Am I a woosy for feeling 5 patients is too much on a medsurg floor

mtmkjr, BSN · Sep 12, 2018

OP, are you a new grad? New to the job/med-surg? If not, how long have you worked in your current situation?

If you've been there a year and are still feeling this way, maybe it isn't a good fit because I agree with PP, 5 is considered reasonable on med-surg.

If you are new... well, it takes a while to get into the swing of things and to learn how to manage your time wisely.

Kooky Korky, BSN, RN · Sep 12, 2018

Reality check. It's normal to have five on a day shift in my hospital.
It's all about time management and prioritization.

It is also about how complex and time-consuming the required care is and how much help one gets from aides, how many are going for procedures, how family members are behaving, and do you have a ward secretary. There are likely other factors, too, these are just the first I thought of.

Admits? Discharges? Patients confused? Falls? Pulling out tubes?

/username, BSN, RN · Sep 12, 2018

If I had 5 patients on my unit, we would all die, and the hospital would lose it's level 1 accreditation.

hawaiicarl, BSN, RN · Sep 12, 2018

The word is 'wussy'

and the answer is yes. In a nice way though :-)

Meriwhen, ASN, BSN, MSN, RN · Sep 12, 2018

CA's nurse-patient ratio is 1:5 for med-surg. So your assignment would be perfectly legal if you were working in CA.

Ruby Vee, BSN · Sep 13, 2018

At first I was honestly thinking that the OP wanted us to determine if he/she felt woosy. Oops.

That would be "woozy".

K9lover, ASN, RN · Sep 13, 2018

Being 'normal' does not make it right. As a Californian we had legal ratios for years, makes it no less hideous...I fled bedside nursing @ 5 years ago upon discovering options and only regret is not doing it sooner.

The patients in maximum security prison are far more polite than any hospital patient and if they need a higher level of care out they go. When being treated in prison if they get rude with us that visit comes to an abrupt halt and back to cell until they can be civil. Bedside nursing we get kicked, hit and bit and it is just accepted as part of the job. After all they had too little seasoning in their mashed potatoes and the pain meds were a nanosecond late.

Those 5 patients are much sicker, the moment they are off the vent they can go to M/S. I hear they are planning ways to 'monitor' when a patient leaves to ram another patient down the overwhelmed nurses' throat.

That is the 'reality' of it.

Penelope_Pitstop, BSN, RN · Sep 13, 2018

When I was a new grad 12 years ago, 5 patients on days, 7 on nights was the norm. This was a busy med/surg floor. It was doable.

That being said...

The acuity level has risen - 2006's stepdown patients are 2018's MedSurg patients. People are discharged quicker and sicker, thus the population is more acute.

Additionally, the amount of tedium has increased (clicking through a million things when charting, requiring a different assessment form for every last intervention, requiring two nurses to check pressure areas on admission, etc.) resulting in an emphasis on tasks vs critical thinking. Task-oriented thinking can lead to more stress for the nurse - reason being that there is so much pressure to get everything done for everyone, and have that timestamp match up. ("I have to pass my meds or I'll have to put in a reason why they're late! OMG my Foley reason task is overdue and the CSM is really hounding us about that..."

One final consideration...some facilities have limited space in ICUs, stepdown/intermediate units and therefore the acuity on medsurg floors is high as a result of this. When I worked in the ICU, sometimes we needed to open up beds and we had to play a game of who was the LEAST critical to downgrade.

Goodmom2 · Sep 13, 2018

Previously worked corrections-infirmary ward -typically 2 nurses-meds -treatments-emergencies and also covered clinic emergencies and facility stuff that came up. 16 infirmary patients apiece-sometime a nursing assistant sometimes not. Did this for many years-more then 20 years at 2 different facilities. When I felt the inmates were treated better then staff time to leave th toxic area.Looked forward never back.

LibraNurse27, BSN, RN · Sep 13, 2018

I don't think you're a woosy or a wussy or however you want to say it, haha =) Being a Med/Surg nurse is tough! I agree with above posters that task-oriented thinking can really impede you. It's so frustrating when the chart auditors are hounding you about why you checked vitals on a totally stable patient at 1230 instead of exactly 1200 while meanwhile you were dealing with an emergency (or just an unsteady patient who had to pee!) in another room. My question is how can one person take vitals on 5 people at the same time at exactly 1200? Last time I checked I can only be in one place at a time and only have two arms (secretly hoping Davey Do might create a cartoon about an amazing multi-tasking octopus armed nurse, haha!).

Anyway, as much as possible try to prioritize critical thinking over task and timeframe oriented thinking (if your auditors are not super strict). For example some meds are time sensitive but I doubt giving a multivitamin at 1100 instead of 1000 will really make much difference! I make a grid at the beginning of my shift with the room numbers across the top and the times (0700, 0800, etc) down the side, then list out which tasks need to be completed each hour for each room, and check them off as I go. If something urgent happens with a patient I re-prioritize and ask for help if I have time to ask and if others have time to help. If no one is available, the patient who's vitals have been stable q4 hours for the past 5 days may have their noon vitals done at 1300 if I'm in another patient's room who is crashing. Good luck and don't feel bad for feeling overwhelmed; it's great that you work so hard to meet your patients' needs and frustrating when you feel you can't due to staffing and other issues.

dayandnight · Sep 13, 2018

Like I stated in the title, I feel 5 patients on day shift on medsurg is too many. I feel like I am in a constant marathon from the time I hit the floor!! And it is STRESSFUL!!! Am I alone in this?......

Not with techs/cnas who can assist you.. but I work in a unit with absolutely no tech, no cnas, and have almost 5 patients on a regular basis. With mostly total care patients, it gets heavy very fast. Our unit secretary/scribe leaves at 4:30pm and the charge nurse much earlier than that. I don't work in the states but I guess I am a wuss also. It is stressful and ok to acknowledge that it is. Just ask your coworkers for help and focus on prioritization

ArrowRN, BSN, RN · Sep 13, 2018

It really depends on the type of med surg floor you are on and how sick the patients are. For me 5 is just on the edge of tolerable but it takes only 1 patient to turn it to a nightmare. Most hospitals in my area do up to 7...I will stick with my hospital which is union protected and can't assign us to more than 5, if fully staffed my floor gets 4:1 but we are often seem to be short. Reality is you probably won't find a hospital floor in med surg that does less than 5. I did work on one that does 4 patients but it was progressive care...always a trade off. Maybe consider ICU, less patients but more work per patient but it give you that focus, if thats what you looking for.