PCC's taking patients

[MrsWampthang, BSN, RN]

So, Ok. I'm the charge in an LTAC last night. We have 23 patients on the regular med/surg floor and 4 patients in the special care unit, two of which I have to be primary care nurse for. In the unit we have patients on monitors, vents, and sometimes drips. This night the patients I had happen to be on the monitor, with vents. One patient is obese, unresponsive and on an NG feeding, the other patient I had is on the vent, monitor, tube feed, and is constantly incontinent of bowel. The other two patients were vent/monitor patients, but no feeding tubes. I made the mistake of letting the other nurse talk me into letting her have the easier patients because she had had them the night before. I felt so inadequate last night. I am the type of charge nurse that likes to be one the floor constantly asking my staff if they need any help, making rounds, making sure everyone has what they need to do their job. I feel like it is my place as charge to be there for the staff if they need something, like if they are overwhelmed and need help with blood draws or whatever. Call me kooky, but being tied up with 2 high acuity patients made me feel like I wasn't stretched thin enough. I went out on the floor to help another nurse draw blood because it was due at 2000, and he was trying to get all his meds passed and his patients taken care of. The nurse that I was working with in the unit wasn't happy about that, but I did what I thought was best. Needless to say, that put me behind taking care of the two patients I had in the unit. So, I don't think I did a good job in either hat I was wearing last night. Sorry to ramble, I guess I am just frustrated and a little more than worried about putting my license on the line everytime I am in charge. Am I out of line for feeling this way? Is this the norm for LTAC charge nurses? The patient load on nights at this facility is usually 7:1 on the floor (a mix of vent patients, patients in restraints due to confusion, and patients that are just there taking up a bed) and 3:1 in the special care unit with most patients being on vents, tube feedings and sometimes drips. I know the staff feels overwhelmed with this load, as do I. Is this the norm with these type of patients? Am I just not a good enough nurse to handle this many patients? I can usually handle about 7 patients, depending on high the patient's acuity is, but throw in patients that are morbidly obese (400+), patients that are constantly on the call light for pain meds, but then the thing is, all I do is do basic patient care. Forget having time to get to know patients, do little things for them that would make them more comfortable. At least on the floor we have CNAs, but in the unit there are none assigned. If the nurse in there has three patients she/he is on their own to turn, bath and change these patients along with doing all the nursing stuff for them. Sorry, I guess I am whining.

Our hospital is supposed to be a rehab hospital but more and more we are getting hospice patients and nursing home patients, (patients that have no potential for rehab). According to what I have been told, the charge nurse isn't supposed to take patients if the total census is 26 or more, but that rule has gone out the window lately. We are losing nurses right and left, we are so short on nights that it is ridiculous, and they won't let any of the day nurses come to nights because they are short on days, although not as much so as on nights, and besides they have a lot of ancillary personel around during the day that are nurses that could pitch in and help, but don't. I guess I am just over it. I am tired of going in and feeling like I'm not doing a good job. Am I just not cut out for this type of patient load? The only reason I have stayed as long as I have and haven't just left and not came back is because the DON is a friend of mine, otherwise I would have left not long after I was hired. I just can't take it anymore. I know every place you go is going to have thier own share of problems, and no place will ever be perfect, but GEEZ!!!! Like I said, am I just being a whiner or is this pretty much the norm for LTAC? On a side note, I will have another job before another month has passed if it kills me. I won't just quit without notice on this job, but I can't take it anymore.

Sorry this is so long, guess I just needed to vent. Thanks for listening.

Pam

[TrudyRN]

I think it sounds bad. Talk to your friend and see what you come up with.