Bait and Switch

[Indy, LPN, LVN]

So I feel like I've been lied to, like I definitely took the bait hook, line and sinker. And it's a bad feeling. I wanna run go find another job, but there's always the possibility that I'm being irrational.

A little background. Our tele unit is actually 3 units. They have 12, 11, and 14 beds respectively. Ok. One reason I applied was that in school the nurses looked like they had reasonable ratios. No problem. In the interview there was a long bit of gibberish from the director about one of the units which basically amounted to a stated goal to staff it better at night. I had not the foggiest idea what she was talking about, and my being nervous precluded me asking smart questions.

Fast forward to coming off orientation, at night, and finding out that it's common to run the 11 beds section with 2 nurses. That wasn't pleasant, and for a while it was 2 and a tech. I love our tech! She's wonderful and makes it doable! ...anyhow. Over the course of my employment there have always been apologies if we wound up with just 2 nurses, for that 11 patient section, and many times someone would be called in to help, etc. So I felt like an effort was being made to staff it appropriately.

Now I'm getting the word, no, sorry, we're going to just go with 2 there period due to the hospital being over budget this year. WTH! Now I have walked more miles than I can count in that unit, I know where everything is and isn't, all the little quirks, all the electrical outlets that might not work, which heaters have to be smacked to work properly, which windows won't open and which BP cuff used to fly off the wall if you tugged at it too hard. I've spent most of my worst nights there, and not all of 'em were understaffed either. But the entire time I've had the idea that people in charge of me wanted me to have adequate staff, and were trying to find it, so I've been trying to do my best. I've tried not to be too loud or too much of a witch about the staffing.

Now I've got to go to work knowing that there is not any intent whatsoever to give me what is needed to work that unit properly. And the 12 bed unit is facing the possibility of running with a new definition of "3"; 2 nurses and 1 tech =3 people. So that'll be 3 nurses each night with possibly 6 patient loads when days usually gets a 3 patient load (frequent discharges and admissions and all the heck of changing orders being their downside- make no mistake, it is hectic).

I'm partially venting, but also asking for advice. There are different routes to take, and I wanna know, what would you do?

If I choose to be a passive aggressive type, I can stop doing extra things night shift did try to do to make it easier for the oncoming shift. No coffee, no making the report sheets make sense, no stocking, people can find their own stuff, and restarting IV's? Are you kidding? Neaten up the desk? That's funny.

I can also talk to my DON and /or ADON and ask what the problem is. I feel that if I do this, with my current lump of disappointment and pissed-offedness sitting in my tummy the way it is, I will talk my tired butt out of a job. Our units have had some of the best ratios in town, even for nights. I'm more upset over the "bait and switch" than I am over the ratios at the moment. If the beds were all together it would seem like our help was closer, even if we had more patients. Argh.

[StrwbryblndRN]

If you can deal with what you can't change and find a way to be happy with your job, stay and work on it.(staffing issue) However being that this situation can make you stressed in and out of work I would probably find another job.

This would apply to any career too. Your sanity should come first or you could end up resentful and burnt out early. And most of us know what that kind of nurse is like.

It is all about what you can handle and still maintain.

[anonymurse]

From what you say, it was not a case of "bait and switch" on the part of anyone you spoke with. It was a case of circumstances changing on them. You might want to check their own frustration level over the situation instead of charging in; you might be lighting off a powder keg. But even before that, ask yourself it they have the power to change things.

[morte, LPN, LVN]

From what you say, it was not a case of "bait and switch" on the part of anyone you spoke with. It was a case of circumstances changing on them. You might want to check their own frustration level over the situation instead of charging in; you might be lighting off a powder keg. But even before that, ask yourself it they have the power to change things.

i understand you point, to a degree, however the budget is something that the "powers that be" should have been aware of, and not indicated they would try to do what they should have known they could not...

ps.. this could also simply be an excuse to save money...and now that the op has been there long enough

to feel "habituated" the inertia would lead her to stay rather than leave....and they may be counting on that...

[RNsRWe, ASN, RN]

Just as a matter of perspective, having an 11-bed tele unit staffed with two nurses (plus a tech?) at night doesn't sound like a hardship to me, it sounds like heaven.

I work med-surg (with light tele patients thrown into the mix frequently) at night. The GOAL for staffing for us is "only" 7 patients per nurse, with a tech for each nurse; the reality is we usually have 8 or 9, and oftentimes one tech for well over 20 patients. I have done 10 patients in the past, but have learned how to put my foot down and refuse. I've had two of my 9 patients be tele ones.

Our actual tele unit, with a maximum of 35 beds, has seen it staffed with 8, 9, and yes-10 patients per nurse, with limited techs. A good night has them staffed with "only" 6-7 as well, usually the higher side.

Not saying it is a dream job you have, but from my POV, having two nurses and a tech for 11 beds (even if they're tele) looks pretty darned nice!

[Jami RN, BSN, RN]

I've worked on many tele units as regular staff and as a traveler. 5 or 6 patients at night is pretty standard everywhere, as is 3 or 4 patients on days. I've never worked anywhere that had a ratio of less than 5 to 1 at night, and have worked a few places that had an occasional ratio of 7 to 1 at night. I don't know if you're going to find a better patient ratio elsewhere.

[oramar]

Oh my, it has been 8 years since I did telemetry. Back then the telemetry unit which had 11-13 patients, got two licensed people and 1 aide on nights. The med/surg worked with 11-13 patients and only two nurses but telemetry always got the aide. I can't believe they are staffing same as med/surg now. All those drips and drugs you have to push plus watching the monitors. Add to it the fact that their is usually admissions and no secretary. Like I said, OH MY!

[clemmm78, RN]

I'm sorry Indy, but that ratio, although not ideal, doesn't sound all that out of the ordinary. I don;t know what a tech is though and what he or she does. I realize that you won't have this tech any more, but as I said, the ratio sounds much like what many have.

[Mommy TeleRN, RN]

Our tele unit where I intern has been having 1:7 on DAYS. Where I do clinicals it's 1:4 or 1:5 days on 1:6 or 1:7 on nights.

[banditrn]

I'm sorry, it doesn't sound too terrible to me - back in the old days when I did tele, we usually had 8 at nite with 1 or 2 cna's for the entire floor.

Of course, I was a lot younger then.

[RNsRWe, ASN, RN]

I'm sorry Indy, but that ratio, although not ideal, doesn't sound all that out of the ordinary. I don;t know what a tech is though and what he or she does. I realize that you won't have this tech any more, but as I said, the ratio sounds much like what many have.

tech=patient care tech, who may or may not be a CNA. We call them "PCT"s, patient care techs in our facility because they oftentimes are NOT CNAs, just trained by the hospital to use the dynamaps and do basic move-and-wash patient care.

[RNsRWe, ASN, RN]

Well, Indy....now that you've gotten some feedback, what do you think? If having 5-6 patients at night seems too high to you, what WOULD you consider appropriate? If you're looking to have only three or four patients on nights, I'd have to say you are being unrealistic.

Best of luck to you in your decisions.