Is it just me? (Nurse/patient ratio related)

[devi, ADN, BSN]

Hope it's alright to put this under general discussion. I just wanted to get some other nurses' opinions on a new staffing grid that's supposedly going to be unveiled during our next unit meeting at work because I'm not sure if I'm overreacting.

I'm a new grad RN, a couple months shy of the one year mark. I work nights on a Surgical/Oncology floor. Mostly post-op orthopedic surgeries, abdominal surgeries, bariatric, etc. and maybe 1/4 Oncology patients, although we're seeing more and more of them and are working on getting all our nurses chemo certified. We also get medical overflow as well as many patients on telemetry. Assignments are not based on acuity.

When I was interviewing, I was told ratios were 1 nurse to 5-6 patients. The reality has been 6-7 patients per nurse and one PCT to anywhere from 10 to 30 patients. No LPNs.

On the rare night with 5 patients (only when we are accidentally "overstaffed"), it seems ideal to me. 6 is usually fine. 7 feels unsafe and is impossible most nights without cutting major corners. I often don't feel safe with 7 patients, and I leave work depressed after a night with that many. Of course, this is all relative. We all know that some days, 5 patients can be busier than 7, but I just mean in general.

There have been more and more nights with 7 patients and less with 6 lately. And now...word is that our staffing is being changed to a standard of 8 patients per nurse on nights. I've never taken 8 patients and can't even imagine it. IMO, it would be very unsafe for the patient and for our licenses.

So, I guess what I want to know is...AM I overreacting? Is this an acceptable ratio for the types of patients on my floor and I just "had it easy" with 6 or 7? I've never worked anywhere else, so I have nothing to compare to, but I'm just so upset about this and trying to figure out if it's just me (being a new grad, less developed time management, etc?) or if this would be unacceptable to even more experienced nurses.

Thanks in advance for your replies!

[tma0312]

i would start looking for a new job ASAP.

[Harleyhead]

8 Pts is too many I concur with tma start looking. That is just failure waiting around the corner.

[firstyearstudent]

The overnight nurses on our heme/onc floor get 4 patients, the day shift gets 3.

[Michelle15417]

I worked 3-11 on the same type of unit in a small community hospital. I am a 'newer' nurse, graduated in '05, and the stress of having 7 pts, usually including at least one with dementia, made me leave as soon as I passed my one-year mark. Like your own experience, no attention was paid to acuity of the patients we were assigned. We always had 1 LPN on this shift but they weren't allowed to do IV meds, admissions, d'/c's, so honestly, qualified as they were they really didn't help when I had this #patients plus doing their IVs. I can count on one hand the number of nights I had 5-6 patients and actually enjoyed doing my job. Forget teaching, listening, all the other nice things they teach you in nursing school. At least at this hospital, that was pure fantasy. I am now a home health nurse and love it, but the down-side is the long hours and the on-calls and weekends you have to do (in addition to the full work week). I'd still never go back to a hospital setting unless the nurses were unionized. I am very much in favor of unionizing in order that our profession can begin to enjoy the wages and benefits and fair treatment that we so much deserve. By the way, the nurses I worked with who had been there for years were just as stressed and frazzled as I was, sometimes breaking down in tears while racing down the hall to answer the next call bell. Our CNAs were union members and did as little as they could get away with, knowing full well their jobs were protected. They took every break they were entitled to and were out the door at precisely 23:00, no matter WHAT was going on. One last thing to anyone out there considering becoming a nurse. Although nurses certainly enjoy job security, the wages are an insult. Not including fringe benefits, here in the Pittsburgh area new RN's start at about $20-$22/hr. Many non-professional jobs that require anywhere from 3 to 6 months of training start at this same wage rate in our area. What's wrong with this picture?! Phew...thanks for letting me vent!

[sundayj]

Well, I worked at the Children's Hospital and our night shift ratio was 6 patients per nurse. That was manageable, really not too bad. Whoever did the assignment always tried to take into the account the acuity. My friend, who is also a nurse, works nights at an adult unit (Stroke). She takes 8 patients and often complains about how difficult it is and that she doesn't havea minute to sit and rest. I personally do think that 8 is too many to enjoy one's job.

[rabbitgirrl]

What they are asking (telling) you to do is ridiculous.

When I have been in similar staffing ratio situations, I felt like I was colluding in patient abuse by accepting the assignment. These aren't nursing jobs, they are butcher jobs.

