Any Peds nurses out there? I have a few ?s to ask...

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Specializes in Pediatrics.

As stated in the thread title, I'm looking to ask a few questions to any peds nurses out there. If you're in NYC, that'd be even better.

I am currently finishing my first year as a pediatric nurse in a hospital in NYC. I didn't start as a peds nurse, I was moved there by chance when some rearranging of units happened and my hospital (I was in Post PACU care before). I have to admit I fell in love with pediatrics and would like to continue doing it, but there's a bit of an issue. The unit I work in is quite small, 16-bed max, and despite the presence of a Peds ER, there is no PICU. We have a very high turn over and there are nights when I have to float elsewhere because there are no kids in the floor at all. The problem I have is that even if there are 2 or 6 kids on the floor, administration still leaves only one RN to run the entire floor whether there are admissions or not, no CNA, no clerk, nothing. Just one RN. Every night I am alone I am terrified one kid may go south on me while I'm taking care of another, leaving me with absolutely no clue what to do because I obviously cannot split myself in three. The fact that there is no PICU is even scarier, because if something like that were to happen, it's the adult ICU doctors who have to come in to stabilize the kid for transport, and while they are highly skilled and trained, it's still just not the same.

Now my question is. Who can I go to to present my concerns? I fill out an unsafe staffing paper every single night, but it seems like nothing is done. The managers even act like I inconvenience them by asking for help. I work almost every night with no break time because even when I have help, it's usually a CNA, and while I greatly appreciate any help I can get, I just cannot go off on break and leave the floor to the CNA to handle. What can I do? Does this happen anywhere else? Particularly in other NYC pediatric hospitals? I don't want to go to work every night being afraid a child my crash on me while I'm busy with someone else. A human life is precious and my RN license didn't come in a cracker jack box....

Please help???

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Specializes in Gerontological, cardiac, med-surg, peds.

Do you have a union that could become involved?

Take it up the chain of command. If not satisfied with responses on the lower level, take it all the way up to the medical director, if need be.

If this doesn't work, then quit. What you describe is clearly unsafe, not only for your precious patients, but also for your license.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

if you fill out unsafe staffing papers every night does that mean you are union? i'd contact the union if you are i'd contact the nysna...http://www.nysna.org/ . http://www.nysna.org/practice/staffing/intro.htm.

www.nysna.org/images/pdfs/practice/staffing/safe_rn_staffing.pdf

nurses everywhere rank staffing as their biggest problem. research shows it is a problem – for patients: insufficient nurse staffing is linked with poorer patient outcomes, lengthened hospital stays and increased chance of patient death.

http://www.safestaffingsaveslives.org/ is the ana national campagain.

rn safe staffing act re-introduced in congress

the rn safe staffing act (s. 58/h.r. 876) was re-introduced for the 2011-12 session of congress. it would require hospitals that participate in medicare to implement staffing plans, established by a committee comprised by a majority of direct-care nurses, for each nursing unit and shift. read more...

you can also report them to fair wage and labor for not providing breaks and relief as required by law.

http://www.dol.gov/dol/topic/workhours/breaks.htm but also check labor laws for your state.

i would take it up the chain of command as well.....but remember if you make enough waves be prepared to get dumped out of the boat.....hospitals are notorious for this and are excellent information manipulators. what you are describing is truly unsafe. you can't be left alone with patients....if something goes worng and you need to be with the child...then, who calls for help? most "well" pedi units (i call them that as there is no picu in house) have a lot of cancel and/or floating due to census fluctuation and transfer out to tertiary facilities (hopefully) prior to admit and in the event of a horrible event....a pedi code...the ed is more that willing to help. but it stinks none the less.......do they require pals for their pedi staff? i have seen pedi staffing commonly be 1-3 patients 1rn 1cna 3-6 2rn's

i agree with vickyrn......seriously consider finding another job if they are unwilling to change don't chance your license. i am a huge advocate of .....make sure you have some....be safe instead of sorry....best of luck!

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Specializes in ER.

