How many patients is/are too many?

Nurses General Nursing

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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?

Specializes in LTC, Memory loss, PDN.

When I started in med surge, average patient load was 8. We had IV teams, urinary techs, etc., so 8 patients kept you busy, but it was manageable and I loved my job. When the average load went up to 10 patients, things went south, but I thought it will get better again. When it went up to 12 patients I submitted my resignation.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
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 is the only state in the union that has legally mandated nurse/patient ratios. Unfortunately, the other 49 states do not have any ratios that have been enacted into law.
Specializes in LTC.

I have about 25 each night. Would love to have 7.

I have about 25 each night. Would love to have 7.

Do you work in acute care? On a med /surg?

We start our own ivs, no wound nurse, nary a tech to be found. 1 tech for the floor they are too busy to help. They work hard hard hard, and then they quit if they are smart.

No wonder it is so hard to get an RN job in Cali, sounds like a dream!!!!

Instead of anonymously complaining, why not approach your nurse manager with these patient safety issues?

I work Med/Surg and we have no more than 7 patients, often starting with 6 and getting an admit during the night. Many nights though I start with 7 and then those with 6 get the admits. Once or twice a year we may have to take 8 if extra help can't be found and we get slammed. That being said I work at a great non-profit Catholic hospital. All the other hospitals in the area the night staff has from 8-9 patients and I know this from nurses who have gone elsewhere and then come back to work where I do.

If you quit I doubt you are going to find a better situation, only more of the same assuming you can even find another position at all. I would suggest that you work on your organizational skills and your routine, especially since you say your are new. Analyze what you do and when you do it, what can be cut back on, what can be delegated, what can be skipped entirely. Examine your routine with a very critical eye and I think you can organize yourself in a manner that makes you feel less crazed.

It's terribly hard being newish at this, for many it seems to take 2-3 years before they feel together, organized and can get everything done and out of work on time. They don't tell you about this learning curve in nursing school, they graduate you with graduates thinking they are ready to go to work with a smooth transition.

If you think none of this will help you I would suggest looking into a transfer, however many places won't transfer unless you have been employed for one year.

Even though you are stressed and harassed, you are learning valuable skills every day. I also need to add that in 35 years of nursing I have never worked at a single place where staff did not constantly b**** about being shorthanded.

Specializes in LTC.
Do you work in acute care? On a med /surg?

We start our own ivs, no wound nurse, nary a tech to be found. 1 tech for the floor they are too busy to help. They work hard hard hard, and then they quit if they are smart.

No wonder it is so hard to get an RN job in Cali, sounds like a dream!!!!

Even worse.. LTC/Short term rehab.

21-27 patients. I have a 5 hour medpass, 4-5 CNAs who work their tails off so I still find myself toileting, answering call lights, passing trays and feeding during the 5 hour medpass and also calling doctors, picking up orders, charting, treatments, hanging g-tube feedings, putting out fires etc.. and lets just hope no admission comes through the doors.

Specializes in LTC, med/surg, hospice.

We range between 5-8 pts on the night shift...this is on a medical floor. It's not based on acuity so sometimes the person with 5 patients is busier than the one with 8.

Specializes in Plastics. General Surgery. ITU. Oncology.

Back in the Dark Ages my Plastics ward had a ratio of 1 nurse to 10 patients. I know that sounds a lot but most of our patients were young and self-caring with the exception of the big flap reconstructions who needed close post-op monitoring. Sister knew this and would make sure an extra nurse was on duty if we had a big reconstruction scheduled. Plus we had a lot of brilliant HCA's

1 to 10 sounds bad? My next surgical ward was a nightmare. Big stuff like total gastrectomy and oesophagectomy went on on there. Nurse ratio...1 to 12. One HCA for the entire 34 bedded ward, No HCA working just with you like it was before.

It was dangerous. End of. I was constantly fighting to keep the post-op patients alive and could not give proper care to the less acutely ill. Thus we were constantly complained about by relatives and recovering patients.

I quit. Went to a specialist Oncology unit with a worldwide good reputation and a ratio of 4 patients to ! nurse.

Specializes in Critical Care.
Was the California nurse/patient ratio reached through the help of a strong nurses union there?

The California ratios were based on Evidence that showed a sudden increase in morbidity/mortality rates for every patient assigned to an RN beyond the ratios they set (I think it was about a 7% increase in mortality for every patient over the threshhold).

The evidence based ratios were successfully made law by the California Nurses Association, which has since teamed other with some other state-wide unions to form National Nurses United, the largest Nursing Union in the U.S.

My state is an ANA dominated state, and we have a "safe staffing" law. Unfortunately, the ANA in their infinite wisdom thought that the California law was too rigid. So our law says that the Nursing profession can "suggest" to Hospital administrators what they think the ratios should be, and then the administrators can choose to either abide by them, or ignore them; guess which one they have all chosen so far? (The ANA is worthless).

The California ratios were based on Evidence that showed a sudden increase in morbidity/mortality rates for every patient assigned to an RN beyond the ratios they set (I think it was about a 7% increase in mortality for every patient over the threshhold).

The evidence based ratios were successfully made law by the California Nurses Association, which has since teamed other with some other state-wide unions to form National Nurses United, the largest Nursing Union in the U.S.

My state is an ANA dominated state, and we have a "safe staffing" law. Unfortunately, the ANA in their infinite wisdom thought that the California law was too rigid. So our law says that the Nursing profession can "suggest" to Hospital administrators what they think the ratios should be, and then the administrators can choose to either abide by them, or ignore them; guess which one they have all chosen so far? (The ANA is worthless).

As we say in Brooklyn, they're about as useful as tits on a bull! JMHO and my NY$0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

Instead of anonymously complaining, why not approach your nurse manager with these patient safety issues?

Yeah sure, that will go well. She will get rid of me. I cant afford to leave until I am ready. When I give my notice I will tell them why I am leaving. I have a second interview in january and I am crossing my fingers it goes well and I can find a safer situation.

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