Looking for Advice-New Grad, 8 patients?

  1. 0 Hello,

    I recently interviewed for a position that would be for nights on a med-surg floor. One of the floors may even be telemetry (interviewed for multiple open med-surg positions). I was told that during nights I will have up to 8 patients. I am guessing on busy days it may be even more. Orientation would be for at least 6 weeks (on days) and could be extended if needed. Do you think this can be handled by a new grad? Did anyone else start off with ratios like this? Thoughts? Suggestions? I really value everyone's opinion on this board! Thanks!
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  3. Visit  RNRapunzel1029 profile page

    About RNRapunzel1029

    Joined Mar '08; Posts: 54; Likes: 21.

    25 Comments so far...

  4. Visit  turnforthenurseRN profile page
    0
    I think anything is possible. If you really have an interest for this unit it's doable. They shouldn't expect you to take on a full load of 8 patients on your first day. They should gradually increase your workload and in the last few weeks or so have you up to the full load of 8 patients. And please realize that you will never be alone - you will have your coworkers to help!
  5. Visit  Aurora77 profile page
    0
    I'm a new grad and I've handled up to 7. My charge has been pressured to make us take 8 and she refused to make me take an 8th due to my noob status. I just have to be organized--I make a to do list before I do anything else (unless there's a pt that needs immediate attention). We've also got a very good team vibe on our floor, which I think is essential for taking that many pts.
  6. Visit  tokmom profile page
    1
    Nights may be a bit easier due to pts not coming and going, but eight is a lot.
    Hopefully they aren't really sick. Do you get CNAs?
    turnforthenurseRN likes this.
  7. Visit  westieluv profile page
    11
    Wow. I have been an RN for almost 22 years, have several years of Med/Surg experience, work nights, and no way would I ever work where I had to take eight patients on a regular basis. We get plenty of admissions on the night shift, patients often don't sleep at night, and I wouldn't feel comfortable being responsible for eight patients any time of the day or night. Sorry, but I'm just being honest. In the hospital where I work I usually get five, sometimes six, and there are still plenty of nights when I am too busy to take a break. I'm very organized, it's just that patients are sicker and sicker these days and they have so much going on. Eight patients? Never. I don't think it's about whether you're a new grad or an old hand like me. It's about one person only being able to do so much. Eight patients to be responsible is TOO much, IMHO, even with CNAs to help you.
    Miss Kitty00, Pixiesmom, scottjon, and 8 others like this.
  8. Visit  Eeyore_fan profile page
    1
    For my first job as a new grad, I had usually 4-5 (rarely 6) patients on days.

    For my 2nd job (with now a little over a year of experience), I get 5-6 patients on nights. I work on a tele floor/PCU. A PCU is usually considered a step-down from ICU. Many of the patients are acutely ill, and sometimes I feel like I'm not able to give the care they need. I don't think I could handle 8 patients.
    usmbsn2007 likes this.
  9. Visit  MJB2010 profile page
    1
    Can you talk to other RNS on the unit? Let's be honest, if they tell you 8, that means more than that usually right? My first job we had 10! I did not stay there long. But ask the other nurses, or ask to shadow and see how it goes. Do they all look frazzled, stressed, and close to tears? Are there enough techs and a charge nurse that helps out? Is the floor properly staffed? I'd be a little leary, but I had a bad experience at my first gig.
    nerdynurse00 likes this.
  10. Visit  ashleybancroft profile page
    0
    I say go in there organize yourself, and do the best dam job you can and prove to them that you can do it and you have what it take. You have to start somewhere. One day you will be able to tell the to take a hike.
  11. Visit  mamiekay profile page
    1
    I am curious about where RN's work that they have to take so many patients! I've got a little over 3 1/2 years' experience, I work 12's and I usually have 6 patients at night. Our day RN's never have more than 4, and that's a full day's work! Of course, during the day, that can turn into 6-8 different patients by the time discharges & admits are done, but never more than 4 at a time. There have been a few times at night when I've had to take 7. Six is doable most nights, although there have been more than a few nights where five was impossible. Seven? All it takes is one patient take too long to pee and the whole night gets thrown out of whack. We work with one CNA per 12-15 patients at night, more due to the layout of our floor than to do with actual numbers. I'm sure we'd get fewer if the floor layout would allow for it.