You need to talk with somebody higher than your NM, probably DON? Think of how hard you worked for your license only to be taken away because of unsafe staffing. Good luck!

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Specializes in Pediatrics.

You've received excellent advise thus far. I wonder, what do your patient's parents think of this? Immsyre they realize this. I would think their influence may be of some help.

As a former peds nurse who lives in your geographic location, I can honestly say that I have never been completely alone on a unit, even with a low census or low acuity. I've worked on 4 different peds units/hospitals in the NYC/ long island area. I've always had at least an ancillary staff member. I used to work on a bmtransplant unit, max 4 beds. One night, I had 3 patients. I definitely could have used a 2nd nurse. But I had to compromise with 2 PCAs. I took it, and they questioned why I needed 2. Glad I had them both. We had an emergency on the unit. So yeah, we don't always need another nurse, but we cannot function 100% independently.

How do you even go to the bathroom?

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Specializes in Pediatrics.

BTW, is this a staffing issue (not enough staff), or is it that they don't feel the need to staff the unit? Or are they pulling your second nurse to float?

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Specializes in Pediatrics.
Do you have a union that could become involved?

Take it up the chain of command. If not satisfied with responses on the lower level, take it all the way up to the medical director, if need be.

If this doesn't work, then quit. What you describe is clearly unsafe, not only for your precious patients, but also for your license.

I haven't had very good experience with the union covering my hospital, so I don't even know if I should bother bring this up to them... Someone also mentioned something else that had me thinking. Nursing shortage is massively widespread in my hospital (32:2 patient:nurse ratios), yet hardly anyone fills out the unsafe staffing papers. Will the union listen to the one person that's actually doing it (me) or see it as "why is she complaining when the others aren't"?

Believe me, I've thought about leaving that place so much... Getting my resume ready to start sending it out. I won't place anyone's life on the line like that anymore.

Thanks for your reply, :)

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Specializes in Pediatrics.
if you fill out unsafe staffing papers every night does that mean you are union? i'd contact the union if you are i'd contact the nysna...http://www.nysna.org/ . http://www.nysna.org/practice/staffing/intro.htm.

www.nysna.org/images/pdfs/practice/staffing/safe_rn_staffing.pdf

nurses everywhere rank staffing as their biggest problem. research shows it is a problem - for patients: insufficient nurse staffing is linked with poorer patient outcomes, lengthened hospital stays and increased chance of patient death.

http://www.safestaffingsaveslives.org/ is the ana national campagain.

rn safe staffing act re-introduced in congress

the rn safe staffing act (s. 58/h.r. 876) was re-introduced for the 2011-12 session of congress. it would require hospitals that participate in medicare to implement staffing plans, established by a committee comprised by a majority of direct-care nurses, for each nursing unit and shift. read more...

you can also report them to fair wage and labor for not providing breaks and relief as required by law.

http://www.dol.gov/dol/topic/workhours/breaks.htm but also check labor laws for your state.

i would take it up the chain of command as well.....but remember if you make enough waves be prepared to get dumped out of the boat.....hospitals are notorious for this and are excellent information manipulators. what you are describing is truly unsafe. you can't be left alone with patients....if something goes worng and you need to be with the child...then, who calls for help? most "well" pedi units (i call them that as there is no picu in house) have a lot of cancel and/or floating due to census fluctuation and transfer out to tertiary facilities (hopefully) prior to admit and in the event of a horrible event....a pedi code...the ed is more that willing to help. but it stinks none the less.......do they require pals for their pedi staff? i have seen pedi staffing commonly be 1-3 patients 1rn 1cna 3-6 2rn's

i agree with vickyrn......seriously consider finding another job if they are unwilling to change don't chance your license. i am a huge advocate of malpractice insurance.....make sure you have some....be safe instead of sorry....best of luck!

i am part of a union, but read above regarding how i feel about them. i'm not sorry to say that they have been utterly useless all the times i've had to deal with them (left me without benefits for nearly three months because they kept loosing my paperwork), but i haven't tried the nysna. i'll have to do that.

