when you work in a State that doesn't have caps on patient loads and/or you don't work in a union shop that has that in the contract. And even then, guess what, it still happens. You can grieve it later, but you've got the patients tonight. You can file complaints later, but you still have to get by...OR, if you're going to refuse the extra patient(s), you risk getting fired OR having someone ELSE have to take an even more insane load because you refused it. Doesn't bode well for your future there.

I did what you described for five years. My best advice is to remember that there really are good nights, although they don't "balance out" the bad ones. I never quite understood that thinking, because after all, the bad nights are just that. And remembering that last week you had two good nights doesn't make tonight's chaos go easier. What it DOES do for you, though, is give you a break now and then so that you can keep going, week after week.

At some point, you either really do get adjusted to this kind of juggling chaos and realize you've been at it for umpteen years, or you find yourself something else, somewhere else....until it kicks in there, too.

The hospital I worked in had gone through phases, swings in staffing when we had weeks of only 5-6 patients each on nights ("oh, yeah, Administration finally gets it, this is how it should be!!") and then after that, weeks of 9-10 patients each ("Jeez, what's wrong with Administration, we can't do this, I'm quitting in the morning!!"). Rinse, repeat. Same nurses. Some leave, most don't, because they've learned that this kind of staffing not only happens everywhere, but as hospitals struggle more and more with low reimbursements and high expenses, the cuts they are going to make will be on things like this. You did "fine" with 8 patients last year, so now 9 is the norm. Nine and no one died or sued? Ok, this year it's 10. And "we promise it's going to get better, we're looking for more nurses (sure) blah blah blah. Whatever it takes to get you through one more night. And the next. And the next.

I'm sorry if this isn't uplifting and encouraging. I'd really like it to be, but instead I'm going for honesty. If you can find something else, somewhere else, where you truly think it'll be better for you, I of course encourage you to take it. Just be aware, what looks good now becomes a victim of cuts later and....rinse, repeat.