Well.. I *was* a cardiac nurse

Nurses General Nursing

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As of 8 weeks ago, I am a cardiac post-op AND neuro nurse. Our hospital shut down the neuroscience unit so now I am responsible for everything from pre/post CABGs (with insulin gtts, amiodarone gtts, etc.), acute MIs, pre and post cardiac caths, being transferred any med surg pt from the hospital who starts going into afib or starts throwing tons of PVCs PACs or a few sweet runs of Vtach.. but at least my nurse to patient ratio was rarely over 5. Now that our floor has added neuro patients (NIH scales, q1 hour neuro checks, feeds, dysphagia assessments, q1 hr vitals, etc etc) they have decided a minimum of 6 patients is what we should be taking care of-- along with a lovely speech about TEAMWORK and how now, more than ever, we have to start helping each other out as much as possible.:rolleyes:

I really love being a nurse even though I've only been at it for 1 year, but now I have an appt with a PCP tomorrow because I am cracking emotionally. I always thought of myself as a strong person, but I just can't handle all this anymore without some kind of help. On my days off I only want to sleep and I hate it when my 7 and 10 year olds see me crying. :crying2:

Anyway, was just curious if anyone else has this particular combination of patient population and if there's any hints you have to offer. It just seems like an odd combination of patients because they are both so high acuity.

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Specializes in Acute Care, CM, School Nursing.

I don't even know what to say... What a horrible situation for you. Stay strong, I hope things improve. Take good care of yourself!

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Specializes in CCU, cardiac tele, NICU.

What's your legally mandated ratio for tele patients? That sounds like a LOT - and I can't imagine how you have been doing this for 8 weeks with q1hr neuro checks and vitals. Time to leave - do it for your sanity AND your license.

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I think legally it is 6.. but not all stroke pts. are tele, so I guess that's their loophole. I would love to leave, but I'm weekend program and I make very good money.. the job market is a disaster in my area and the local market is flooded with nurses. I think the hospital knows this and is taking FULL advantage.

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Specializes in pulm/cardiology pcu, surgical onc.

Remember to fill out incident reports for unusual occurences due to unsafe staffing. That's definitely not a good combo. Please do what you can to keep your pts safe but you have to take care of you too. Maybe a transfer to a diff unit?

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Up2nogood, that is actually an awesome idea... I may have to conspire with a few other nurses and get them in on it. Administration likes their paper trail and I can't think of a better way to bolster our case than to start cranking out incident reports.. it never occurred to me to do that because I was so damn busy (the online form is horrendous to use-- probably on purpose).. but, even one incident report a shift can be very helpful... thank you!

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I have been wanting to work in hospice since nursing school.. this might be my cue...

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Specializes in pulm/cardiology pcu, surgical onc.
Up2nogood, that is actually an awesome idea... I may have to conspire with a few other nurses and get them in on it. Administration likes their paper trail and I can't think of a better way to bolster our case than to start cranking out incident reports.. it never occurred to me to do that because I was so damn busy (the online form is horrendous to use-- probably on purpose).. but, even one incident report a shift can be very helpful... thank you!

They can also track staff overtime and it would be a kodak moment when you tell them you are racking up overtime today filling out an incident report for a med omission (or whatever reason) due to high acuity and unsafe staffing ratios. It would also be interesting to start tracking and reporting the incidence of patient falls. Those neuro pts are notorious for jumping out of bed. Do you have a unit safety committee? That would be an awesome project for them.

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Specializes in Hospice.

Not to mention tracking compliance with all those q1h assessments! Have your docs given you any feedback on care and staffing?

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The q1hr checks are the first 4 hours after admission then q2 for i think 6 hrs.. then q4 for .. I don't know 2-3 days maybe(?) (I follow a form so I'm going by memory). We do have a safety committee. I may have to join it. The neuro docs are ****** in general, and are known for acting like bizarre bungholes. So, in one corner, we have the suave, top of their class mcdreamylike cardiac surgeons and cardiologists.. then in the other corner, we have the neuro docs who each seem to enjoy sporting horrendous displays of fashion abominations and..to put it mildly.. just plain odd physical attributes.

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Specializes in Critical care.

Anyone with an acute process that is requiring q1h neuro checks belongs in a neuro ICU, period. Neuro patients who are that acute can and do go bad quickly, the results of which could be devastating for the patient. It puts the hospital in a position to be sued, just imagine an acute CVA who vasospasms and has a decline in neuro status that doesn't get caught because the nurse has too many patients to get to the q1h check. Not to mention the learning curve with neuro assessment, subtle changes to be aware of and medication side effects masking things. Acute neuro patients need to be in an environment where things will be caught and intervened on in a timely fashion. This is no disrepect to your type of nursing, OP....your hospital is setting your floor up for a bad outcome.

My second reaction to your post is about the NIH scale....really!?!? How can they expect nurses with 6 patients to go through that properly? My hospital uses the MEND scale for the neuro patients both in ICU and the stepdown (once they are stable and not q1-2 h anything!) When my hospital became a primary stroke center and the neuro stepdown was created, it was integrated into an existing tele unit. However, their ratio is 1:4 or 1:5 most days and they were all put through comprehensive neuro training (ASLS and Apex hemispeheres courses).

The MEND scale is more more user friendly. Maybe the hospital would at least consider that. http://www.asls.net/mend.html

Hopefully things will change. Maybe this is your chance to move into hospice. You are being put in an unsafe situation and it is not worth the risk to your emotional health or RN license. I once left a CVICU with some unsafe practices, there had been 2 lawsuits in 2 years and I didn't want my name to be next one. Best decision I ever made.

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Maybe you could change to school nursing and be on your

kids schedule....just a thought.:nurse:

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