How many patients are you assigned? - page 5

I am a graduate practical nurse and our hospital here routinely assigns 5 patients per nurse. The do not have CNA's. I worked the ortho floor during my last practicum weekend and it was pure h***:devil: . The patients were total... Read More

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    I guess I'll jump in here...I am a charge nurse on a 33-bed Ortho. Ward, and I work 7p-7a. I'll second the previous comments on the demanding nature of Orthopedic nursing. Guess its the challenge I enjoy, is why I stay on. As most nurses at our hospital think our ward is 'the ward from ____,' because of the patient population/workload.. I don't think of it this way. We're absolutely busy, the patients can be very demanding-however, I don't allow anyone to abuse my staff or my patients and get away with it- be it patients,families, staff, OR doctors! We treat everyone w/respect and expect the same in kind. I find it a challenge to be charge nurse and expected to take (nearly)a full team,and 'put out fires',and stay on top of things..but I do my best Most nights we are full,and have between 4-5 nurses, and 4 PCA's. Like everywhere else,many nights we have to accept patient's who don't belong on our ward - the most difficult are the alcohol/drug abuse withdrawl patients...Those lot need to have a separate ward unto themselves as they are TIME CONSUMING & a pain in the ___! This is when the nursing humour comes in handy as stress relief!! Yay for the nursing profession!

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  2. 0
    I work as an RN on days shift (7am-730pm) on a 32 bed Orthopaedic unit in NJ. we usually start out with 6-8 patients based on the census and the staff. Ortho is a high turnover. you can discharge several patients in a shift to rehab and can have 10 EMA's (early morning admissons for scheduled elective surgery). the most patients i've had at one time was 12. i feel its crazy and unsafe. i don't feel like i can give good care to my patients with a poor ratio. picture this you have 3 post op day 1 joint replacements with pca's have to give 3 units of blood, 2 patient vomitting all shift and a patient with a new onset of chest pain, and 2 patients need pain meds all at the same time. craziness!! but a normal shift is having 6-10 total all day. wish there was a state mandate for nurse to patient ratios like there are on tele or icu units.
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    RN2b - yes there certainly needs to be a mandate for safer patient/nurse ratio, and it must be made mandatory ACROSS the nation, not just willy-nilly, here and there...I guess it takes losing some folk be they nursing, or patients,before the 'powers that be' will wake up and get their head out of their ___('wallets'...HA-got you)! If they stopped to think about it, hiring adequate amounts of nursing staff, and changing the nurse/patient ratio to SAFER numbers would create the following: 1) safety of patient AND nursing staff, 2) MUCH better quality care would be given, 3) patient satisfaction ratings would rise(ooops, what was I thinking? this should have been placed at #1,as most 'powers that be' usually only care about the 'bottom line' in the end...), 4) retention of staff!!! I've heard this same 'remedy' OVER, and OVER, and OVER again from many different nurses,from my hospital as well as others, and on-line. We nurses really LIKE what we do or we wouldn't continue what we're doing, but for crying out loud, we're SICK of being worked in unsafe environments. I have voiced my concerns to my assist. nurse manager, nurse manager, AND the (coolest)'QueenBee' DON of our hospital. Ok, in case anyone is wondering, yes, I did it with DIPLOMACY & TACT - gets you places quicker I am really personally disappointed that at the end of many shifts (where I was understaffed, and the patient load was maxed)I'm telling myself, ' you didn't give the best care that these folks deserved AND are PAYING for...sure you got the tasks done,answered call lights,helped clean patients up, worked the codes, gave the pain/antiemetics/antibiotic medications as quickly as possible, listened to their complaints,'put out fires', but you could have done it SO much better..so, so, much better...' There have been loads of mornings I leave, feeling pretty good about the job I did. Oh, and to add to this, our facility(as probably MANY others across the nation have done/are doing) made mandatory the cerner hand-held PC's for giving medications... it has saved many errors from occurring(YAY!),but it has loads of 'bugs' to work out, and it lived up to the reputation of, "it won't save time in medication administration."
    So, my friend, its down to this: we'll just have to take a deep breath, square our shoulders , march on, continue to do our very best-like we always do, keep schmoozing w/ other nurses(de-stressing,I call it),and hope things change -soon. We nurses are made of TOUGH STUFF and can GET THINGS DONE!! OOOO-RAHHH!
    NJLaurenRN likes this.
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    what do you mean by hand held PC's? like a palm pilot? out computer system (TDS) is the same system they started in 1987. and we are a fairly large hospital. sure its been upgraded and changes are made about every 2 months, but most of our charting as far as nurses notes go are written with check of going thru the systems and a page for a narrative and the back for am care and I&O's. im interested in what other hospitals do for charting. i know some of the nurses igraduated with are charting only on a computer. we do our fall protocols, med charting, admission assessments, MD orders, pharmacy send mores, central supply send mores, d/c instructions, pt ed, and IV documentation (site location, and IVF) all on the comp. but our shift head to head assesment and narrative is still written. i hate writing. God, it's 2008 my hospital needs to catch up. they said it would cost millions to switch our computer systems and programs...blah blah blah... money money money. we just got rid of our med carts and now use the Pyxsis system for meds and clean utility supplies
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    I work on an ortho unit in a large urban hospital. Our max census is 25 (all single rooms) and we are allowed, with a full house, five RNs during daylight with four nursing assistants and four RNs at night with two nursing assistants. 33% of the time, however, we have 4 RNs/3 NAs and 3RNs/2NAs, respectively. All in all, I think ortho is a breeze. Yeah, it can be difficult on the body (especially if you're not using proper body mechanics), but you don't typically have to worry if sometimes status is going to change in five minutes (ICU) and you often get to see your patients ambulate off of the unit. I often joke that we are drug dealers with retirement plans. Half the battle is administering a patient's Percocet, Vicodin, oxycodone, Oxycontin, morphine, and/or Dilaudid on time. Throw in a little Zofran/Compazine/Reglan (postop) and Flexeril for good measure and, well, you're good.

