How do you handle so many patients at once?

[UnidentifiedNurse]

I know some of you have very large patient loads (7+ patients) and I'm really amazed. How do you handle all that? Where I work the standard patient load is 4. Sometimes we get three if there is really good staffing. Sometimes we get 5 if we get shorthanded. I've been working on the floor on my own for almost 3 months and had to take 5 patients twice. First time I had 5 patients, it was not too bad. Sure I was busy, but the patients did not require to many things, so I was able to handle it ok. The next time I had 5 patients it was crazy! I was already busy enough with 4 patients at the start of shift because all the patients were quite difficult. If they weren't needing pain medications often, they needed a blood transfusion, or they had really needy family members. I was already working my butt off to get caught up, but it was not working. Since I was going between patients and talking to doctors so many times, I barely even got a second to sit down and chart (computerized charting). Later on I got assigned a new admission, making my patient load 5. Fortunately, this patient was not too difficult a patient. I assessed him, got him settled, then I went on to my other patients again. Right before end of shift though, I got bombarded with three patients needing pain medicine, one patient whose blood transfusion finished, one patient whose family needed my attention for something, and one patient who had a foley and wanted it taken out instantly. My head was truly spinning trying to finish everything up. I had no choice but to leave several things for the next shift to do, which many of them weren't too happy about, and I ended up staying an hour and a half later than I usually to do finish up all the charting that I did not get a chance to do during my shift, and I still felt I was not as thorough as I would like to be. My mind was just so fatigued that I could not think as clearly. I did try to prioritize and delagate as much as I could, but the nursing assistants can only do so much and the rest is up to the RN. On an upbeat note though, I finally got the chance to do a blood transfusion though. It was my first time ever, even through nursing school that I got a chance to do it. I am really wondering for those of you who have those really high patient loads, how do you manage everything? And yes, I do try very hard to organize my shift, and to do as much clustering of care as I can for the patients. There was just a lot of extra things that the patients and/or family members wanted to be done.

[kwagner_51]

Oh sweetheart, I wish I had your patient load!!

My patient load is 28. All of whom need pain pills, ativan [for some and all routine ativan has been d/ced, so they were awake ALL night] I have pts that wander even had one that eloped and WALKED all the way back to her house.

I have to do tube feedings for my pts and for the QMA's pts. I have to do hhn's the same way. I give insulin shots to both units also!!

I have worked several nights where I was the ONLY RN in the building!!

5 pts sounds really good to me. In fact I quit working at the job I just described last night. I was putting my pts and my LICENSE on the line every time I walked in the door!!

Thanks for making me smile. I have a cheat sheet for who gets insulin, pain pills, reg. routine meds etc. I still couldn't get everything done and had NO clue why the res was there to begin with!! It was a NIGHTMARE!!

_________________________

In His Grace,

Karen

Failure is NOT an option!!

[SpudID]

I would love to see some practical, doable, time saving suggestions here. I know that I struggle with this as well. I am in high risk OB and it is hard for me to chart patient progress every 15 minutes on multiple pts receiving pitocin, assess CTX pattern, FHTs and run to rooms upping the pumps. I am thinking that I need to just make a copy of the MD orders and place them in ea room. Do my initial assess and then wait until 0400 or early morning to try and get my paper charting done. (We do a mix of computer and paper charting often causing at least double but more like triple and s/t quadruple charting.) On top of this I have a student, who I am trying to keep challenged but I cannot trust to reliably do things because she is just learning. It is so stressful. Any advice?

Thanks.