How many patients is too many & addressing staffing issues.....

[CareBayer]

I am a new nurse. I work on a Stroke-step down floor, but we receive all different kinds of patients. All of our patients are on heart monitors, but we have no ventilators on our floor. We do have patients that have cardiac and heparin drips from time to time. On a typical day-shift, we are required to provide care for six patients. This seems like way too many (four would be ideal.) Does this seem like a huge patient-load to you? Oh, and we also work without a nurses-aid frequently.

The other nurses that work on my floor are always complaining about the patient load (both seasoned nurses and newbies.) Since I am new, I'm not sure how responsive our unit director is to these complaints. What other steps can be taken to increase the awareness to other hospital administrators about how unsafe everyone feels about caring for six patients at once?

Thanks for your advice!

[Miami NightNurse]

Happy loser I hope you are a nurses aide and although 15 patients would still be too many, for an RN it would be impossible. I won't take more than 7 ever!!! And there are nights when I have 6 and won't take another. My attitude is I walked in here with a license and I'll walk out of here with one. "They made me" isn't going to cut it when they are yanking your license. We need to start putting our feet down. Oh and they can afford to staff better. I had a coronary stent placed 2 months ago, I was in the hospital for 4 days on a regular tele floor on a heparin drip. My hospital bill was $80,000

[Okami_CCRN, BSN, RN]

Yup I am a tech amd trust me 15 patients make me want to throw my Badge at the staffing office and tell them to shove it.

[Miami NightNurse]

I know the feeling. Especially when I know they spend millions on landscaping. And our firework show for the 4th of July is one of the best in South Florida but it's never in the budget to have enough care techs or nurses

See isn't it pretty.

[Okami_CCRN, BSN, RN]

Well our hospital currently constructed a brand new cancer center that it rents out to another facility, we just got licensed as a stroke center, we own and collect rent off a medical office building yet we are in a hiring freeze and techs are leaving because of stress at work. There are days when I am the only tech on the floor and they still want me to have a smile on my face as I am running from room to room answering call bells while doing blood sugars and drawing blood, and feeding, and cleaning... *sigh* we just dont get paid enough for all we put up with

[RNperdiem, RN]

Your area sounds like it is in a gray zone between a floor and a step-down unit.

Where I work, stepdown units have monitored patients, rare arterial lines, every 4 hour vital signs and quick turnover to the floor. Every once in a while there might be a stable vented patient. Heparin drips are common, but no vasoactives requiring titration.

These units have a 3:1 ratio for medical and surgical stepdown units, and up to 4:1 for cardiac and cardiothoracic stepdowns. There are unit secretaries on all units , and an aide on the 4:1 units. During the day, the IV team and transport nurses(for trips to tests on monitor) as available.

Telemetry floor patients have a 1:5 ratio. Every eight hour vital signs, more aides(depending on aide staffing).

[armymatt]

At my hospital (Tripler army med center) out load depends on our team. If we have a nurse, lpn, and an aid/medic we will take 8, but every hosptial is different. Its not uncommon when we deploy that we may be the only nurse in a 30-40 bed cach and you work long hours and everyday. If you are lucky you will have a medic or two but you teach the medics about giving iv push meds and administering meds. Things get wild and different when your in foreign lands with no jacho there to do anything for you or against you. I will take up to 5 on my floor, but prefer 4. Matt

[jjjoy, LPN]

I wonder when nurses are going to stand up to the administrators and physicians who fail to recognize the negative impact that having too few nurses, taking care of too many patients, working double shifts and days off. And how long we are going to continue to put up with it. None of these administrators or physicians or even us, would fly on a plane where the pilots and flight attendents had worked double their allowed time. The air line industry has long had limited work time for pilots and flight attendents. But no one thinks a thing about expecting us to do what we will not allow pilots to do.

Woody:twocents:

Many nurses aren't just taking it. They try to get someone to listen at their facility and when nothing happens, they quit.

The reason why it's easier to regulate airline personnel is that if you end up having to cut back on flights, that's just a hassle to people. But if you have sick patients, how do you say "sorry, we've reached our limit. try again tomorrow"? I agree that something has to be done!!!! Just not sure what!