    In any case, fully utilize your preceptors during orientation. Ask the other RN's you'll be working with how they do it. Watch them. Take notes, use your resources and never be afraid to ask for help, even with the simple things. If you do nothing else, open the MAR at the bedside & chart your meds as you give them. Write everything else on your brain sheet so you can chart it accurately later. As you go, you'll learn what YOU need to see and do, and what you can ask someone else to do. Pain meds? Antibiotics? Potty call? Ask your charge or another RN. Wound cares? Probably want to do it yourself so you can see what it looks like, although asking for an extra pair of eyes and/or hands is often a good idea. It won't be easy but you will figure out how to make it work for you. And remember, hospital nursing is a 24-hour job. That doesn't give you license to slough off stuff you don't want to do, but sometimes you just can't get it all done in your shift and do need to pass on some of the work. Good luck!
    Corvette_ZO6_RN likes this.
  12. Visit  Carrie_MTC profile page
    2
    I work nights on a med/surg/telemetry unit. I normally have 6 patients, occasionally 7. I've been working med/surg/telemetry for a year now, and have never had more than 7 patients. Even when I have 6 patients, I often don't get a break or time to go to the bathroom more than once a shift. To me 8 patients is just not safe. How could you possibly have time to accurately assess patients, and do quality charting? I would also ask if there is a charge nurse available to help with IV starts, passing meds, doing admissions, etc.
    Miss Kitty00 and nerdynurse00 like this.
  13. Visit  NewbieNeedsHelp profile page
    2
    I graduated in may and I take 7 on a normal basis...I'm days too... If there's a glitch in the matrix and I have, say 5 patients, I hardly even feel like I'm at work.. So yes it is doable.. Just try to build up ur patient load progressively in orientation. I got to 7 by day 4 and stayed at 7 all 12 weeks of orientation so I got comfortable with such a high number fast...you can too!!! I cried a few times but every day gets better!! I work on a busy tele floor so it's really the admits and DC's that make it hard and not the base number... It's sorta an adrenaline rush running around all day and making it to 715 thinking dang I got everything done, nobody died, my patients are happy, yahhh baby. Lol good luck!
    Skeletor and ktliz like this.
  14. Visit  LLawsor520 profile page
    1
    I agree with you Carrie MTC. I worked at a hospital that did not have magnet status (meaning that there was not a limit to how many patients that were assigned to nurses at any one time). As long as my Medical-Surgical:Renal Unit had vacant rooms, we accepted patients or were threatened with termination. This was an awful experience as a new grad. Because there were so many acutely ill patients on my floor, there was no time for proper lunch breaks or restroom breaks (even though managers tell you to take one during your shift). I constantly had headaches for the lack of breaks and nutrition. I did not learn proper time management until I moved away after working my first 7 months of hospital floor nursing. I felt that I missed out on a lot of my new grad internship due to the business of caring for 8-9 patients. Due to poor time management skills learned from my first nursing job, led to an end to my employment at my second job because I was constantly getting off work 15 to 20 minutes past my shift. Then and there is when I decided to go back to school to gain a BSN in order to find a career in nursing where I had reasonable time to provide patient care and where I felt valued as an RN. Being made to care for 7-8 patients will only lead to negative outcomes for patients and quick burnout for you.
    sweetgeorgia likes this.
  15. Visit  PunkBenRN profile page
    4
    Don't fall into the habit of understanding patient assignments in terms of numbers. Focus more on accuity and appropriateness of patient assignments to determine safety, not merely the number of patients you are responsible for.

    If it was mentioned during the interview, its likely they told you the higher end of pt ratio to gauge your reaction and confidence. 8:1 is a little high, but I have done it before safely. If all 8 patients are stable, A+O, walkie-talkies; it can be done. If 3 are immediate post-op, 2 total cares on contact precautions, 2 demented/ETOH withdrawal, and one who is crashing from a cardiac event - this ratio could be a BIG problem.

    Play it by ear, pay attention to the morale of floor staff. If you are brand new, I am sure (I hope anyway) they will ease you into it and not throw you in a situation that is unsafe. Besides, patients sleep all night anyway so you won't actually be doing a whole lot

    For the haters, I work nights and the above was indeed a joke.
    sweetgeorgia, Skeletor, amarilla, and 1 other like this.


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