awful pt assignment or the norm?

[maybug, ADN, BSN, RN]

I work on a med/surg unit where the normal ratio is 1:6. For the last several months it has been 1:7 (due to low census) with only 2 nurses on the unit. We have 2 CNA's for 14 pts and a secretary that only works half the day (unless she takes PTO then they staff no secretary). On this particular day in hell 5 of my 7 pts were on isolation precautions for MRSA/VRE and 1 on droplet precations for meningitis. One patient had an anoxic brain injury and showed no real signs of life besides constantly thrashing herself all over in bed. Her rails were padded with anything imaginable (and had to be repositioned anytime you walked by the room), her legs wrapped from toes to thigh with dressings to prevent any further abrasions and skin tears (which would last about 2 hours). She had a trach and a PEG tube with continuous feedings and a fever I just couldn't get down no matter how many times I alternated Tylenol with motrin. Not to mention the needy family members that rushed me into the room for every cough or grimace. I had another lovely patient that hit, kicked, bit and spit on me, thus forcing me to put him into restraints before he pulled his PICC line out. The doctor comes in the pts room to find me cowering below the pts bed attempting to tighten his restaint as he flails his arm at me and nonchalantly tells me im going to have to put an NGT in him. O_O are you serious? This man? This man that will spit and yell and fight and refuses everything under the sun? I've never cried during a shift, but tears were stinging my eyes at this moment. I called my supervisor the for third time (my prior calls for mercy were ignored) and begged her for help before I lost my mind. She finally came, and with much help from staff (and some haldol) we got the NGT down. During this time I did 2 discharges and also got 2 new transfers. At no time did I get a lunch break, a sip of water, or even a chance to pee. I have only been at this job a little over a year and in that period of time 4 nurses have left the unit. I know at their exit interviews they made it very clear that the ratios are unsafe, the acuity is too high, and the managerial support is severely lacking. I do not feel like wasting my breath when they are aware and obviously don't care. Yes, I am in the process of looking for another job, but I really wrote this wondering if this is the norm of hospital nursing? Are there floors and units that staff fairly and actually take pt acuity into consideration? Is there such a thing as a manager being on a unit for more than 5 minutes of the entire day, someone that can see you drowning and will actually take time to help? I don't want to give up on hospital nursing entirely because I love the skills and the new things I constantly learn. Should I find a new hospital or find a new specialty?

[anh06005, MSN, APRN, NP]

There are some floors and hospitals that care (to a point). Three are also days that are from hell. There are some supervisors I've had who were amazing and would have come to help me if I had called in your situation. Others would have given some excuse. Sorry you are having a horrible time!! I've had those days too but did break down and cry.

[maybug, ADN, BSN, RN]

it wouldn't be so bad if days like these were rare, but they are constant!! My unit has earned the tagline of being the "red-headed step child" because we seem to be abandoned and neglected. We are given the leftover pts no one else wants. When nurses get pulled to work on our unit they thank their lucky stars they get to go back to theirs!

[anh06005, MSN, APRN, NP]

Completely understand!! If it got to be constant and your pleas go unheard I'd wind up leaving too. That's how it was when they increased the ratio on our cardiac step down unit on dayshift from 1:4 to 1:5. Not long after that I (and many others) left. They got the picture I guess cause last I heard they were taking it back down. That's too many considering they are on cardiac drips, fresh lobectomies, fresh heart caths, cardioversions with conscious sedation (that WE administer if charge nurse busy), etc.

Anywhere has to be better than that pretty much

[maybug, ADN, BSN, RN]

that's the way I see it... no matter where I go... it cant be any worse! ha

[annie.rn]

Wow! That sounds really bad and I think you'd be hard pressed to find another floor that consistently crazy. I've done med/surg for over 20 years and have never worked anywhere where the ratio was higher than 1:6. On occasion I've had to bump up to 7, but rarely. I'd find new employment. Hang in there! As painful as it is, the fact that you have handled it for over a year says a lot about you.

[Guttercat, ASN, RN]

This post hurt my head just reading it. Many of us have "been there." It's not right.

I am so sorry.

[Lev, MSN, RN, NP]

To answer your original question: awful patient assignment.

[ProudStudent]

The ratio is common, but our unit tries to stick with a 1:5. When it goes 1:6 and the patients have that high of an acuity level, it becomes unsafe for you and your patients. Glad you spoke up instead of just trying to "keep swimming".

[Dranger]

I would have written up an incident report and sent it to risk management. I do it to the ER all the time when they bring my unstable patients. That's just a bad run...

[chi1099]

I work nights on a 30 bed med-surg/ortho unit and it's normal for us to have 8 patients and at times when we can't get help from the float pool, I have had as many as 10. Some have had 11 at times and it is very stressful to say the least. It's a myth that patients sleep all night so it justifies lower staff numbers. We rarely have 2 pct's working because they are harder to get than nurses. If you need a sitter you have to use your pct which makes all your patients total cares.

Complaints about safety go unaddressed. There's usually a "we're in the process of hiring more help" response so we've basically adjusted to moving at warp speed for 12 hours at night. Add onto that no secretary, being charge nurse, chasing IV pumps and keeping up with all the duties that a pct would handle if you had one and it's a miracle everything gets finished (charting twice a shift on that many people, passing meds all night and doing your own blood draws, vitals and cpm's, assignments for day shift, admissions, etc.) There is also a 1 hour of over-time per person per pay period rule to keep the budget in check. Exceed the 1 hour rule and it's a mandatory written reprimand. I knew a med-surg floor was challenging but this is true craziness. However, I have developed wild organizational skills.........and plantar fasciitis!

[THELIVINGWORST, ASN, RN]

I work nights on a 30 bed med-surg/ortho unit and it's normal for us to have 8 patients and at times when we can't get help from the float pool, I have had as many as 10. Some have had 11 at times and it is very stressful to say the least. It's a myth that patients sleep all night so it justifies lower staff numbers. We rarely have 2 pct's working because they are harder to get than nurses. If you need a sitter you have to use your pct which makes all your patients total cares.

Complaints about safety go unaddressed. There's usually a "we're in the process of hiring more help" response so we've basically adjusted to moving at warp speed for 12 hours at night. Add onto that no secretary, being charge nurse, chasing IV pumps and keeping up with all the duties that a pct would handle if you had one and it's a miracle everything gets finished (charting twice a shift on that many people, passing meds all night and doing your own blood draws, vitals and cpm's, assignments for day shift, admissions, etc.) There is also a 1 hour of over-time per person per pay period rule to keep the budget in check. Exceed the 1 hour rule and it's a mandatory written reprimand. I knew a med-surg floor was challenging but this is true craziness. However, I have developed wild organizational skills.........and plantar fasciitis!

I can't believe you are all still working there. So unsafe. I bet they manage adequate staffing when state stops by. This sounds cliche but your licenses are at stake here. I honestly can't believe your organization is letting this go on! 11:1!