I come from a general Med-Surg Ward that accomodates the occasional pedi patient. We used to have a 1:4 patient ratio, and we had the highest patient satisfaction in the hospital. A few months ago, we got a new supervisor who promptly kicked the ratio up to 1:6, saying we weren't real nurses and our patients weren't "real" patients (not that sick), and that we had been sitting on our a**** doing nothing with 4 patients. We were even told we should be grateful weren't getting 8 patients because "that's how it is everywhere else." Anyhow, errors and complaints are on the rise, and everyone is scrambling to get the heck off the unit. I committed a patient safety error by not reassessing a patient post-procedure because I had 4 other patients one with dc orders one transfer out and one admission coming from ER and was still passing meds. I literally couldn't find my charge nurse and everyone else was just as busy. Luckily, the patient was just fine but I got yelled at by the night shift charge and then invited to have a "discussion" with my supervisor. I retorted I had some things to discuss as well and was informed if I was going to complain about the safety of the patient load it would just reflect my inexperience.
Other nurses have questioned the safety of our new load and are always dismissed as having poor time management or "inexperience." The supervisor even states we could have 7-8 patients at once depending on the acuity. However, the time-consuming are treated as exactly the same as observation patients so it never goes the other way with being capped at less.
Before anyone says anything, I realize I should have assessed my post-procedure patient before I did anything else, and I think I would have thought to do it if I hadn't been running around like a chicken with my head cut off. Most of us are brand-new grads, so I feel management should be taking safely concerns seriously but we are being ignored and morale is in the toilet. And did I mention, night shift crucifies us for anything not done on day shift, no matter how small? Thanks for listening.
Dec 3, '11
I am on a med/surg oncology/hospice unit dayshift(for now anyway) we are almost always 6:1 ratio, sometimes we get 7. Safety is a big issue and with the new medicare laws it will impact how hospitals get paid. Do you have councils in your hospital? They are usually the ones to bring this up and does surveys on the different units. You need to know if this supervisor was put on the unit for a reason and who is backing them up on the decisions. We also have a lot of new nurses but I tried to schedule a couple seasoned RN each shift. I am a clinical supervisor so I am always in charge, I tried to do the assignments as fair as I can and if someone is overwhelmed I will take a patient or do meds whatever is needed to make sure the patients are safe. 4:1 would be ideal but California is the only state to pass that law, until then we have to make do.
Get involved in councils if you can, they make the difference and there are usually people in management in these councils so it helps to get to know the people making the decisions.
Don't beat yourself up we all get so busy we don't do everything we are suppose to do.
Dec 3, '11
Your manager is an a$$.
Not every hospital runs like this. We staff at 4:1 and go up to 5:1. It's a med/surg tele floor.
With that ratio of 6:1, does that include CNA's? Do you do your own admits and discharges? Our nurses have me as a charge and I do discharges for them. I think they have it pretty good, but even they get crazy busy.
I worked at a hospital that ran that high at 6:1 and I burned out. You can't give good care and when it climbs higher at 7 or 8:1, all you can do is run around like a crazed person!