Management knows what they are doing, they just don't care. If I were you, I would look for another job ASAP.

[surferbettycrocker]

i have to agree. look for a new job. the longer nurses stay in positions like that, and let's just be real, serving the needs of 8 people in general is exhausting, let alone sick people that could have an emergency at any time, the longer we accept ratios such as this, the longer mgmt will keep on giving this sort of ratio to RN"s. let's not run down the hall totally frazzled answering call bells. let's stop the abuse.

i like the skills part of nursing, i enjoy the pt. interaction but let's be serious here fellow nurses, do you really enjoy pt. interaction that much that you would suffer abuse at the hands of management by understaffing let alone abuse by pts-demented and otherwise and their families? i don't love anything enough to feel the way i do. tired, in pain and totally overworked at hte end of my shifts. it's not right for me or any of my fellow nurses. now i know bedside is tough, but does it have to be this tough all the time? sorry to bump this thread but i would love ot hear from my seasoned nurses out htere. how the heck did y'all last for so many years at bedside? wehre do you get the physical strength? and is hte secret to not take the abuse personally?

thanks for letting me vent!

[MikeyBSN]

When I started I often had 8 patients in the ER. On one night I might be giving blood to bed 1 because he's bleeding out into his GI tract but we have no beds in the ICU and now he's puking blood and his BP is tanking. But bed 2 "holding" for the CCU because her troponin is jumping and she keeps running V-tach and the amio has been "pending" from the pharmacy for 2 hours now. So while I'm waiting for that I'll try to put an IV in the IVDA in bed 3 who doesn't have a vein in her body and has abcsesses everywhere from "popping", but I'm distracted from this by the sickle-cell patient in bed 4 who keeps pulling the curtain open and demanding her diluadid because god forbid she goes more than 1 hour without another dose. Next I'll need to go to the nursing home patient in bed 5 because she has a fever of 104 and I know the no-nursing home didn't give her any tylenol and her HR is 150, which is why EMS said she was in SVT, but she is really just in sinus tach from being dry and sepic as she pobably hasn't been watered in 5 days. I'm sure I'll need to document her 10 bed-sores and change the foley with green sludge coming from it, but first she'll need blood cultures with a ton of antibiotics, which I'll have to mix myself because I just can't wait 7 hours for the pharmacy to send them. I feel bad for bed 6 because she's been puking on the floor for 10 minutes now but I just don't have time to go put a line in her and give her meds, plus I'm betting she'll need at least a CT, but first I'll have to fight with her to get a urine sample so I can be sure she isn't "preggers." I'm not too worried about the "abdominal pain" bed 7 because he has been here for exactly 57 seconds and he is already asking me for a sandwich. This wouldn't be so bad if his wife wasn't following me around everywhere because her husband is "hungry" and "in pain", which prevents me from doing everything that will allow me to get to her husband any time this century. Let's not forget that she wants a sandwich too. Meanwhile they're calling rapid response becaue my paient in bed 8 was down in CT when he had a seizure because the night shift left him "drunk" all night and now he is in ETOH withdrawal. Let's not forget my "hallway" patient who drank 3 pints of vodka and keeps getting off the stretcher and ******* on the floor. I'd have security restrain him, but security is busy with the psych patient who somehow climbed into a ceiling tile and won't come down, or I would put a foley in him if I could hold my breath that long. So...

Do I think that a medical floor nurse being so concerned about having 8 patients is overreacting? Maybe just a little. I think that our floor nurses always have at least 8.

[rizzle]

I think you and MikeyBSN should both look for new jobs. Oh, wait... he already did.

The situation you described sounds like a serious safety issue. It's unfortunate it's so common. :angryfire

In the end, you need to do what is right for you. Above all, do not put your license in jeopardy. That is your livelihood and you've worked too hard to come this far.

Just my

[newtress, LPN]

Wow, earlier in the day I was feeling so insignificant and bush league for becoming an LPN, but the experiences I am reading day after day of the emense responsibilities RN's have, I don't know if I want to further on trying to obtain the RN. The ratios are so unsafe for the patients, and so unsafe for the nurses who might end up loosing their license AND their minds.

[wooh, BSN, RN]

And when you regularly take 8 without too many people dying, then it will be 9 patients each. It's just going to keep going up and up until the money spent on extended hospitalizations and defending against lawsuits is obviously more money than paying for appropriate staffing. And don't forget that on top of "nursing" you also have to play cruise director and make sure the Press Gainey scores stay high!