Acuity staffing for Oncology - page 2

by Testa Rosa, RN

6,310 Views | 15 Comments

Hello! As a new grad on an intense oncology unit where I am seeing experienced nurses overwhelmed by how acute our pts are, I am wondering if this is the general trend on all onc units or it's just unique to my hospital. It... Read More


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    Where I work, we have 16 beds on an our Oncology Med-Surg unit. I have been a nurse for almost three years and have seen our staffing go down down down as the patients get sicker and sicker. I am at the end of my rope. I am ready to go work as a waitress! I have had enough! I cannot effectively take care of patients as they deserve. We are assigned 5 or 6 patients per RN and we almost never have a tech on the floor. We are doing everything at all times. We are lucky if we get a tech. The day shift is usually no better.

    Sunday night two weeks ago, I had an unbelievable patient assignment. I had 5 patients, no CNA. Our charge nurse had 6 patients. Just three nurses were the only staff on our 16 bed unit. I gave 4 chemo drugs to two patients, three units of blood to one of them, multiple IV antibiotics, one was neutropenic. I had a patient receiving tube feedings where all meds were crushed. I had another very confused 90 year old patient with a broken hip. Three of 5 patients were high fall risk. I was so angry when I left work in the morning. It was the last straw.

    The next night, our charge nurse was so busy (we had 3 admits coming all at once at change of shift), she had not seen most of her patients yet at 9:30 pm when our shift started at 7 pm! Well, we heard a loud thump way in the back corner room where a patient fell on the floor. She was naked and had not been seen for hours. We had no tech to help answer call lights. The patient's bed alarm was not working! I was so angry then, too! This job is making me completely frustrated and depressed. I cannot believe I worked so hard to become a nurse for this!!
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    I can't believe the patient safety issues that are created in health care. I work in an outpatient infusion center. Our administration has decided that we can reduce to 1 nurse and a med tech in the infusion area. we have been slow, but it varies from 4-8 patients/day lately. Point is, that it is unsafe to have only one nurse working. When I need someone to double check chemo or blood, I am going to have to call the nurse from the clinic side to help me. If she is doing a new patient assessment, I could have to wait a long time. I was really mad the other day and had a melt down. I hope I don't get fired. I got to work and didn't think we were starting this 1 nurse thing yet. I found out I was working alone, I had 5 chemo infusions and a blood transfusion before noon. They ended up calling in our only pool nurse, thankfully she was available. I would like to find another job, but I live in an area where there is one hospital here and one in the next county. I have worked home health/hospice and oncology for a large portion of my 18 year career, so it's been a long time since working acute care. I love where I live, and I would be very sad if I had to leave the area.
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    I see that this is an old topic started about a year ago, but this comment caught my eye:

    Quote from Testa Rosa, RN
    Onc = ICU w/o Vents! LOL
    Could not agree more!

    It has been about 13 years since I left the hematology/oncology/BMT floor so a lot may very well have changed since then, but that "regular" medical floor took patients from other hospital's ICUs! They were sick, and that was before the chemotherapy was started. Honestly, I have no idea to what extent the acuity is on present-day heme/onc floors, or to how present-day heme/onc floors manage their patients, but I can't image things getting any easier in 13 years. (It seems that the acuity seen on almost any hospital floor is increased throughout recent years.)

    My first seven years of nursing was spent on that heme/onc/BMT floor. In many ways, it was a great experience. There are times when I miss working on that medical unit. Honestly, though, it would take me some time to get up to speed in managing 6 or so patients as ill as they might be on that floor.
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    I work on a 20 bed Onc/Med unit. Our day ratios are RN=1 to 5-7 CNA=1-2 to 20 (the only time we keep our second CNA is when they're not pulled to another short staffed unit). At night we always only have 2 RN's and 1 CNA (which is mainly responsible for bathing patients who are unable to do themselves) Yes our facility believes it's a wonderful idea to wake up pt's in the middle of the night to give them a full bath because after all it was stated to me that "it's night the rest of your patients are sleeping, you can't have that much care to give, you can toilet patients yourself" Which is why I am currently leaving with the other 6 RN's that quit in the last 4 months.
    efiebke likes this.
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    ONS says for oncology acuity 1 RN for 4-6 patients.

    I work on a 20 bed unit. Nights we have 5 nurses and 1 nurse aide.

    Try having active chemo, prn pain meds, pca, nausea, med-surg, jp/drains, pegs, colostomy, combative, confuse, climing oob, tube feeding, trach and restraints patients while being charge. We use to take 6 on nights. Now we take 5 but it is still a lot. I truly think onc nurses should have 4 patients. We should be considered step-down without tele experience. Oncology is a special field that needs detail assessment and monitoring. Our floor takes it all... I just feel bad I don't spend enough time with my cancer patients doing teaching... Oh well. I do my best on night shift.Btw does anyone do PRN chemo on other units while having your own patient load?
    Last edit by mzjennx on Apr 3, '12 : Reason: Extra
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    Our charge nurses have the same patient load as any other nurse, day or night. That's 5 or 6 patients each. Yes, when necessary (not often), we may have to go to ICU to give chemo, even with our own patient load. Just last weekend, our charge nurse on the day shift had her own patient load, but was away at ICU doing complex chemo for a patient. Meanwhile, at change of shift (1855), they were calling a code blue on our unit. She had to try to finish up the chemo quickly and run back to our floor to help out with the code. The patient did not make it. And the day shift nurses were there til 2100 + finishing charting.


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