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

  1. 0
    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 background...

    I've gone back to tele/med-surg now, at a small, rural, community hospital. During the interview I was told sometimes patio ratios could get as high as 1-7, but that wasn't most of the time. I kind of looked surprised, but I needed the job. My home health gig was over because my grandparents I'd been caring for had to enter a nursing home. There are not many jobs in our rural community, so I had to take what I could find. Finances, ya know.

    Six weeks of orientation offered, and I'm in week 4 now. I have had my doubts and reservations all during the process but just tried to stick things out and believe that in time it would be better as I got used to things. I'm not so sure. My preceptor and I have regularly had 7-9 patients to deal with, and so have the other nurses on the floor. Many times they do not have enough techs, or a tech is pulled to another floor and so the nurse has to do primary care. They do usually drop that nurse's patient load to 5-6 when she has to do that job as well as her own, but STILL.

    This is a tele floor with no monitor watcher! Most of the nurses cannot read rhythms. They have ICU as backup to watch our monitor. The computer system is confused, since they are trying to go "all electronic" and some doctors resist this, they are still going back and forth between a lot of chart stuff and some computer stuff. Protocols are sketchy-many times no one seems to know who is supposed to do what (who transfers orders when a patient comes back from surgery?), you don't have a charge nurse or unit secretary on the weekends so you do all of their work too (and being new, I'm lucky to understand what the heck the NURSE is supposed to be doing in this place).

    Bedside nursing has never been something I enjoyed, but I recognized it as a valuable tool to learn a lot, and it's really the only job op I have right now. Many of my other nursing friends who are still in large hospitals are telling me that seeing my coworkers crying in the breakroom due to the patient load is a sign to me that it's a bad work environment and I should get out.

    In two weeks, yes, right as I get out of orientation, we are moving to our new hospital that they just built. Management said they had "high hopes" of our floor becoming more of a stepdown unit once we get settled at the new facility, where we are ACLS certified, titrate meds, and get a monitor watcher. That's great, but they also said they wanted to see us have a max of 6 patients there. That would be more than we should have, in my opinion, if we are doing all those other skills...however, the new schedule came out and it plainly shows our manager is not scheduling to have enough nurses for us to have 6 patients. So, same old same old...they are going to require us to become more highly certified, have higher acuity patients and more duties, and still have 7-9 patients.

    I'm not comfortable with this, but I don't know what to do! I hate the idea of having gone through my orientation and then just going and finding another job! I mean, that will look like crap on my resume, and make it harder on the other nurses on the floor because my leaving with cause them to have to train someone else new for 6 weeks. I have been working in different settings since I graduated, trying to find the right place for me...I've never stayed anywhere longer than 1.5 years. If I leave, I'll have to explain in interviews why I went through orientation at a hospital only to seek another job.

    Financially I had to take this job, we couldn't wait any longer for me to find something because we were sinking. But I feel I may have made a mistake. Maybe I will just have to tough it out for awhile, but I was really hoping to find someplace where I could put my feet down and STAY so my resume wasn't so jumpy. It seems I'm looking for another setting every year or so.

    I don't know...I'm worried about the patient acuity/ratio and potential dangers...


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  2. 12 Comments...

  3. 0
    You are not alone, I now have 17 years of LTC/sub acute experience and after 4 years of it initially I found that I had to seek other avenues to improve myself. I didnt succeed. I was stuck doing a job that repeatedly injured me and made me depressed. I wanted to voyage out and onward thinking I can improve my chances of landing a job that was new and challenging. It didnt happen. Now I am 56 and are just about giving up. I want an office job, I even applied for medical assistant jobs hoping that I can(through the office) get other certifications while I worked. I am overqualified THEY SAY...overqualified????? How is that? If a person is intensely willing and able to perform and improve oneself why wouldnt anyone out there give you a break.????? I find this humilating and discouraging. Being a new nurse is even tougher, you start wondering what did I do? Why did I put myself all through this only to not be able to find work.
    I wouldnt stop myself from bettering myself....if you think of it all down the line, this is your decision and your life...no one will be there to hoist your butt out of a bad nursing job or something that you feel that you can do to get yourself a better posiiton. Unless an angel drops down from heaven above and walks you into a new job, this is the only way.
    You are having second thoughts. you feel guilty now and its unstandable. But its a dog eat dog world out there now with the economy and all and you just have to be a little more self centered now with the help of God you will pull through and determine what is best for you down the line. I have seen Directors of Nursing come into faciltiies and bring their families and friends in to work at the same place....only to find that they werent satisfied and QUIT...to leave the nurses/staff/patients left high and dry without adequate staff. This is very extreme and should be stopped. Its downright evil when these nurses do such a thing, but it happens. Think before you leap and I am sure you will get the right answer to tell you what to do. I wish you the best of luck.
  4. 3
    You only have one license. You can find another job.

