I had another bad night at work last night, and the worst thing about it is that nights like this are beginning to be the norm. Our community hospital became part of a major health system about two years ago, and things have been getting worse ever since. Seems the bottom line is the major motivator for these people. Last night we had seven patients in our ICU, staffed with two RNs with less than six months critical care experience, an LPN, and myself, along with a new orientee who has been with me for only a week. There was another seasoned RN scheduled, but she was given the day off for "low census." My patient was a septic shock with renal failure, CVVH, hourly accuchecks with an insulin drip, PA line, ordered q4h hemodynamics, and multiple other drips. His MAP was never above 55 all night. All of the other patients were high acuity also. There was a cardiogenic shock on an IABP, an active GI bleed, a post arrest and a massive CVA who was seizing. My patient was 1:1 so I was expected to cover the LPN, giving her IV ativan and dilantin for her CVA, calling her docs, and signing off her orders. The other two RNs were so overwhelmed with their own assignments, that they were little help. As a matter of fact, they both came to me several times through the night for help and advise. When I protested about the RN being given off, I was told "Your numbers only call for four people, and you have an orientee who can be an extra pair of hands." So I asked why one of the newer people or the LPN had not been given off instead, I was told that it was Nurse A's turn to be given off. Now the new girls and the LPN think I was complaining about them, and I wasn't. I just thought someone should have used a little common sense and looked at the staffing mix and acuity. I documented my objection to the staffing and assignments and gave a copy to my unit manager and our DON, but I don't think it will do any good. When I talked to my unit manager about the situation, she confided that she was thinking of resigning her position because of problems like these. I have always loved my work, and this hospital, but with the big corporation mentality that has taken over, I don't know how much longer I can continue to work here. The only problem is that the other hospital in our area is part of another corporation, and has similar problems. All I want is to give safe and competent care to my patients, but I feel that I can no longer do this. There are safe staffing laws before the legislature in my state. They can't be passed soon enough, IMO.
