I work on a med/surg unit where the normal ratio is 1:6. For the last several months it has been 1:7 (due to low census) with only 2 nurses on the unit. We have 2 CNA's for 14 pts and a secretary that only works half the day (unless she takes PTO then they staff no secretary). On this particular day in hell 5 of my 7 pts were on isolation precautions for MRSA/VRE and 1 on droplet precations for meningitis. One patient had an anoxic brain injury and showed no real signs of life besides constantly thrashing herself all over in bed. Her rails were padded with anything imaginable (and had to be repositioned anytime you walked by the room), her legs wrapped from toes to thigh with dressings to prevent any further abrasions and skin tears (which would last about 2 hours). She had a trach and a PEG tube with continuous feedings and a fever I just couldn't get down no matter how many times I alternated Tylenol with motrin. Not to mention the needy family members that rushed me into the room for every cough or grimace. I had another lovely patient that hit, kicked, bit and spit on me, thus forcing me to put him into restraints before he pulled his PICC line out. The doctor comes in the pts room to find me cowering below the pts bed attempting to tighten his restaint as he flails his arm at me and nonchalantly tells me im going to have to put an NGT in him. O_O are you serious? This man? This man that will spit and yell and fight and refuses everything under the sun? I've never cried during a shift, but tears were stinging my eyes at this moment. I called my supervisor the for third time (my prior calls for mercy were ignored) and begged her for help before I lost my mind. She finally came, and with much help from staff (and some haldol) we got the NGT down. During this time I did 2 discharges and also got 2 new transfers. At no time did I get a lunch break, a sip of water, or even a chance to pee. I have only been at this job a little over a year and in that period of time 4 nurses have left the unit. I know at their exit interviews they made it very clear that the ratios are unsafe, the acuity is too high, and the managerial support is severely lacking. I do not feel like wasting my breath when they are aware and obviously don't care. Yes, I am in the process of looking for another job, but I really wrote this wondering if this is the norm of hospital nursing? Are there floors and units that staff fairly and actually take pt acuity into consideration? Is there such a thing as a manager being on a unit for more than 5 minutes of the entire day, someone that can see you drowning and will actually take time to help? I don't want to give up on hospital nursing entirely because I love the skills and the new things I constantly learn. Should I find a new hospital or find a new specialty?
