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.

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Specializes in Corrections, Cardiac, Hospice.

Honestly, I just don't think 5:1 on a med-surg floor without an aide is either realistic or safe. I bet your hospital figures out very quickly it is going to be easier (and cheaper) to pay for aides rather than RN overtime, or a lawsuit. Yeesh, I really don't know what to tell you. Med-surg patients are sick, sick, sick people. What are they thinking?

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Specializes in tele, oncology.

See those hills over yonder? Run for them.

There have been nights working tele when we've only had one tech for the floor, so we had to do just about everything for the patients (teams of five). Those were the nights that I wanted to rip my hair out and ended up leaving way late. Especially the night that I had three patients on GoLytely at the same time, and no help to clean them up. There's a horror movie in there somewhere.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

You manage your time, never sit down, multi-task and make every step you take up and down the hall count. I had large pockets in all my uniforms to hold all the junk in them so I didn't have to keep running up and down the halls to get stuff. Get a great report sheet to help you organize all the information about the 5 patients so you remember all the things you have to do for them. It is not only about prioritizing, but organizing as well. This is the last report sheet ("brains") I used: 

Report Sheet (2).doc

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Specializes in OB, HH, ADMIN, IC, ED, QI.
daytonite said:
You manage your time, never sit down, multi-task and make every step you take up and down the hall count. I had large pockets in all my uniforms to hold all the junk in them so I didn't have to keep running up and down the halls to get stuff. Get a great report sheet to help you organize all the information about the 5 patients so you remember all the things you have to do for them. It is not only about prioritizing, but organizing as well.

That is great advice, and will help any newby. However (you knew that would come), where is the room for noting things the patient asks for, information you receive from patient/doctor/aux?

I was in the hospital this week for a gi bleed (npo, dehydrated), and asked 4 times (to 4 different nurses) for lip salve/ chapstick/ anything to avoid cracking lips. On my last inpatient day, some great stuff came, and I already finished my ivs and was on clear liquids. Also the clear liquid diet was so salty I could hardly take it, (did anyone notice there wasn't an order for losalt, clear fluids?) since I've been on a losalt diet for 20 years (did they ask?No!) I was told, "You have high bp!" several times. Did I ever get the medication I'd been on for that, for 20 years? No! I came home with bulging les......And a bp of 180/80, a higher read than I've ever had! Of course, I had been stressed from not getting my essential meds and vits (especially iron) while in the hospital........

Thankfully the nurse did get an ice bag for the humongous hematoma from one of the frequent h&h blood draws, though - I had to ask for it, but ladies and gentlemen, they do need to be refilled every now and then......

Where has the polish remover gone? All those adhesive strips and ekg leads do leave their dirty leftovers (if all of them had been removed). I know I've seen them in individual packets, somewhere. Why not have them in the rooms where patients with ivs and ekg leads (or their nurse wishing to give adequate care) will need them, to remove those dirty marks. Comments about the o2 sats being unreliable due to my nail polish might have been avoided, had one nail had the polish removed.......

By the way, now that I've vented, I think you're on the right track staying at the hospital where you did your clinical. You know the best way to get there, where the oparking can be found, and all the little cubbies for supplies. In 6 months, if you can't stand it and have been hired elsewhere, you can always leave. The patient:nurse ratios sound awfully good to me! One of the 2 year nurses who gave me care, said that her "New grad" orientation on nights was 2 weeks, and then she was assigned 10 patients to do herself!

Hit the ground running, don't look back (unless you dropped someone), keep your ethics and rights in mind, and know it will get better! Good luck, and may the sun shine on your back always. 

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Specializes in med/surg, telemetry, IV therapy, mgmt.
lamazeteacher said:
That is great advice, and will help any newby. However (you knew that would come), where is the room for noting things THE PATIENT asks for, information you receive from patient/doctor/aux?

That's why I never sat down. It's all included in the multi-tasking and making every step count.

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Specializes in LTC,Hospice/palliative care,acute care.
Daytonite said:
That's why I never sat down. It's all included in the multi-tasking and making every step count.

;) And never eating or drinking because you won't have time to go to the bathroom...Nursing is a calling -we must all be self-less...Isn't it neat that we even get paid for making the sacrifice? It's such a privilege to care for everyone's sick loved ones and suffer the verbal abuse heaped upon us by the dis-satisfied consumer/customer...Seriously-the last time I did med surg we did team nursing and myself and an RN usually had 10 to even 14 patients and shared usually 2 cna's on the 40 bed floor...The cna's often did the completes we did the set ups as we went around in the am along with our assessment.After that the RN would go chart,I would finish the st ups and do the meds within my scope-she would pick up the rest and then the crap would start to hit the fan and the rest of the shift was a blur.....

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2B_RNin2010 said:
... So how does one nurse and less than half an LPN manage to do total care on 5 patients?

Sheesh. I meant one RN and less than half an LPN. Thanks for not flaming me; I didn't mean it the way it looked when I just read it. :uhoh3:

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Daytonite said:
That's why I never sat down...

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:

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Specializes in Medical-Surgical.

Doesn't sound that bad to me. Wish you luck whatever you decide to do!

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Specializes in Cardiac Telemetry, ED.

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?

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Specializes in Operating Room.
daytonite said:
You manage your time, never sit down, multi-task and make every step you take up and down the hall count. I had large pockets in all my uniforms to hold all the junk in them so I didn't have to keep running up and down the halls to get stuff. Get a great report sheet to help you organize all the information about the 5 patients so you remember all the things you have to do for them. It is not only about prioritizing, but organizing as well.

Well, as a nursing student myself browsing allnurses between studying I find this helpful, yet unsettling . I feel that this is good advice, however, it is setting up the future nurses of society for inevitable burnout. As we know already oodles of nurses leave the field and seek other careers due to working conditions. I don't know, I am not a nurse and am only writing this out of concern and only from things I have heard and not actually experienced. Forgive me but I do not want this as I enter nursing-- I love pt care and everything that comes along with it. But as nurses how are we to give sufficient care to those in need if we can not take care of our own basic needs?

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