So fed up:( Could use some help:(

[Nikelbee]

Hi All:)

I'm actually not a new poster, I've posted before but not for a while and cannot remember my old log in name so here I am again:)

Anyway, I just really need some words of encouragement, wisdom, advice, anything right now, before I crawl into a corner and literally cry my eyes out.

I've been a nurse for a about three years now. I just started working in a hospital on an oncology/ med-surg floor in June. The hospital is a catholic hospital, and pretty run down to say the least. Most of our patients don't have insurance and are on some type of medical assistance. I'll make a really long story as short as possible here...

About a month after I started the job, it was announced that our "plan of care" was changing to "Primary Nursing". The idea behind primary nursing is that they will give us four per nurse, but take away our nurses aides. The nurses are responsible for EVERYTHING. Vital signs, baths, incontinent changes, accu-checks, medication administration, dressing changes, feeding...etc. What they told us is that the doctors were complaining that patients were getting bed sores, and they think it was because the nurses weren't bathing the patients themselves so obviously werent doing good enough assessments. They then assigned people in the hospital for us to page that would do our labwork and ekgs. Any and everything else the nurses are responsible for. This scared me when I first heard it. I thought, what if one of my patients goes bad? Its hard enough these days as a nurse WITH an aide to get what you need to get done, but now..take my help away?? The best part of it is...they kept our aides on the floor...the aides that dont have to do anything. They are there "if we need some extra help, but are not required at all to do what they were doing before." Needless to say...solitaire has become a popular game:madface: .

It has come to the point to where the aides..and not all of them, we have a few great ones on there, but yes sadly, most of them...love their new position, and I can't blame them. I'd love my job too if I was them.

Now heres the doozy...all the nurses usually have 6 patients. Or for example..last weekend I had SEVEN patients. The aide on the floor refused to do accu checks or vital signs for me stating "I dont have to do them." I called the supervisor and was told later "I can't make her do something shes refusing":angryfire One of my patients passed that day, another was put in restraints...it was just a horrible horrible weekend. My manager addressed the issue that week with the aide telling her that if I have that many patients she must help. But that was only one incident. Never have I had four patients since this plan of care started. Its usually 5-6, most of the time 6. I cannot keep up with my work, my medications are late, the pateints arent getting the care they deserve, the rooms are a mess (housekeeping is a whole other story), trash gets emptied three times a week maybe in patients rooms...I just cant do it, and its not my fault. None of the nurses can do it. Were all so frustrated. And the head of the nursing dept. who thought up this lovely idea stated that if we dont like it, we can walk...how nice

I work a 12 hour shift, at 3 pm alot of the staff leaves. We had a census of 20 patients today. At 3 pm, all that was left was another nurse and I...and one aide. They were about to give both of us 10 patients each. I lost it right then. I said "I am not taking 10 patients, I refuse to take 10 patients, I dont even think that's legal! If I'm givin 10 patients I am walking out of this hospital right now. That is a risk to my license and a risk to these patients." I was FURIOUS. My charge nurse who was also to leave at three was right there with me being as upset as I was. She was making calls everywhere to everyone trying to get answers...noone knew anything or what was going on. She even called the head of the nursing dept who thought up the lovely "primary care" idea....paged her three times. Surprise surprise, no call back. I then told the charge nurse that I wanted to know where the head of nursings office was because I was truly going to go there that second myself and demand support. I was then in the med room with my charge nurse and we were both talking about how upset we were about the situation. She then said to me. "I told the manager of the floor that you are going to leave..she said if you do shes going to report you to the state and get you for abandonment of patients"

Right then it hit me. Shes right, I am abandoning my patients..this isnt their fault. But its a catch 22 here. She was right, but on the other hand I was SO ANGRY that I was threatened..and not offered any type of support. TEN patients?? O and did I mention the other nurse on the floor with me just passed her boards last week and it was her FIRST day on the floor? How is that safe? How can you tell me that youre going to give me ten patients with one aide for the whole floor and think thats okay? They know its unsafe, they know its unfair, they know its dangerous. But after what my charge nurse just told me my manager said ...they know they can do it to me...I cant abandon my patients.

