A unit with one RN alone with patients?

[pickledpepperRN]

I drove a friend for a minor surgical procedure, the drove her home and stayed with her until her husband came home from work.

This unit has several rooms with beds, chairs, call bells etcetera and a ward with beds separated by curtains. There was an RN as the ONLY staff.

She said the patients come in pre op after X-rays are done and blood drawn. They return from recovery until ready to go home.

I asked, "What if someone falls, or even codes?"

She said, "I would yell and the clerk from the other unit would send help."

I think at least an aide who knows CPR and how to use the phone needs to be with her.

Have you experienced a unit like this?

What do you think?

PS: My friend is fine and plans to go to work on Monday.

[canoehead, BSN, RN]

I work an ER at night by myself. It can be horrendous and extremely unsafe. We're gradually putting pressure on TPTB for secretary coverage every night. For extra nursing help the docs do what they can, or the floor helps, or I just give very explicit instructions to the maintenance man (I'm not kidding). EMS is supposed to be able to help, and some of them are excellent, but some take learned helplessness to a whole new level.

For any level of safety you have to have emergency equipment within arms reach at all times, be well experienced, and good at delegating. I have to remember every night to call and report the need for help to my boss, so some responsibility shifts to them. Perhaps some interrupted sleep will make them invest in a minimal level of safety.

I did OB as well in a small hospital where we were alone at night. The difference being I had one patient rather than several, and we always had someone on call, and a supervisor who could jump in and help. There is a world of difference when you know you have backup at the touch of a button.

[Antikigirl, ASN, RN]

I have been to clinics where minor proceedures are done and where pts go to a smaller ward for recovery then home where only one nurse was there. This doesn't seem to be too uncommon. Most has to do with staffing and paying staff to be in there with frequently changing census (or most cases very little census).

Most of these places will not allow an unstable pt to be in that ward for the reason of having only one nurse. If the pt is unstable, they are admitted to a hospital for eval and monitoring. So that is one checks and balances system.

I think another RN nearby would be a good idea instead of a unit clerk though in case of something bad happening, but from those nurses I talk to in those situations...rarely does anything horrid happen, and if it did...they stablize and call 9-11 or call for a team to help (in hospital).

I also see it this way...I worked as the only nurse for a 150 pt ALF. This facility had NO emergency equipment...and through begging and finding good deals on automated defibs...they still didn't find the cost to be worth it (nor another nurse and boy it was needed!). All my code experiences were there, and I have been through many ON MY OWN till 9-11 arrived. Anything could happen with 150 pts over a shift...and I always handled it and got them transported quickly (never lost one pt...the one that did pass was dead for a few hours before I got there ). Now if I could do that, a nurse alone can handle a few stablized minor post op pts :)...

In a perfect world there would be more staff...but as we all know well...it isn't, got to deal with what is given and do your best and hope you can illicit change when needed.

[begalli]

Yes there is a unit like this at my hospital.

This unit is considered an outpatient unit (ambulatory treatment). They take post cardiac cath and IR patients, 23 hour post-ops, and pre-op work-ups who spend the night in anticipation of a very early OR. Used to do infusions but recently that has changed.

Frequently, FREQUENTLY during night shift there is only one RN - no aide - no other unit to call out to for help. This one nurse will take up to 4-5 patients ALONE.

Also, this unit takes pre-op transplant patients. So if in the middle of the night an organ becomes available the patient is admitted through this unit. As a nurse who works in an ICU where transplants come post-op I think this is an absolute shame. The patients are so incredibly terrified pre-op and they do not get the attention they so desperately need because the nurse is so busy with all of the other patients.

When I found out about how this unit works, I was shocked. Management does next to nothing to solve this staffing problem...they leave it to the RN to try to get staff.

One of the biggest problems is the noc RN's don't complain about it. It's just so wrong if you ask me. Some of the 23 hour patients, especially post-op ortho and ob, have major pain issues. How can one nurse deal with all of this?

Another thing about this unit is that it is considered outpatient so it doesn't fall under the protection of the staffing law but it is just as busy if not moreso than a med/surg or surgical floor.

[tridil2000, MSN, RN]

I work an ER at night by myself. It can be horrendous and extremely unsafe. We're gradually putting pressure on TPTB for secretary coverage every night. For extra nursing help the docs do what they can, or the floor helps, or I just give very explicit instructions to the maintenance man (I'm not kidding). EMS is supposed to be able to help, and some of them are excellent, but some take learned helplessness to a whole new level.

For any level of safety you have to have emergency equipment within arms reach at all times, be well experienced, and good at delegating. I have to remember every night to call and report the need for help to my boss, so some responsibility shifts to them. Perhaps some interrupted sleep will make them invest in a minimal level of safety.

I did OB as well in a small hospital where we were alone at night. The difference being I had one patient rather than several, and we always had someone on call, and a supervisor who could jump in and help. There is a world of difference when you know you have backup at the touch of a button.

the maintenance guy?????????????? :angryfire :angryfire this is completely insane! you know that saying, 'if you're not part of the solution, you are part of the problem'... well, you're part of the problem imo putting up with this! you need to document this to several people! your direct boss and the don to start with. put your concerns in writing and yes CALL your manager at home every night! also, you should call your state's health and human serivices dept.

how long have you been an rn and how long have you been working solo????

you can not delegate clinical things to the maintenance guy!!!!!!!!!!!!!

[banditrn]

the maintenance guy?????????????? :angryfire :angryfire this is completely insane! you know that saying, 'if you're not part of the solution, you are part of the problem'... well, you're part of the problem imo putting up with this! you need to document this to several people! your direct boss and the don to start with. put your concerns in writing and yes CALL your manager at home every night! also, you should call your state's health and human serivices dept.

how long have you been an rn and how long have you been working solo????

you can not delegate clinical things to the maintenance guy!!!!!!!!!!!!!

No, but they can answer the phone and wheel people out to their cars, or show an elderly person where the pharmacy is! All of which we've had to do in the post-anesthesia/day surgery unit where I worked, when the SHTF.