    The name of the game, if you find ortho challenging, is to make yourself available to the highest bidder. I think it's smart to capitalize on this buyer's market that we nurses find ourselves in. Why destroy your body for $20 an hour when you can travel and make double?
    WindyhillBSN and NJLaurenRN like this.
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    the cerner hand held pc's are (among other things)used for medication administration- you review the patient's medications, scan the medication(s),scan the patient's ID bracelet, then 'sign' that the medication has been given...as I mentioned before, there are 'bugs' in this system which SLOW this process down...arrghhh...All of our charting is done on a c.o.w.(computer on wheels). As far as I know, this hospital has been doing that for a couple of years. I've only been here about a year. I like it, as I don't have to spend SO much time writing all my charting. We get our narcotics and a few other certain medications out of the accudose(similar to pyxis).
    NJLaurenRN likes this.
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    choc- our pyxis has most meds, only a few non common non narcs or expesnisve ones are sent up by pharmacy. the only thing that sucks about it is an order can be put in and unless its a stat u have to wait for a pharmacist to verify it (make sure dosing is proper and no interactions) before it appears as an option to withdraw from the machine. tell me more of ur charting or anyone else hows ur charting done computer vs written. we have c.o.w. as well same system i talked about before though. i worked today out census was low out of a max of 32 beds we only had 14 otho pts. we had 1 NA a charge RN, and 2 staff rn's. we d/c'd 9 pt and got two ER's. out of my 7 pt's i discharged 5 to rehab and then got an ER. so i got flexed off (left early at 4 not 730 and am still being paid, just comes out of my PTO (paid time off)). it was so nice and its such a gorgeous day today. u said you've been on ur floor for about a yr, mee too. are u a new grad? or just new to that hospital? i graduated may06 but took a yr off. was bartending and wanted a break from school before i started my career and became a "grown up" lol. plus i made awesome money. w/b and tell me more about ur charting system
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    awandering- i love my floor. sometimes it can be overwhelming but so can any job or any other floor. ortho is a breeze. the total joint pt's we call healthy pt's cause they need to be prior to surgery and it elective. so all u have to deal with is the typical pain management and administration aof antiemetics. love that "drug dealers with a retirement plan" LOL one of my pt's the other day was getting 4mg of dilaudid IVP Q 3hrs had a spinal infection. he had a great sense of humor and quite a bit of a flirt. he used to say there's my cute little blonde drug pusher and then wink at me. lol so when u said that i remembered my little 85 yr player of a pt...lol...what u said about traveling nursing. i thought about. i have only been a working nurse since 7/10/07 (just had my 1yr anniversry this week...yea i made it). i want to get a bit more experience before i think about that/. i knew someone who did that and said she felt it was tough. the agency she worked for sent her to a numerous amt of hospitals thru jersy. so she had to learn 3 different computer systems and policy's and hospitals. 1 day she would be 15 minutes from her home then the next 2 hrs. and only had 12 hrs notice. she made i think 40 an hr. i currently make 26/hr as a new grad ADN. thinking about going back to school. there are several RN to MSN programs. from an associates degree to MSN thru an excellerated program available online. other schools have a similar prog u get ur BSN and a few of the courses are graduated degree courses that carry over to ur MSN. eventually i want to be one of the suits we all hate. a director of a nursing unit or something then climb the corperate ladder. hey i wouldn't mind being hated by a few staff members if i made $125,000/yr. thanks for ur response fellow drug dealer ttyl
  9. 0
    I'm sorry to hear your staffing is so terrible. I'll tell you, the more I read about this, the luckier I feel. We usually have 5-6 patients, and ALWAYS have someone with us, whether it be a CNA or sometimes even an LPN.
  10. 1
    rn2b - heehee...thanks for the reply. I am new to this facility. I have been an RN for 18 yrs -about 8 yrs in ortho, the rest a compilation of ICU, CCU/step-down, general medical, home health, and cardiac rehab. I like ortho best. keep in touch if you like best wishes to you in your career!
    NJLaurenRN likes this.


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