How to give adequate care?

Nurses General Nursing

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I'm finishing my first year of an ADN program and I have a real concern that I just can't seem to figure out. The hospital in which I do my clinicals is the one I most likely want to work in once I graduate, and I want to work Med-Surg.

The thing is, the hospital is in the process of doing away with all the CNAs and PCTs and are supposedly going to reduce the patient-nurse ratio to 5:1. They will be hiring more LPNs, but a floor with 40 beds will have maybe 3. So how does one nurse and less than half an LPN manage to do total care on 5 patients? In school, I do total care on 2 and I can barely manage. I realize I will improve my time management with experience, but 5? Two weeks ago, I had two pts who were confined to bed, could not feed themselves, were incontinent x2, multiple meds -- you get the picture. I like giving patient care! But what if I had five patients like this? By the time I get everyone cleaned up and the beds changed, there would be no time for everyone else. I am sure I don't even have an idea of everything the RN does besides the things I've learned in school so far.

Does anyone have any real-life suggestions? I've been talking to my CI and she says I just have to prioritize. Okaaaaayyyy. How? And if I left off something or "cut corners," how do I live with myself?

Realistically, should I just plan to work elsewhere? I might add that morale on that floor seems to be headed downhill fast. That doesn't have to be me, but they probably know lots of things I don't.

Thank you if you've made it this far and have any suggestions for me.

Virgo_RN said:
If everything is routine and nothing happens to upset the flow, then it's doable. But what happens when a patient starts having problems and you need to call the doc and implement new orders? What happens when one of your five patients suddenly needs your full attention?

My question exactly.

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Specializes in med/surg, telemetry, IV therapy, mgmt.
2B_RNin2010 said:
Frankly, I am just not sure I want that for myself. I love being on the floor at clinicals and taking care of patients. But I am a human being (and not such a young one, at that). I might need to pee, or get a drink of water...:bugeyes:

The time goes by so fast you don't even notice it. It was my daily exercise! Ha! Ha! You find the time to pee. We all laughed about how things would be so much easier if we could just have foleys with leg bags.

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Specializes in med/surg, telemetry, IV therapy, mgmt.
Virgo_RN said:
If everything is routine and nothing happens to upset the flow, then it's doable. But what happens when a patient starts having problems and you need to call the doc and implement new orders? What happens when one of your five patients suddenly needs your full attention?

You give them your full attention. Your coworkers help out. That's why we have teamwork.

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Daytonite said:
The time goes by so fast you don't even notice it. It was my daily exercise! Ha! Ha! You find the time to pee. We all laughed about how things would be so much easier if we could just have foleys with leg bags.

We actually kidded about that in clinicals. I can work up quite a sweat... maybe if I don't get time to have a drink, I won't even need to go to the bathroom.

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I quit my first med-surg job because I was not able to give the care I think my patients deserved.

I rarely went home feeling pride in my work.

I'm not sure how to make a 5:1 ratio with no CNA and maybe no LPN work.

It would be helpful if the floor has round the clock secretarial coverage, an IV team, patient transporters, dietary that delivers trays to the room, and well-located supply rooms. If the turnover is high, then add an admission/discharge nurse and maybe I'll consider working there.

If this floor has these kinds of services and a strong teamwork ethic, then you might succeed.

If everything falls to the nurses, then beware.

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In Canada (at least the province I am in), most hospitals do not have LPN's (known as RPN's) or CNA's (known here as PSW's) to help out. From the hospitals I have done my clinical on, its usually 1:4 on days and 1:6 on nights - total patient care for 1 RN with no assistance from LPN's or CNA's at all

We are expected to do all bed baths, cleaning, personal hygiene, nursing skills, etc for all our patient load (depends on the hospital but med surg is commonly at least 4 patients days and 6 on nights, some hospitals might have higher patient nurse ratios). Usually no IV team, etc either

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RNperdiem said:
I quit my first med-surg job because I was not able to give the care I think my patients deserved.

I rarely went home feeling pride in my work.

I'm not sure how to make a 5:1 ratio with no CNA and maybe no LPN work.

It would be helpful if the floor has round the clock secretarial coverage, an IV team, patient transporters, dietary that delivers trays to the room, and well-located supply rooms. If the turnover is high, then add an admission/discharge nurse and maybe I'll consider working there.

If this floor has these kinds of services and a strong teamwork ethic, then you might succeed.

If everything falls to the nurses, then beware.

Hmmm... good points. There are ward clerks, pt transporters, and dietary brings trays to the floor but not the rooms. No IV teams. Centrally located supply rooms. I am going to be keeping my eyes open. I believe I have a lot to offer but don't want the life sucked out of me.

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RN2B123 said:
In Canada (at least the province I am in), most hospitals do not have LPN's (known as RPN's) or CNA's (known here as PSW's) to help out. From the hospitals I have done my clinical on, its usually 1:4 on days and 1:6 on nights - total patient care for 1 RN with no assistance from LPN's or CNA's at all

We are expected to do all bed baths, cleaning, personal hygiene, nursing skills, etc for all our patient load (depends on the hospital but med surg is commonly at least 4 patients days and 6 on nights, some hospitals might have higher patient nurse ratios). Usually no IV team, etc either

How many pts do you manage as a student? How do you do it? How do you think the nurses fare with this arrangement?

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Specializes in Pain mgmt, PCU.
2B_RNin2010 said:

The thing is, the hospital is in the process of doing away with all the CNAs and PCTs and are supposedly going to reduce the patient-nurse ratio to 5:1. They will be hiring more LPNs, but a floor with 40 beds will have maybe 3. So how does one nurse and less than half an LPN manage to do total care on 5 patients? In school, I do total care on 2 and I can barely manage. I realize I will improve my time management with experience, but 5? Two weeks ago, I had two pts who were confined to bed, could not feed themselves, were incontinent x2, multiple meds -- you get the picture. I like giving patient care! But what if I had five patients like this? By the time I get everyone cleaned up and the beds changed, there would be no time for everyone else. I am sure I don't even have an idea of everything the RN does besides the things I've learned in school so far.

I've had several jobs in the past 4 years due to my DH frequent job changes. At each new hosp I have been given a preceptor to help with the paperwork and the hosp P&P. I started with 1 or 2 pts and worked up to 4 or 5 over a period of a couple of weeks. One would hope that as a new grad you would receive the same orientation but protracted since you do not have 20 years of experience under your belt. Check into the orientation period.

You would be surprised how fast you will give a bedbath in a few months. And the assessment you can do at the same time! Unbelievable. Keep your chin up, pockets full and to do list handy!

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