How many patients is/are too many?

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In a med surg setting, when would you refuse the assignement? What if you were a new grad? What are the repercussions for refusing ann unsafe assignment? If I refuse an unsafe assignment I fear I am going to be fired, if I keep taking on the assignment that is clearly too many patients I am prob going to lose my license or make a dangerous mistake. I am stuck between a rock and a hard place. When interviewed I asked the patient ratio and was told 5, maybe 6 patients. I have yet to have less than 7 and the norm has been 8. There is no way to properly care for this many patients, what can I do? I can't afford to quit, as a new grad jobs are hard to get. I also cant afford to lose my license. The patients are not being cared for properly. The staffing issue keeps getting worse and the PRN nurses are all quitting. (three this past week) so now it is going to be worse this week. Other nurse will not float to our floor, they all refuse the assignment & run away leaving us to deal with the unsafe patient loads. Can I annonymously complain somewhere?

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Specializes in ER, Med/surg, LTC, and correctional nurse.

Think twice before you quit, I am still trying to get an interview at a hospital and I have been an RN for over one year. If you don't want your job, maybe I do. Said with love,

Lighteningkrashes

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You can have it!!!!!!!

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What state are you in? I thought that there were rules in some states about nurse pt ratio, like NY and CA. I read on the internet that in CA.... Dont know if thats still true or adhered to.

"California's nurse-to-patient ratios, which were fully phased in by April 7, 2005, call for

one nurse for every two patients in the intensive care, critical care, and neonatal intensive care units, as well as in post-anesthesia recovery, labor and delivery, and when patients in the emergency room require intensive care.

One-to-three patient ratio is called for in step down units.

One-to-four patient ratio is required in antepartum, postpartum, pediatric care, and in the emergency room, telemetry, and other specialty care units.

One nurse for every five patients is required in medical-surgical units and

One for every six in psychiatric units."

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What state are you in? I thought that there were rules in some states about nurse pt ratio, like NY and CA. I read on the internet that in CA.... Dont know if thats still true or adhered to.

"California's nurse-to-patient ratios, which were fully phased in by April 7, 2005, call for

one nurse for every two patients in the intensive care, critical care, and neonatal intensive care units, as well as in post-anesthesia recovery, labor and delivery, and when patients in the emergency room require intensive care.

One-to-three patient ratio is called for in step down units.

One-to-four patient ratio is required in antepartum, postpartum, pediatric care, and in the emergency room, telemetry, and other specialty care units.

One nurse for every five patients is required in medical-surgical units and

One for every six in psychiatric units."

There is nothing like this in my state. I wish there were. Only 5 patients seems like a dream! I googled, no such law in my state.

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Specializes in Med-Surg, Cardiac.

Maybe instead of quitting and instead of refusing assignments which could jeopardize your job you could find someone on your floor who is handling their patient load well and ask them for advice on how to handle the load. Maybe they could turn into a mentor for you. I say that because you're a new grad and you will certainly improve in your ability to handle difficult loads so what seems impossible to you now may be doable after you've had more experience.

You can always keep your eyes open for other jobs while you're getting experience on this one.

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Specializes in Oncology; med/surg; geriatric; OB; CM.

I work nights and we can have as many as 8. I know at my facility on days they try not to give more than 5--depending on acuity & such. But everyone's version of acuity seems to be different.

When I was orienting to go back on the floor after 12 years, I was on days. I worked up to 6 patients by the last 2 weeks time. Once I went to nights I handled up to 8. Since being off orientation the most I've had on nights is 7 (now that I've said that I'll have 8 tonight!!).

I just work hard to remain organized from the beginning of the shift to the end & if I have a patient who's more difficult or someone who starts to have problems, I let my charge RN know and my co-workers know. We all help each other out when things get crazy.

I have taken advice on organization from just about all my preceptors and it's really worked for me! My patients are well-cared for and I generally get out on time!

Hope that helps!

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I don't have any good advice, but i just wanted to say good luck and stay strong! It does suck to be in that position. New grad jobs are ridiculously hard to come by so I suggest doing what you can to keep your position. The hospital might have a specific number of patient ratios they adhere by, try checking your hospital policy book?

I wish you the best of luck and keep those patients and yourself SAFE!

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Specializes in Ortho/Neuro/MedSurg.

I would be grateful to have an 8 pt assignment. I work nights and at my facility, I can have up to 12 pts. But, I usually avg 9/10 pts at night. And our assignments are not assigned according to acuity either. :crying2:

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Med surg was my most difficult job I have ever had. I empathize with you. I had eight patients on daylight, nine on evenings, and ten on nights. I was a new grad myself back then. I stuck it out for a year and then moved on. I think it is easier to get a new job when you still have your old job.

Are there any new grads with you? I bonded with the new grads along with the other more experience nurses while I was working there. Even though it was difficult work I was also surrounded by some of the nicest nurses.

I would never not accept a whole assignment. I have heard of people not accepting a patient to the floor because of the patient's acuity. It gets resolved and the patient goes to the correct floor. I never heard of anyone not accepting an entire assignment. Look up your state's Nurse Practice Act for better reference on this.

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I've worked in both California and Pennsylvania.

Pennsylvania, was pretty much the same deal 8 pt's on 7a and 10 pts on 7p, telemetry, it was stressful, difficult, but all of our assessments and etc. were q4 hours. As long as something, not unexpected occured, like a code, it went fine but awful otherwise. I felt at night, with 20 pt's on the unit, 10 pt's per RN and only two RN's on the floor wasn't necessary safe staffing, with no CNA.

In California, it's true we have the safe nurse to patient ratios. I'm on a cardiac step down and I have three patients but everything is q2 hours. So you are still always busy and when the doctors come in, there are always a ton of orders. But not stressful, but it is busy.

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Was the California nurse/patient ratio reached through the help of a strong nurses union there?

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