In the old days, 10 patients on med/surg?

[dudette10]

You gotta explain something to me about the ways things used to be. I see posts all the time about having an astronomical number of patients to care for "way back when." What was different then than now? I can, depending on acuity, manage seven on tele-med/surg, but a few of them (three, at least) would need to be independent with toileting and hygiene, and I would need a good CNA to work with.

Something had to be different, but I can't figure out what. Was it less charting? Was it more efficient floor layout? (There is one unit I work on that you have to walk a minimum of 30 feet one way from the closest room to get fresh water or non-Pyxis supplies, and it's 150 feet one way for the furthest room!) is it patient expectations? Is it fewer home meds? A combo of all?

[Farawyn]

I think I had much more than 10 on a team.

but, people often weren't as sick. Would check in the evening before surgery for their work up: h&p, anesthesia, labs, etc

Would stay longer, receive a leisurely w/u, a test today, another tomorrow etc.

still remember someone staying 7-10 days for r/o occult bleed. Person was fairly healthy, and could've been done as an OP.

Yes. Even in the 90s it was like this. During the day we had 8 patients at night it was 12, and if the off shift 11pm RN called in sick we took the whole side of the floor- 18 patients each! Yes, we did. Which was basically throwing pills at people and hoping they lived. The night CNAs and "orderlies" were awesome. They had to be.

[SHGR, MSN, RN, CNS]

I think I had much more than 10 on a team.

but, people often weren't as sick. Would check in the evening before surgery for their work up: h&p, anesthesia, labs, etc

Would stay longer, receive a leisurely w/u, a test today, another tomorrow etc.

still remember someone staying 7-10 days for r/o occult bleed. Person was fairly healthy, and could've been done as an OP.

People are so much sicker now. People are surviving now who would have, in the past, died from any of their multiple chronic conditions that all inter-relate. When they are in the hospital, they require more critical monitoring.

Anecdotal: In the 80's/90's there were signs that said "I&O" for the patients who were on I&O. As in, not everyone required such monitoring.

Also, regular units didn't have tele. I have been told that in the 60's or so that what differentiated the ICU from the other wards was... there was telemetry there.

[dudette10, MSN, RN]

Thank you for all your replies. At least administration had the good sense to lower our ratios as times have changed....except for one unfortunate poster in this thread.

[Cafelattee]

God I remember that crap as for charting a lot of time the charting was done after the next shift came on there just was not enough time to do meds, dressing changes, resp tx, lab draws. We did not have all the excess staff. We did not sit down. We ate at the desk and usually had a French fry in our mouth while whipping someone's butt. I'm not kidding. I've actually seen nursing get easier. My patients ratio/acuity have never been as hard then what I experienced in the 90's

I hold back wanting to respond to all the its so hard I had 5 patients today. I guess I also don't think they are more sick the difference is they just don't' stay as long. I had a step down patient with MRSA that remained with us for 9 months through numerous amputations, bedside debridements etc. I literally could smell the rot of my patients the minute I got off the elevator on my floor. We had so many rotting from the MRSA back then.

I haven't worked the floor/unit strictly for a long time. I've been float or ER since around 2000. The urban hospital of the 90's prepared me for anything. I haven't been overwhelmed by any thing since. The place was HELL!

[dah doh, BSN, RN]

I started nursing working night shift on a med-tele unit around 15 years ago. 10 patients was considered "a good night". I averaged 12-15 patients that were mostly total care type patients. We had a few CNA's to help with toileting, feeding, bathing, and vitals. I did assessments, passed meds, blood glucose checks, dressing changes, gave blood products, and GI preps. I also did telemetry monitoring, titrated cardiac drips, pulled arterial sheaths, covered for the registry LVN's IV meds, and did charge nurse. We charted on paper back then. My patients were never close together so I was constantly running around. I lost 15 pounds my first year as an RN. The CNA's felt bad for me & would gather up my charts & warm up my lunch and I'd eat as I charted at the nursing desk. I thought I'd lose my license if I continued with what I considered unsafe patient ratios; so I trained for ICU (who already had state mandated staffing ratios). Apparently I was correct because my state now has mandatory staffing ratios for all patient care areas...I think the unit I used to work on has a max of 4 tele patients & 5 non-tele patients.

[NanikRN]

I,too, remember the days of higher pt load. But i also remember that pts came in the night before surgery, stayed longer and pt acuity was much more mixed. In onc, pts that would be admitted for 3-4 days for chemo and pts now go to outpatient for that same treatment.

