Nurscee's Freaking Out! - page 3

Help! I've only been a nurse for a month and a half. Last two nights I've worked 12 hours (supposed to be 8) that's not the big deal though. First I had 7 patients alone....won't even go into the... Read More

  1. by   SmilingBluEyes
    I agree; nurses accepting unsafe and dangerous staffing levels are NOT doing ANY of the rest of us favors. We need to quit martyring ourselves. Hopefully, the OP sees this. I think, instinctively, she knows this already. GOOD LUCK!


    And I in no way meant to attack SaskNurse....If my post is seen that way, may I know apologize.
  2. by   SmilingBluEyes
    Quote from saskrn
    I gave good care, but worked like a dog to do it. You don't "know" that cannot be, that is your opinion. You don't know me, you have never worked beside me, don't judge me.
    I am not attacking you, believe me. I am sorry you feel attacked!

    Still, I can't believe 13 med-surg patients got truly comprehensive total cares from one nurse. I have worked in med-surg (floating)----- no way could they all get what they needed from me as one person. We did team nursing (1 RN, 1 LPN, 1 CNA) per 8-10 med-surg patients, and could barely meet all needs THAT WAY. They are sicker than ever, many now would have been in ICU 15 years ago, what with their mulitple system failures....... Most need multiple med passes (some as many as 6 or 8 meds per pass! and many of these meds like, dig, required assessments PRIOR to giving). Add to that bedbaths, feeding assists, incontinence care, etc. We worked like dogs to get this much done with the team we had. Forget it if we got new admits or other crises like CODES-----omg there went the whole system.

    How could anyone keep up as ONE person for 13 of these sorts of patients? Truly, I have to ask, cause I can't see it. I repeat, I would not want to be a patient in that sort of staffing matrix. It's dangerous. Again, I am NOT putting YOU down, just the lack of adequate staffing.
    Last edit by SmilingBluEyes on Feb 13, '05
  3. by   pickledpepperRN
    Quote from stevielynn
    IMustBeCrazy - great post.

    No one is attacking - we are all just being honest that 13 patients, in our opinion, is too many, even as a seasoned nurse.

    And you can't say you don't have a choice. We aren't indentured slaves. We are professional Registered Nurses and can say no to unsafe staffing. No one forces us to take these assignments.

    steph
    Well said!

    For the sake of simple math I am using an assignment of 12 patients.

    Would you agree that a head to toe assessment requires at least five minutes?
    If so for 12 patients and ZERO interruptions you have used two hours.

    How about checking each chart? Orders, progress noted, read the H&P atcetera? Checking lab results? IF 5 minutes per patient is all this takes you spent another two hours.

    Medication administration including checking the order, MAR, and patients band. Crushing some, getting juice and a straw for another, explaining to another why he needs this medication, being sure the patient on lasix is getting the K+ checked and so on. Five minutes per patient twice a shift = four hours.

    Baths - 5 minutes each = 2 hours
    Charting 5 minutes - 5 minutes = 2 hours.

    This is 12 hours. If you work 8 hours you cannot do it at all.

    If 12 where was the teaching? Did a doctor or family member call? Did a patient need an intervention, PRN medication, treatments (dressing change, NG or Foley insertion), pre op instructions and checklist? How long did that take? Oops! impossible.
    Was an abnormal lab result missed. Did you take time to evaluate the care plan? Medical orders? Listen to your patients?

    Did you take a meal and rest break?

    It is no wonder so many new nurses leave the bedside in the first couple years.
    We need role models to show how to avoid harming patients by not accepting an unsafe assignment
  4. by   RN4NICU
    Quote from spacenurse
    Well said!

    For the sake of simple math I am using an assignment of 12 patients.

    Would you agree that a head to toe assessment requires at least five minutes?
    If so for 12 patients and ZERO interruptions you have used two hours.

    How about checking each chart? Orders, progress noted, read the H&P atcetera? Checking lab results? IF 5 minutes per patient is all this takes you spent another two hours.

    Medication administration including checking the order, MAR, and patients band. Crushing some, getting juice and a straw for another, explaining to another why he needs this medication, being sure the patient on lasix is getting the K+ checked and so on. Five minutes per patient twice a shift = four hours.

    Baths - 5 minutes each = 2 hours
    Charting 5 minutes - 5 minutes = 2 hours.

    This is 12 hours. If you work 8 hours you cannot do it at all.

    If 12 where was the teaching? Did a doctor or family member call? Did a patient need an intervention, PRN medication, treatments (dressing change, NG or Foley insertion), pre op instructions and checklist? How long did that take? Oops! impossible.
    Was an abnormal lab result missed. Did you take time to evaluate the care plan? Medical orders? Listen to your patients?

    Did you take a meal and rest break?

    It is no wonder so many new nurses leave the bedside in the first couple years.
    We need role models to show how to avoid harming patients by not accepting an unsafe assignment
    Not to intrude on this discussion, but the math here is driving me crazy

    a 5 minute task on each patient X 12 patients is 60 total minutes
    That is one hour not two.


    Carry on
  5. by   saskrn
    Ok, I give up. I am a horrible nurse, with a huge ego. Is everyone happy now? I was only stating what I have experienced. If I am going to be condemned for it, I will not make the mistake of posting again. I'm done here. Tear me apart, as you see fit.

