Acuity staffing for Oncology

[Testa Rosa, RN]

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 seems we are treated/staffed as if we are a general med/surg floor (with one less pt), yet it feels like we operate like our own ICU in that we manage our most critical pts.

Often you need to be one-on-one with a patient for a large block of time while not being able to round on your other pts. (ie, bedside bone marrow biopsy where the pt was oversedated due to extreme pain and therefore needed close monitoring and narcan is just yesterday's example that comes to mind).

Most of our pts are direct admit, often coming in with intractable pain or severe dehydration, n/v, etc. Also, any one of our pts can have tanking BP's or go septic or bleed out at a drop of a hat. I've just floated to the other med/surg floors a couple of times and it feels like the pts there are more stable--work is just as busy but more manageable, and the stress from constant vigilance less sharp for me.

I love onc and for personal reasons it's where I belong; but I don't think our unit is being staffed with adequate aid/RN coverage for the acuity of pts we are dealing with. Wondering if this is a general trend in all onc units as the orificenal of treatment for oncology has expanded and we treat more aggressively, and admin/staffing has not caught up to the trend....or am I just feeling/seeing things from a newbie's perspective and this is the case in nursing overall? If yes, I question my ability to give safe bedside care.

Thanks!

TR

[Ted]

I see that this is an old topic started about a year ago, but this comment caught my eye:

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.

[ScarryBear,RN]

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.

[mzjennx, BSN, RN]

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?

[BBQvegan]

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.