What do I do? I ask because...this WILL happen again, I can guarantee it. How wrong was I? Theres got to be some type of nursing law in PA about a nurse patient ratio. If there is, can anyone tell me exactly where to find it because I'd like to keep a copy handy;) And...if there is a law, and they gave me over the ratio that is legal, and I did walk out because of it..could my license be taken away?

I came home in tears..I am beyond disgusted with what has been going on there the past month and I dont know how much longer I can take it. But I'm not one to just quit...I want to fight...how can they do this to us..how can they do this to the patients..how is that okay? Or ...is it? And if it is..I see why theres such a nursing shortage.

Can anyone please help me with my situation. I'm just so sick of coming home in tears, its truly starting to effect me outside of work. How do I fight this..or can this even be fought?

Thank you so much for listening everyone:( *hugs* I look forward to hearing from you.

[CarVsTree]

Why do nurses stay and put up with this sh**?

You would have not been abandoning your patients by refusing additional patients. Just continue to care for the ones you have and refuse additional. Call the department of health, JCAHO and the BON and report these practices. As long as nurses continue to remain in an abusive relationship, we will be abused.

I take care of 6 patients and the techs have 10 patients. When we are short, the most patients I've ever had are 8 and that was not for a whole shift.

Leave and tell everyone else to do the same. That is ridiculous!!!

[nursingis4me]

Dear nickelbee,

Could you PLEASE tell us what is the name of this hospital (& where it is located) that puts lives in jeaporady? I want to make sure neither myself, my family, or my friends EVER go there-and if anyone I know has a PCP or specialist affliated this disgrace of a hospital, they change docs QUICK!!!!

NURSINGIS4ME

[augigi, CNS]

It would probably be easier to call your board of nursing. Regardless of no patient ratio, there must be some mechanism for nurses to refuse to care for too many patients, or else they could give you 100. I would make sure before I left that I wrote a letter to your employer detailing in writing the concerns regarding patient safety and copied it to the BON.

[gitterbug]

Dear Nickelbee,

You would be abandoning patients, you work 12 hour shifts, so you are picking up, not getting rid of patients. I know how overworked and stressful a situation like this one is. The only thing you can do is report unsafe working conditions to the DON, PBON, and other agencies involved.

You have been fed a line of crap regarding the doctors c/o poor skin care and lack of RN involvement. I have never seen a doctor c/o this in over 25 years unless bugs are actually crawling on patients. I think your DON has decided to institute a new "Primary Nurse Care" role for RN's at your institution, she did not think the whole thing through. I have gone through this same thing 3 times, tell those CNA's that their jobs will be cut next, they cannot justify being on staff, earning a salary, and not doing productive tasks. The sad part of this whole mess is, patients lose by not getting care they need, nurses become too stressed and overworked and quit, and the institution has a big slide in reputation. After a while, someone in administration will be confronted by an angry family, law suit will start to fly, and heads will role.

Do yourself a favor, look for a new position, hopefully one in a new area of nursing, a unit, a clinic, a office, for the Red Cross, or state. Never forget this experience. Never forget to always work where there are "real" CNA's.

When you hand in your notice, smile, do not discuss your reasons, just say a change was necessary for health reasons. You are not required to explain further. Your health will surely suffer if you stay at this job.

Good luck, let us know how all of this turns out.

[RNfromMN, BSN, RN]

Utter insanity...I mean, that's just NUTS:bugeyes: ! Nice CNAs - they just sit and watch?!? Have they heard of "work ethics?" I suppose they think they've "earned" this nice paid vacation, or something. I've worked with nurses that I didn't particularly cared for, nor did I respect, but I always gave them a hand when they needed it. Why? Not only because it's my job (hello!), but because I cared about my pts.

