High patient ratio-that's just the way it is... - page 2

by Hoosiernurse 3,406 Views | 12 Comments

I'm a nurse who is 5 years out now. I've been in tele/med/surg, home care, long term care and cardiopulmonary stepdown...yeah, been looking for my "niche". I started late in nursing and it's a second career for me. I'm 43. 'Nuff... Read More


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    Well, after moving to the new facility, the crapola hit the fan. I wish I had just listened to my gut and left during orientation. That would have been easier to explain later.

    In the new hospital, they had placed so much new technology they hadn't tested that it was a nightmare! Our Iphones don't work and don't hold a charge the whole shift, the computers were having problems, due to the new phone system the fax machines only work half the time and they rely on them for their admission and discharge processes, the phone number list is updated every 2-3 days-which keeps things confusing, and they haven't even rolled out all their "exciting" new features yet. The staff are stressed, frustrated, and OHHHHH, guess what? The six patients per nurse promise was a sham right from the beginning. We are regularly getting 7-8 patients, and our techs are getting 10. The call lights are going off constantly, the techs are nowhere to be found (often we have a full floor of 25 pt with only two techs, so each of them gets ten patients and a nurse ends up doing her own teching for five...)

    People are exhausted and miserable, fighting the great technology and trying to pass all the pills, get all the documentation done, half the time teching for themselves, trying to contact doctors who refuse to leave progress notes or check in with nurses so they know what's going on...the communication breakdown in the hospital is staggering.

    Each shift I work I make errors, small and correctable ordinarily, but I am constantly fighting the urge to cry (like that will help me) or have a panic attack (also not helpful). The feeling that I am drowning is constant, and most often I do not get a lunch because there is no time to manage that. I'm lucky to stay hydrated. The only way we survive is our charge nurse and our unit secretary run from pod to pod (that's what they call our nursing sections...) and try to do our discharges and admissions for us. Their workload is staggering as well.

    Finally, after being offered work at a local nursing home, I gave my notice. I sat down with my manager and told her frankly why things were not working, that I had hoped things would get better when I was out of orientation but they have only gotten worse. We talked about the staffing issues, which she readily agreed were a problem (!) and the problems with the technology not working well and how much harder it made the work day. We talked about being given 7 patients or more to deal with, and they were on tele ruling out CP, post surgical, unstable cardiac issues, total hips, on PCAs, Bumex drips, etc, and how sometimes the tech was so bombarded the nurse was doing it all. We talked about it all, and she asked me if I would stay anyway. I told her there was no way I could do that. She promised staffing will get better, but many things she had no way of promising they would improve.

    In truth, my nerves are shot and I am sick before every shift. I mean stressed and sick to the point of crying and trembling. I have begun to suffer chronic migraines.

    So here comes the part I will probably get picked on for, but I honestly felt I had no other choice:

    I only made it through three shifts of my two-week notice before yesterday happened. I walked in to 7 patients and the zoo that usually ensues. I had a doctor scream at me for not answering a phone that was ringing in the pod when I was trying to pause and get my notes straight and wasn't even HEARING the phone, I was keeping my head barely above water all day, taking until nearly noon to pass AM meds (and I NEVER stopped, not once...I am not the kind of nurse who stands about talking about what they did over the weekend and giggling for a half hour, and then exclaiming that I have no time to finish my work. I NEVER STOP because I am desperately trying to get every detail finished so I can get the heck out on time). It was, as usual, a terrible, suffocating day where I feel my patients aren't getting adequate care, I hardly know anything about any of them but am expected to converse intelligently about them and know every detail about their issues, I am getting their rooms and names confused when talking about them...oh, it's impossible to explain it all. There is so much that goes into every moment in a 12 hour shift that is just overburdened like that.

    Anyway, around 8pm when I was finally finished with documenting, reporting, a bit of wound care I'd forgotten to do, etc. etc. I walked into the breakroom and realized I never want to do that again...that I COULD NOT do it anymore. I felt my license and my sanity were truly at risk. I sat down and jotted a note to my manager, telling her I felt the staffing was too unsafe to continue in this manner any longer, and that I would not be returning for the second week of my two week notice.