Not that pts werent sick-of course they were But along with those acute pts, there were also lesser acuity pts as well

[TiffyRN, BSN, PhD]

I remember one night being floated from my usual Stepdown unit (3-4 pts each there) to the general med-surg floor; would have been in the mid-1990's. Commonly known throughout the hospital as the "The Black Hole of Calcutta". The Stepdown unit lost me and an LPN that night; my best friend at work. When we arrived at the "Black Hole" we were informed that as an RN and LPN, we could be teamed together if we liked along with a CNA. Our assignment: 19 patients. Lots of total cares unlike what I heard other nurses talking about the "old days". Quite a few with IVs. I think between the two of us we restarted 3-4 that night. Including the little old lady on "renal" dose dopamine (no monitor on this floor). The CNA assigned to us was amazing, did turn rounds on her own; only called if the patient was large.

We were very busy, but we were both experienced and had pretty decent time management skills.

We also missed out an a horrible code on our floor. Literally blood splattering around the room. Everyone there seriously traumatized. Kind of made me not hate getting floated.

That was a one time event and the charge nurse said our assignment was usual for that floor.

Next story comes from the late 1990's. Another hospital I worked at had several telemetry "pods" and on two of them, the nurses worked in pairs with 6-7 patients each. Those two pods shared a tech. The third pod had 10 beds where they assigned 1 RN and one tech. That was usually me. This was a place where there were seriously good techs; you know the kind that actually answered call lights, took people to the BR, and threw snacks at them to appease them until the nurse could get around to them. I was intensely busy until about 11 or so, then it was pretty calm and steady.

[Jm0136]

I have worked as an RN in ltc for six years, and recently accepted a day shift job on a medical floor. The ratios are usually 6 patients to one RN plus one tech per 10 patients. There will be a free charge most days. I do not think the acuity is too terribly high. The charting is all epic and the meds are pixis dispensed and scanned. Any thought on this? I know I will be busy, and I'm not anxious about working hard. I just want to be ale to provide good care to my patients.

[Anna S, RN]

I've had more than ten pts in Med-Surg in the early 2000s. No CNA, no LPN. Pts very acute.

That's why I quit and have never gone back to Med/Surg. :)

[blackribbon]

Do you know this to be the truth or only what they told you and is the ideal. Sounds like my floor...except I was hired for night shift (my preference)..I was told the ratio was 1:5...turns out that is day shift's numbers not night shift. The techs are assigned 10-12 patients each...their rotation for breaks means that there are usually only 2 covering 30-36 patients except at the beginning and the end of shift. And our charge nurse usually carries 2-3 patients but on short days, I've seen her doing 5-6 when we started short and had a wave of admits. Day shift also has a nurse specialtist that floats and lends a hand. We don't have that at night. We use epic and pyxis but that doesn't mean the patient specific meds show up in the pyxis when they are supposed to or that computers sign on when we need to scan that emergency med. I think that 6 patients on days sounds like you will be very busy. We do have a computer and a vital signs machine dedicated to each room...that helps a lot.

[CapeCodMermaid, RN]

I work in a skilled nursing facility...y'all would call it a nursing home. We participate in the Medicare waiver so we get patients straight from the ER. My nurses on the post acute (HA! nothing post acute about many of them) have 15 patients each when the unit is full. We have, out of a 46 bed unit, an average of 10 IVs,we insert PICCs and MidLines, Life Vests, Gtubes, wound vacs, chest tubes, nebs q2 hours, PRNs and more regulations than the nuclear power industry. Add to that pesky families who treat my nurses in a way they would never dare treat a hospital nurse, and it adds up to piles of stress and unhappy staff. No one is content these days with the patient load, but unfortunately, there is very little we an do.

[RN_SummerSeas, MSN, APRN, NP]

I work in a skilled nursing facility...y'all would call it a nursing home. We participate in the Medicare waiver so we get patients straight from the ER. My nurses on the post acute (HA! nothing post acute about many of them) have 15 patients each when the unit is full. We have, out of a 46 bed unit, an average of 10 IVs,we insert PICCs and MidLines, Life Vests, Gtubes, wound vacs, chest tubes, nebs q2 hours, PRNs and more regulations than the nuclear power industry. Add to that pesky families who treat my nurses in a way they would never dare treat a hospital nurse, and it adds up to piles of stress and unhappy staff. No one is content these days with the patient load, but unfortunately, there is very little we an do.

I may have actually looked at going back to a SNF if I had ever found a place with such high acuity. I know it is hard and the ratio isn't good but the experience would be phenomenal!