I get (& respect:bowingpur ) that you're not a quitter, & it's very sad that ultimately it's the pts that are going to suffer, but you've gotta think about your license - which it sounds like you've done. You're not going to be able to advocate for anyone if that gets taken away. I know you were looking for support with your post, so forgive me, but I gotta say, it's stories like this that make me terrified of my impending graduation.

Good luck - please keep us posted :)

[Hellllllo Nurse, BSN, RN]

(((((Nikelbee)))))))

No, it is not pt abandonment if you have not taken report and accepted the assignment. Congrats to you for looking elsewhere for a job and for speaking up about the situation at that hospital.

I was worked in a med/surg unit where I got up to 13 pts by myself- no cnas, no unit clerk. I very nearly had a nervous breakdown and should have quit long before i did.

I salute you for speaking up. This helps nurses and pts everywhere.

Here's an old thread here re: abandonment laws.

https://allnurses.com/forums/f8/fyi-abandonment-short-staffing-1857.html

[adamsmom]

Not all CNA's are like that in fact i know a few nurses who are too good to answer bells when all they are doing at the time is sitting and talking about going to a bar. I work night shift and we only have 3 NA's at nite to cover about 70 beds. One nite the one NA got sick the nurse got worried and called and ambulance. As we were only 2 we did rounds did some of there treatments and answered bells while they sat and joked around. I was so upset I was going to talk to the DON but what would that do. It just shows me what kind of nurse I will not be. Any one of those bells could have been a fall or something urgent.

[NRSKarenRN, BSN, RN]

everyone talking amongst themselves, but not will to take a stand is what i perceive as keeping nursing back from advancing as true professional in driver seat of workplace issues. written feedback to management is important to document unsafe staffing issues using professional objective data.

it's due to issues such as this that nursing unions often enter a workplace.... and why pasnap as a nursing union is growing in pa.

great tool to help nurses find a a voice is book: from silence to voice : a must read for every nurse.

it has certainly help me find my voice.

[gitterbug]

Once again something was missed on this board. This nurse was finishing the last 4 hours of a 12 hour shift, she already had a patient assignment, she was picking up patients, in no way did she say she was changing assignments, This nurse had a right to refuse more patients but she could not leave the patients she had been assigned to for the previous 8 hours. This nurse did not indiciate she gave report to any other nurse on her previous patients. There was no one to give report, so how in blazes could she not be abandoning patients?

Sometimes I think I practice on another planet, in a weird facility, that has a door marked "problems" that only my work mates and myself see. I applaud this nurse in attempting to get the help and staffing she needed, I hope she looks for and finds another job with better conditions, but if she would have left she would have abandoned patients. Her license would have been in trouble. Someone, please explain this to me if I have the problem wrong.

[miracle1986]

Turn the hospital in to any agency you can possibly find. It will be shut down. Restraints are illegal in any state.

If you are not in charge of the whole facility....it is not abandonment. But, I would quit immediately- that is if I were to walk out. In fact, I worked skilled nursing..... Ready for this? On afternoons, I had 32 patients and 2 aids. On midnights, I had only 1 aid with the 32 patients. ALL skilled nursing, not personal care. When the union was voted in and mandation began -- I started getting mandated....On my mandated overtime, I then had 2 halls (64 patients) and 2 aids. I lasted 2 days. If I ever had 10 patients I would jump for joy. :yelclap:

[miracle1986]

Unless you are the supervisor in charge of the entire hospital / facility it is not considered abandonment. But, it is a good idea to quit if you are just plain walking out. Into my mandated third shift after and afternoon shift I had previously worked ---I was given 2 halls, 64 patients and 2 aids...I nearly ended up in the E.R. I quit at 4 a.m. with a blood pressure of 160 / 110. never had blood pressure issues before that night. But it nearly killed me to do the work. I was RUNNING to the rooms with no shoes on, my feet hurt so bad. (A dead nurse is of no use to patients). And honestly--it nearly killed me that night. I have been a nurse since 1980. No write ups or med errors ever. And I still have my license. I turned the facility into the state. It is on probation to date.

[RN BSN 2009]

That is awful! NOBODY should have to put up with that treatment!