    I have long thought that if I were in your situation I would quit and then stand in a public place with a sign stating "This hospital is understaffed and NOT safe"

    It doesn't have to be the way it is.

    Sure I'd look for another job. Lots of employers like to hire nurses.
    malamud69, poppycat, and SoldierNurse22 like this.
  5. 0
    Lots of employers like to hire nurses? Like employers that aren't healthcare employers?? I figured I am pigeon-holed in healthcare.
  6. 3
    I would work in day care, babysit, do private duty in a home with housework included, or work in a store rather than work with such unsafe rastios my license was at risk.
    I haven't had to since being licened but would have.
    MMaeLPN, poppycat, and LTCNS like this.
  7. 4
    Step down is NOT 6 pts and not 6 pts on gtts. Step down has been 4 pts tops in both facilities I worked. They are still fragile and need close monitoring. That is crazy.. I would run.

    7-9 pts, little to no techs, no charge on the weekends or a unit secretary.. Wow
    calivianya, turnforthenurseRN, LTCNS, and 1 other like this.
  8. 0
    Yeah, that's kind of what I thought...but I didn't want to give up on this too easily. Stepdown was four patients in the cardiostepdown I worked in before, too. I can't see how they can ask us to deal with drips on people right from the ICU and give us that many to care for. I'm very worried...
  9. 2
    OK - for sure the OP is in a pickle. My comments are based on the assumption that this is not a unionized environment.

    First - get yourself a personal liability policy.

    Then, investigate to see if your state BON has a 'safe harbor' type process. In TX, this is the formal process that a nurse can use when s/he believes that the assignment is unsafe and could result in a breech of patient safety. The nurse fills out and files this form - facility must follow up appropriately (there is a step by step process). The most important thing - IF something happens, that nurse is pretty much protected from personal liability from things that occurred due to the problem that was identified... not for lapses in judgement, carelessness, etc. If the OPs state does not have this type of process . . .

    Talk to your manager - outlining all of your concerns in a very objective way. Tell her of specific things that have happened, including 'near misses'. Let her know that you are extremely concerned about the impact of staffing on patient safety. Be sure to tell her that you will be looking for work elsewhere rather then jeopardize your job or willingly work in an unsafe manner. Offer to help her with any corrective actions that she can figure out... this may mean scheduling everyone to work at least one OT shift per pay period or something. DO NOT try a 'petition' type approach or other group-based initiative. If you are not in a union environment, this will be interpreted as an effort to initiate an organized labor movement.

    Begin keeping a personal record of all issues and problems that happen due to low staffing along with the nurse-patient ratio for that shift: 'near misses', errors, patient care lapses, family dissatisfaction, etc. Do not include any patient identifiers. Formally report any 'near misses' and errors that occur - using the facility's normal processes. REPORT EVERYTHING. 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.
    MMaeLPN and herring_RN like this.
  10. 0
    I wouldn't worry about the step down unit thing until it actually happens. Maybe they would increase staffing at that time when it actually happens. Do you work night shift or day shift? I do not think 7-9 patients is all that uncommon for that shift.
  11. 0
    I'm day shift, and since I lost posted, things are getting a little better, but not much. We are moving to our new facility on Saturday. I have been told by the manager that there will be a unit secretary on the weekends, too...and instead of leaving at 5, they will stay until 8. That's good. They are making efforts to limit our patient load to 6, but no one even attempts to promise that's going to hold.

    As far as the idea that I report any near misses due to low staffing, I would never be aware of anyone else's near miss. People are very tight lipped about that. I would only know about my own. From what I can see, the nurses have simply adapted to the situation, but are very unhappy about it. I tried speaking to my manager about the situation, but received the brush-off. We get regular "We can deal with any situation, we are NURSES" kind of YADDA YADDA routines to keep everyone feeling like they are somehow disloyal to nursing or their patients if they complain at all. It takes very little to be interpreted as "complaining" or "being negative"...and it is strongly frowned upon. Brother...and yes, I do think there have been worries over the possibility of a union forming, based on what some other nurses have told me.

    I have already begun looking for other work, and I haven't even gotten out of orientation yet. If I find something that I feel is a better situation, I will give my two weeks and explain that a large part of it is the staffing issues. I don't think the situation will ever change, and most nurses there seem to feel it's some kind of "badge of courage" to have made it through, so they don't try to effect much change.

    There are good things about the job, and bad things as well...the bad things are winning right now.

    Thanks everyone....

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