[childpsychnurse]

I work in child psych-with most of our patients being on Medicaid. The amount of money the government pays for stays is rediculous, then add in the great invention of the 90's "managed care", and who gets the brunt of the effect? Nurses and patients. I have had as many as 23 patients at a time-I normally have 12 per day. I have to send staff to save hours and have to do a lot of work at home to keep up with treatment plans. I wish the administrator's of insurance companies no ill-will, but if they became ill maybe they would see how their payment decisions force a decrease in care and increase in stress. I see many retired nurses on my adult unit-depression and anxiety related issues. It is a sin for sure.:angryfire

[mark3274]

Yup I am a tech amd trust me 15 patients make me want to throw my Badge at the staffing office and tell them to shove it.

Nurses and techs need to start saying no even at the risk of there jobs.

where i work right now none of the rns have more than a years experience... yup we are all new grads because all the experienced nurses have run and as soon as possible I am running from this place to. managers are a joke and they are both rns... it almost makes me sick how can a RN suddenly become so clueless just because she is a manager.

[NurseCherlove]

If there could just be some way that we could all really hurt those damn greedy hospital administrations/CEOs without hurting patients - some kind of national hospital nurse walk out, strike, or something. That's probably a lot of the reason they stick it to us, because they know we would not do something like that since being a patient advocate is at the very core of our job description and who we are. It's like they've trapped us by our goodness.

We could just say enough's enough and let them deal with it. What if every staff and agency nurse with an active license decided to become self-serving like most others in this world...and just for one day no hospital in the country had nurses working other than lame admins and others like educators, etc. Can you even imagine the financial impact??

I hate to say it but it may just take something of this magnitude to get these idiots' attention. It's pretty obvious that nurses have the least amount of political clout because we (collectively) don't have the $$ that docs and large healthcare institutions have. Thus, we are ignored and treated like "a dime a dozen".

While unfortunately there would likely be some casualties, some united movement like the above might just make "them" realize that we are in fact extremely valuable and necessary to the healthcare industry.

[jjjoy, LPN]

managers are a joke and they are both rns... it almost makes me sick how can a RN suddenly become so clueless just because she is a manager.

That's because nurses who are good managers that stand up for their nurses meet a brick wall and either give up or are forced out. Sigh! :angryfire

[Jynell]

I want change! I have not exactly figured out how to do this, but the first step that I have taken is working at a staffing agency to see what all the other hospitals are like in my area. The bottom line is that the public needs to have input in this. Does the patient/family really understand that their nurse only has about 10 minutes to spend with them out of every hour at these staffing numbers? NO... most of them think that they are our only patient. I was just reading about how Medicare cuts are going to be made and limit payments to hospitals/facilities from preventable conditions in Oct. 2008. This includes pressure ulcers and falls... So remember this information, because the hospitals will come back and cut even more staffing numbers to offset their losses from government funds. I don't know why they don't cut their own profits from all this money that is allocated for remodeling, dinners, (Bonuses) etc.. There would not be any patients in the first place, if they didn't have nurses to care for them. The nurse IS the backbone of the hospital, and if you don't have enough, then your clients pay for the ****** care, or sue because adequate care was not given... It is not right!

I worked on a neuro floor for 5+ years, and the type of neuro patients have changed from most being lumbar-cervical laminectomy to strokes now. The manager never changed the staffing ratio to match the acuity of patients, he just kept the same numbers. Once that happened, then telemetry monitoring was added, then we gradually have had to pick up technician duties like placing foley's etc... Anyway, six patients are way too many for a nurse to care for during the day. The patient's conditions include weakness, confusion (altered mental status, dementia, etc.) brain tumors, spinal conditions (mennigitis, ms, tumors, injury, pain, etc.). We use bed alarms for the primary watchdog on our units, but that is not enough. I have found that if you can get the job done without any major problems/issues, then that is all that matters in the eyes of management. One day, I complained to the manager that we were 2 staff short, and that it was very dangerous to be working like this. I even stated that we can't get to personal needs, because of critical issues going on that came before the tolieting, and getting drinks etc.. When the blood pressure, glucose, heart rate is low, that comes before someone peeing on him or herself. Anyway, about 2-3 weeks later, I received a verbal warning because of the c/o that a bedside commode didn't get emptied. I found out that it was on that day mentioned before. I have been mad ever since then, and my manager doesn't understand why...... If any changes are to be made, then it is going to cut into the profits for these CEO's and managers of the hospitals. I am afraid that the country club means a bit more than patient care to them.