    To the OP, please note that the world of nursing is not a perfect 5 or 6 to 1 ratio. Good luck to you.
  6. by   begalli
    Quote from saskrn

    There are plenty of facilities in the US right now that have larger ratios than 7.
    Just because there "are" doesn't make it right. In fact, it's very very wrong!

    I don't want it to seem that you are being ganged up on, or that your abilities are being questioned, but I have to agree that I would not want to be anywhere near a place that operates like this.
  7. by   SmilingBluEyes
    Quote from saskrn
    Ok, I give up. I am a horrible nurse, with a huge ego. Is everyone happy now? I was only stating what I have experienced. If I am going to be condemned for it, I will not make the mistake of posting again. I'm done here. Tear me apart, as you see fit.

    To the OP, please note that the world of nursing is not a perfect 5 or 6 to 1 ratio. Good luck to you.
    why so defensive? not ONE nurse here attacked you personally. I agree with those who say just cause it is DONE, does not make it safe OR right. One place allowing 13 patients to 1 nurse ratios compromises safety all over, really. It's not about you.
  8. by   steelcityrn
    Just remember, no matter what the cirumstance, its your license on the line. You will not win if you tell them you "freaked out". They can look at the other nurses with the nine patients and use it as a comparison. I feel for ya, its a very hard job. Alot of ppl are going into nursing because they see these $$$$$$$ signs, but let me tell you, its not for everyone.
  9. by   pickledpepperRN
    Quote from RN4NICU
    Not to intrude on this discussion, but the math here is driving me crazy

    a 5 minute task on each patient X 12 patients is 60 total minutes
    That is one hour not two.


    Carry on
    Yor are correct. I was wrong. :imbar

    I was carried away with the impossibility of being in many places at once.

    I know back when I was assigned 12 patients I could NOT do a complete assessment. Some nights there was NEVER a moment without a call light on. Sometimes every room had the light on!
    Charting was begun after the day shift had taken report.

    One patient was clearly deteriorating so I called all the doctors, got RT, x-ray, lab, there. Wrote telephone orders, started drips, helped intubate and then was told to transport the patient to ICU while the bed was being cleaned because my new admit from the ER was waiting.
    Thank heaven the supervisor took the patient to ICU because medications were late, a patient had pulled out his Foley, another c/o pain, one needed the bedpan, and another help up to the commode. How can any nurse devote 1/2 hour to saving a life and simultaneously care for 11 or 12 other patients?

    I apologize for my error.
    Still IF these can be done in 5 minutes times 12 that would be ONE hour for assessments and ONE hour to check charts and labs. That is TWO hours before any nursing care is provided.
    That is not how we work. We run around doing the best we can. We try to do it all.
    That is impossible!
  10. by   IMustBeCrazy
    Saskrn, I don't think anyone here believes you're a horrid nurse. I believe I said you are probably a very good person. But you also have to be open to constructive criticism in order to continually learn and improve upon your practice. That is what I meant by ego. You have to be able to look past any potential hurt feelings to see the bigger picture and the spirit in which advice is being given. And you have to be assertive enough to take a stand for your own safety and the welfare of your patients. Even when that means walking away from unsafe ratios.

    Peace.
    Last edit by IMustBeCrazy on Feb 13, '05
  11. by   Spidey's mom
    Saskrn - No one is tearing you apart. Really.

    There was a time that for awhile I had 10 patients off and on and I did it but to do something like that on a consistent basis is not good for the patients or the nurse. That's all we are saying.

    We are also trying to advise the OP to not put up with unsafe situations and that is the real subject here .. .not that you were able to care for 13 patients. Day after day of 13 patients would soon burn the best nurse out.

    A new nurse needs to realize something that is not taught in school and that is to stand up for themselves. And their patients.

    We appreciate your input - take a deep breath and stick around. Remember that words on a computer screen can take on a life of their own without that being the intent of the writer. No one intended to attack you. It is just . . . 13 patients whew!!

    steph
  12. by   pickledpepperRN
    Quote from saskrn
    I don't want to come off as being cold, but when I graduated, I was able to do total care on 13 acute patients. Is seven bad?

    If you're having a hard time, I think you should definitely speak with your manager. It is part of professional responsibility and accountability, IMHO.

    Hang in there, you'll be ok!
    We once had a DON who said, "I have been in management for 12 years. I know I was able to care for 12 patients."
    She agreed to shadow a nurse for four hours. She did this three times in one month.

    Her response? "I understand what you mean. These patients are much more acute than the patients were 12 years ago."

    She was a grest leader. I wish she had stayed. The patients a nursing staff at her current hospital are fortunate.
  13. by   Tweety
    The most patients I ever had to care for at one time was 11. It was to be from 7 to 11 only and then help was to arrive at 11p. I had six months experience at this time. One patient decided to have an MI at this time, everyone had needs, need for toileting meds, etc. It was a nightmare. The 11pm nurse came on and there were patients in my assignment I hadn't seen. I gave her report on patients I hadn't assessed "they could be dead in there for all I know".

    The unit I work on now used to routinely give 9 to 10 patients with a nurse and a tech. It was exhausting, but I did it. Now the ratio is 8:1, I don't sit back in gratitude and say "well I used to to 10". I still struggle with 8.

    Ratios matter.

    Spacenurse more power to you if you can spend only five minutes a patient, more power to you if you can chart in five minutes. LOL

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