Former ER & ICU RN Struggling With Tele Ratio

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Specializes in Float Pool - A Little Bit of Everything.

Hi All,

To make a long story short I worked ER and ICU for awhile. My load in the ER was never more than 4 and my load in the ICU was never more than 2 ICU patients, though there were times they would give me 1 ICU and 2-3 Tele.

I then went on a personal hiatus for awhile and did SNF. My load was either 30-40 patients with a mix of skilled and LTC patients. While this was demanding, it is different from a hospital setting, of course.

So now I am back at the hospital. I knew that I did not want to go back to ER or ICU because it had burnt me out so badly in the past. I am in graduate school and I want a few more years of floor nursing experience before moving into something along the lines of case management, risk management, clinical coordinator, etc. Those are my personal areas of interest. I feel I would be better in those roles if I had a wealth of bedside nursing experience.

I am working a busy Tele floor and it is No. Darn. Joke! The acuity of these patients is close to what I am used to in rural ICU. My ratio is 6 to 1 and I find myself struggling to treat this many acutely ill patients and manage my time. Does anyone with similar backgrounds have any advice?

I am my harshest critic and I tend to beat myself up for every little thing, I am so used to having my act together that this is an unexpected curve ball.

I want to stay in Tele and I adore my unit and coworkers, I just need to figure out how to get into the groove. Any help is greatly appreciated. Thank you!

P.S.- Tele nurses.... You Rock!

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Specializes in Utilization Review.

Are you on days or nights? I am sure either way you will eventually get into your own groove. I'm on a med-surg with tele floor and I don't think I felt super comfortable on nights with 6 patients until I had about 6 months under my belt (this was my first RN job). Hope things work out for you! If you love it, stick with it, ask to see other nurse's methods of planning out their day. Best of luck :)

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Specializes in Float Pool - A Little Bit of Everything.
Are you on days or nights? I am sure either way you will eventually get into your own groove. I'm on a med-surg with tele floor and I don't think I felt super comfortable on nights with 6 patients until I had about 6 months under my belt (this was my first RN job). Hope things work out for you! If you love it, stick with it, ask to see other nurse's methods of planning out their day. Best of luck :)

Thank you very much! I am working days. I feel better when I talk with my coworkers and they say after several years with this patient load, they still have rough days. Lots of my coworkers participated in the safe nurse to patient ratio event in DC. We just need to keep fighting the good fight for safe ratios for the profession.

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In my first job, I had 8 med/surg patients or 7 tele (plus an LVN with an equal number of patients to cover). And these were SICK patients. I never found a good way to do everything that needed to be done, I only managed by cutting corners. IV tubing didn't get labeled, blood sugars between 150-200 didn't get covered, etc. It wasn't ideal, but it enabled me to take care of the most critical problems and keep most of my patients alive.

When I see nurses here get stressed about an admission because they already have four patients, it's somewhat amusing. Five patients in med/surg is an absolute dream world to me!!

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There's no easy way to not feel the squeeze with 6:1. I always pray for one out of the six that can be neglected. Although I don't work on tele specifically, all of my patients on the "surgical" unit I work on usually have tele.

The problem is that the patients are getting sicker and sicker and the ratios don't get adjusted. The patients now have multiple chronic illnesses on top of an acute medical or surgical problem.I used to take 7 or 8 surgicals when I worked ar my first nursing job 10 years ago. That couldn't happen now.

Just do your best.

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Specializes in Float Pool - A Little Bit of Everything.

Thank you both for your comments! Speaking of ratios not getting adjusted.... In the ER's I worked our ratios always got adjusted when we had an ICU patient. But not on this floor. Holy crud! The other day one of our nurse's patients became a legit ICU patient and they did not fix her ratio. She said it was the first time she cried at work. It was horrible. She had 5 other patients with an ICU hold on our floor, and one of her other patients pulled out knives and injected himself with a home medication. It was a long day.

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