    I popped my badge off, and since my manager was gone for the day, I slid my badge and note under her door.

    In a job-unrelated, but relevant to my emotional health sidenote: I checked my personal phone and found out that my grandfather-who was the man I called father and raised me-had died yesterday afternoon. I believe I drove home in a fog after that.

    When I got home, my family was crying and broken about my grandfather. I called in to the supervisor and told her I would not be in to work today due to a death in the family. But I also sent a follow-up email to my manager to tell her I would not be coming back next week, and why.

    Having noticed that my manager is going to be off for a few days on the schedule I have at home, I sent another email to the charge nurse to tell her I will not be back next week. Hell, I may call the staffing manager tonight and let her know, too, just so no one will be able to say they didn't get the emails and I did a "no-call-no-show". I want them to be able to have as much time as possible to get someone to take my shifts. But I simply COULD NOT GO BACK.

    Yes, I know that is not the most professional thing I could have done. Yes, I know this will result in a "will not rehire" situation. It is unsafe, and I am tired of ruining my health being sick over it.

    Currently I am still hired at the nursing home and going to orientation next week. I don't know if they will call my ex-current job to ask anything. I had explained to them in the interview at the nursing home that I was leaving due to staffing problems and technology the hospital doesn't seem to be able to make work well, and that I wanted the calmer pace (ordinarily) of a LTC facility and to be able to connect with the patients better. This is all very true. They don't know I didn't work out the last two weeks at the hospital due to safety concerns, though. Don't know if I should bring that up or just move on.

    All I can say is that this ended badly. I am getting 8 hour shifts in this new job, probably some rough staffing issues like most LTC...but still nothing like the continuous panicky situations in acute care I just left. In the future I will listen to my gut and stop worrying what others will think. It would have saved me a lot of heartache if I had.
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    Quote from HouTx
    OK -
    . The higher-ups and Risk Management / Quality may not know what is going on because your manager may be stonewalling problems so that she gets kudos (bonus?) for running on such a lean labor budget. When the incident reports start poring in, this will change.


    If you get no appropriate response from your manager, take it up the ladder. Talk to HR. Talk to the DON. But be very professional and objective, referring to your own records as needed. At this point, you need to accept the fact that you may need to leave this job. If you do leave, you need to consider reporting the situation to your state's hospital licensing agency and CMS.

    Best of luck to you.


    I was told by other coworkers that there is indeed a bonus because she runs her staffing so lean. It's hard to imagine offering such a thing, when the consequences are so high. Recently there have been several complaints from patients that they are not satisfied with their care. As to how many incidents there have been, I can't say. Our floor is so spread out now that we work in PODS that we barely know other nurses are around unless we walk quite a ways to find them. I have no idea what is happening with the rest of the staff...just my own situation.

    In my exit interview paperwork, I wrote down exactly why I was leaving and it asked for suggestions on how to make the hospital better. I gave plenty of them. So HR is aware. I have also been told I am the third nurse to leave shortly after orientation for these same reasons, in less than a year. Who knows if they will pay any attention? They are so hyped up on their new hospital and all its dysfunctional new equipment, I don't think they listen to anything. They are still staffing the same way as always and people are miserable at work. When they talk to the manager, she tells them to ONLY talk to her, because she says their opinions are TOXIC. Read my post above explaining how it all ended. I guess I am no longer toxic...but what I was most worried about was being toxic to myself and possibly causing harm to my patients.
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    I could cry. This is just insanity. When I was a new nurse, my nurse manager took such good care of me. What is happening to the new nurses is simply criminal. This is just making me want to start 'my' union that much more. Just a word of warning. I had patient safety concerns about the hospital I worked in, worked my way up the ladder and finally to the BON. I was fired. I am a whistleblower and I had to sue the hospital. The states BON did not support me saying that it was not within their jurisdiction. Imagine? Be very careful since you are still new. They will chew you up. I'm an old seasoned nurse so I can handle these evil new breed of management. Mention the word union and they start crying. All of the safety violations and labor law violations are illegal and they are losing federal funding because of the lack of quality of care. It'll get better I hope but its going to be a fight. Be careful and complaints must be done anonymously or you'll be made miserable. Trust me, I know.


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