with such little "official" experience under my belt i'm a little wary of making too many waves because i fear that would mar my resume greatly. i love pediatrics quite a lot and i don't want to be prevented from doing it. however, that doesn't mean i'm not willing to fight for the rest of the staff. as for pals, yes, we are required to have it. i have such little trust and faith in the ed staff in my hospital... i've seen trauma codes that need to be halted because they are missing either a nurse or an anesthesiologist or an rt... i've seen rapid responses or even code blues where the doctors and/or nurses just sort of waltz in at their own pace.... this place is seriously messed up...

as for another job, preaching to the choir, :)

thanks for your response, ^_^

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Specializes in Pediatrics.
You need to talk with somebody higher than your NM, probably DON? Think of how hard you worked for your license only to be taken away because of unsafe staffing. Good luck!

This is one of the things that scares me every night... Did I mention that my hospital has 8 hour shifts? Overworked as is, and we also have even less time to be able to finish our work. It's ridiculous.

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Specializes in Pediatrics.
You've received excellent advise thus far. I wonder, what do your patient's parents think of this? Immsyre they realize this. I would think their influence may be of some help.

I don't know if they realize, and those that do have been vocal about it, but in my hospital, the Peds unit, its patients, parents and staff are the bastard, unwanted child. The biggest problem is at night, though all shifts really suffer from it. While I may have been alone during the night, or have had a CNA (the few nights I do), the day shift has an LPN or even another RN. It's rare, but it does happen. So it's so inconsistent that I don't know if anyone really cares.

As a former peds nurse who lives in your geographic location, I can honestly say that I have never been completely alone on a unit, even with a low census or low acuity. I've worked on 4 different peds units/hospitals in the NYC/ long island area. I've always had at least an ancillary staff member. I used to work on a bmtransplant unit, max 4 beds. One night, I had 3 patients. I definitely could have used a 2nd nurse. But I had to compromise with 2 PCAs. I took it, and they questioned why I needed 2. Glad I had them both. We had an emergency on the unit. So yeah, we don't always need another nurse, but we cannot function 100% independently.

How do you even go to the bathroom?

Tell me about it... a few nights ago I (alone), was juggling a kid on IV antibiotics who lost his IV line and I had to restart it (he only let me try once because he was terrified of the needle), a baby in respiratory distress whose mom pretty much left him to us because she had to go back home to do whatever, a kid with a broken arm hooked up to maintenance fluids and another child in status epilepticus. I will honestly say I got through the night with no disasters by the sheer grace of God. Literally. Administration thinks that just because there are 2, 3 or 4 kids I don't need any extra help, but that night proved the obvious fact that whether there are 2 or 6, one RN cannot run the entire floor because a kid can go south on you at any moment. But no... I'm the newbie, I'm the one complaining, it's always been done like that, etc.

Thanks for your response, :)

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Specializes in Pediatrics.
BTW, is this a staffing issue (not enough staff), or is it that they don't feel the need to staff the unit? Or are they pulling your second nurse to float?

There is no second nurse, :-P Just me. Everything else is a combination of both. Officially, as part of the unit, there are only four of us. Two for day shift (can't remember the last time they left two RNs there), one for evening and one (me) for nights. There are other RNs and LPNs trained for Peds throughout the hospital, but their units are so short staffed as is... you see where I'm going. And then they also don't feel the need to staff properly. Apparently they think I have super powers and can split myself in three. Granted, there have been nights where the two or three kids are stable enough that yes, I could handle it on my own. Doesn't mean I should, but I could. Then there are nights like the one I described above where four kids were enough for 10 given the acuity.

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I don't have any advice to offer you because I'm just a CNA, but I imagine how stressed you must be. Our nurses are on the floor by themselves to take care of SIXTY residents. They are constantly stressed and nothing is ever done about it. As I am finishing up my pre-reqs and applying to nursing school in January, I often find myself giving it a second thought. Good luck to you.

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