Acquity of tele patients

[SaltySarcasticSally, LPN, RN]

I'm new to the hospital, started 4 months ago on a Tele floor.

Our ratio is 5:1, from which I have seen here is fairly normal. My question is on aquity and whether or not what our floor takes patient wise is normal.

Example, last weekend my patients consisted of:

1) middle aged patient, chf, DM, relatively new onset a-fib. He was non Tele because he had gone into NSR and was due to be discharged. Half way into my shift, I found he had a HR of 150. STAT EKG revealed afib RVR. Back on Tele, cardizem drip after that.

2) elderly patient requiring bladder scans Q 4, DM, CHF, admitted for esophageal bleeding and had stable afib but was Tele. He was actually my easiest.

3) Deaf patient, uses pen and paper to communicate. So sweet but obviously time consuming. There for hgb of 6, so requiring blood transfusions. Tele due to cardiac hx, also DM. The low hgb was a chronic issue so he was pretty stable otherwise.

4) Middle age patient, both extremities BKA. Stage 4 decubitis, total care, Foley, central line, 4 days post OP. Sugars are crazy, constantly either too high or too low. FVE at the time so had IV lasix and IV ATB. Plus newer onset confusion.

5) elderly pt, 6 days post bowel obstruction and subsequent colostomy. DM and refusing to eat, total care, IV ATB.

3 of those patients on fall alarms, all accu checks.

Normal for a regular Tele floor? I was an LPN for several years prior so not totally green but naive to the hospital so seeking your opinions on this. I feel like I've handled it fairly well so far but having so many sick patients and 2 PCAs if we are lucky, is making me anxious.

I know the nurses on my floor feel the same but most of us have less than 3 years experience so I'm not sure if its that or we are truly getting more than we can handle.. I can't seem to find the time to give the kind of care I want to give when every shift I have at least 3/5 total care, not very stable patients

[Sour Lemon]

That doesn't sound unusual, to me.

[SaltySarcasticSally, LPN, RN]

That doesn't sound unusual, to me.

I figured.....I will need to adjust what I'm currently doing routine wise then to better manage. I just get time sucked by usual 3 heavy patients that I feel like I hardly see my other 2.

[Sour Lemon]

I figured.....I will need to adjust what I'm currently doing routine wise then to better manage. I just get time sucked by usual 3 heavy patients that I feel like I hardly see my other 2.

I love those "forget about 'em" patients as long as they stay "good".

[SaltySarcasticSally, LPN, RN]

I love those "forget about 'em" patients as long as they stay "good".

Lol yes I do too! I've been lucky most shifts those patients mainly have stayed "good" for me but I need to be prepared for when 3 "heavy patients" turn into 5. Most days, it just feels like a literal and figurative **** show. Hoping that changes for me in time.

[Guest374845]

I think "acuity" and "busy" are being used synonymously here. All of your pts sound stable... too sick to be at home but not so sick that they can't be on your floor. They just sound like a lot of work, physical or otherwise.

[kaylee.]

Acuity encompasses all the nursing care required for a giving patient as well their overall stability /instability. Its the hours of nursing work required.

So the stage 4 with complex dressing change and or wound care, yes is part of acuity, max assist with high fall risk, all of it contributes to a patient's acuity.

A well designed acuity system includes all of this...so to the op, this seems like a very heavy load, with 5 on a tele floor...wow. Im in cali so we max at 4, but 5 sounds horrible!

You cant separate busy and acute in black and white terms. Its more global view of the work reqd.

[NuGuyNurse2b]

That sounds like quite a heavy group of patients, but unfortunately it's common for acute care/hospitals to assign them to a single nurse simply because of the division of work. Now add on a sickle cell or two who require dilaudid q3 and you're toast.

[Been there,done that, ASN, RN]

Sounds like a walk in the park.

Delegate, delegate,delegate. Your PCA's should be doing vitals, glucometer checks, and turning and ambulation.

[NuGuyNurse2b]

^ that depends entirely on the amount of PCA's you get. Our floor is lucky to receive 2 aides for a pt load of 30. They always pull because there's a 1:1 somewhere that just started, or the ER is simply overwhelmed and since they are the first line of defense, they get priority staffing.

[rn2015tonow]

I work med-surg specializing in post-surgical patients. This sounds very similar to my assignment that I had Fri, Sat, Sun and very typical for my floor. We are not an actual "tele" floor, but at least one of my patients per shift are on tele and half are on continuous pulse ox/02 monitoring (masimo).

[Julius Seizure]

I'm new to the hospital, started 4 months ago on a Tele floor.

Our ratio is 5:1, from which I have seen here is fairly normal. My question is on aquity and whether or not what our floor takes patient wise is normal.

Dear Salty,

I don't mean this to be petty and critical, but I just thought you might like to know in case you have to write it in an email to a boss or something important like that, and I couldn't tell if it was a typo or just a misspelling: it is "acuity", not "aquity". Again, I don't mean to offend, but I wanted to be helpful. Please disregard if I am out of line!