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

MikeyBSN · Apr 13, 2009

Mikey,
It sounds to me like you work in a pathetic hospital. "God forbid" the pt in sickle cell crisis should have to go for more than an hour without another dose? That is certainly a hideous point of view that i can only hope is based on your large patient load and subsequently frazzled mind, and not a lack of knowledge or empathy.
OP,
In my last med surg job, i had 6 pts almost all the time. That was too many as well, but it was possible to provide adequate care just barely with a little luck. I would certainly refuse 8 pts (or 7 for that matter).

First, our staffing situation has improved, but the point is that it was manageable. In comparison, our hospital is better than most, in many areas. I've also worked at other hospitals and I believe that our nurses are much, much more skilled and capable than others. Our administrative policies are also better. I've taken assignments where I had 6-8 "holding" patients, both tele and med surge (sometimes with an ICU patient in there). Although I don't really like to "hold" floor patients, I find that holding patients is infinitely less arduous than managing patients when they first arrive, and after working their initial admission orders..

Second, I'm not sure how not being able to give someone dilaudid, sometimes up to 8 mg at a time, every hour on the hour, represents a frazzled mind, lack or knowledge or lack of empathy. Especially since these patients are often written for pain meds q4 or q3 hours on the floor, and usually at much lower doeses. Futher, I don't see how concentrating on patients who are dying represents a lack of knowledge on anything, considering that fact that dilauded does not prevent sickling and therefore is only thereputic for pain manangement. You would delay working up a new patient when you didn't know what what wrong with them, and devert attention from two critical patients to give pain medicaiton to a patient who has received pain medication one hour ago and is stable enough to walk into another person's area and start yelling? What kind of priortiziation skill is that? I don't think I'm the one with the lack of knowledge here. If you think I have lack of "empathy" because I'm distracted by someone who has the aduacity to come into another sick person's area and demand a second or third dose pain medicine within 1 or 2 hours, then I would question your definition of "empathy".

nicu4me · Apr 13, 2009

I was told that i would be better off going to an intensive care unit and deal with all that implies and it would be safer than losing my license on a med/sur/tele floor with 7-9 patiens. There is a higher standard of care usually in an ICU. Got out of there and while I am afraid of my lack of knowledge, I totally understood the risks I was taking at the old job. Start writing up unsafe staffing on your QCR's (quality control reports). Had written up the house sup before because she says get your dead patient's room cleaned out because we have somene down here in Er that is crashing and there are no other tele beds. Oh, ok, I have 6 other patients plus this death, I will tell them to move on. Or, out of your 7 which one can you take off tele - we have a new admit and we don't have enough tele packs.....ok, I have to call a hospitalist that doesn't know my patients and explaint to him what I need, giving him a run down on my pts. that I have known for exactly 2 hours. Or having the 30 patients in 3 long hallways with 4 nurses and 2 PCT's. Try splitting those numbers up. All three nurses have to be split which means that we try not to leave the hallway by itself. This is a top 100 hospital! And, since I quit, they haven't replaced me or the other one that quit too, so staffing never improved. They have just stopped hiring. And the new job..... gotta love, but no more bonus and no raise this year. But I love it and while there is a steep learning curve, I know eventually I will be as good as I was when I left that other unit. Think about where you work and what you want to put up with. I told my friend when I left, I think we are all in a little war together but we're too stupid to leave.

MikeyBSN · Apr 13, 2009

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.

Butcher jobs? Nurse-patient ratios have generally decreased over the years, not increased. Salaries have also increased, as ratios have decreased. I'm sure that managers care that their nurses have to work sometimes, but they care more about the hospital going out of business, everyone losing their job, and all the patients losing their hospital.

MikeyBSN · Apr 13, 2009

Devi, I think you have a good reason to be worried about this nurse/pt ratio. I also work on a med surge/onc unit. I am on days and now we usually have 6 pts. When I started 4 yrs ago we had 5. Our night shift nurses have 8 pts. We work in teams, RN and CNA. I am so disapointed the nurse/pt ratio is going up. These cancer pts require/deserve/need more time and special attention. There is no way I can give it to them when we have 6 pts during the day!!!! It is unsafe and sad at the same time. In my area of the country, I think this is common practice......I wish I could have 4 pts and spoil the hell out of them. Now I am barely keeping up.
To Mikey from ER.....You seem to be saying ER pts are so much harder/more acute and we should be able to manage 8pts at a time too?? At least you have docs on the floor......I deal with the exact same kind of pts on my unit. GI bleeding, crazy bad ETOH w/d, SOB spo2 at 80 % on 5L nc, really sick dying cancer pts with temps 104 who need nausea/ pain meds Q2/and are getting CHEMO!!!!! They f*****g DESERVE to get their meds on time!!!! And my pts are supposed to be stable! Its BS!!! And management tells us our pt satisfaction is going downhill...GEE I wonder why??? Sorry for venting...I think my problem is I actually care about the pts. I want to do a good job for them. We are just set up for failure though when they keep upping the nurse/pt ratio.

It is largely recognized that ED nurse-to-pt ratios should be lower than those of the medical floor. I'm not saying that working oncology is easy. If you have a patient on your med-surg floor with an spo2 sat of 80 percent, who is not a DNR, then that patient shouldn't have gone to your floor and that is something you need to bring up with your MOD. Yes, both floor and ED nursing is hard sometimes, but the fact is that if 8 ED patients are manageable, then certainly 8 floor patients are manageble. It might not be ideal, but sometimes that isn't reality. Do you want to make 10 dollars and hour and have your ratio 1:3, or do you want to keep your pay at the same amount with a 1:3 ratio and be out of the job in 6 months when your hospital declares bankrupcy?

wooh, BSN, RN · Apr 13, 2009

Can we please not turn this into an ER vs floor debate? Absolutely, the floor isn't dealing with the issues of the ER, but there's a lot of things we have to do on the floor that the ED doesn't have to deal with. How often in your ED are you hanging chemo? Or complicated discharge planning with home health needs that insurance isn't going to pay for? Or you know, curing the patients instead of just getting them stable? Your job is tough, we get it, it doesn't mean ours isn't just as difficult.

MikeyBSN · Apr 13, 2009

Can we please not turn this into an ER vs floor debate? Absolutely, the floor isn't dealing with the issues of the ER, but there's a lot of things we have to do on the floor that the ED doesn't have to deal with. How often in your ED are you hanging chemo? Or complicated discharge planning with home health needs that insurance isn't going to pay for? Or you know, curing the patients instead of just getting them stable? Your job is tough, we get it, it doesn't mean ours isn't just as difficult.

There is hardly a "debate", every organization I've seen, along with the State of California, agree that the ED ration should be less than that on the floors. If we are holding a patient, sometimes for the entire duration of their stay, we have to do everything for them that a regular floor nurse would have to do. We sometimes discharge admitted patients form the ED. This is in addition to the new patients we get, which might be ICU, CCU or tele patients. However, I wasn't trying to turn this into a debate. He asked if it was unreasonable for him to complain about a 1:8 ratio on the floor at night. I answered in the affirmative and gave reasons.

rabbitgirrl · Apr 14, 2009

Butcher jobs? Nurse-patient ratios have generally decreased over the years, not increased. Salaries have also increased, as ratios have decreased. I'm sure that managers care that their nurses have to work sometimes, but they care more about the hospital going out of business, everyone losing their job, and all the patients losing their hospital.

Ratios have gone down? Care to back that up with some figures from a reliable source? Did you remember to factor in that pt acuity has risen steadily in the last few decades as well as the complexity of medical treatments and the scope of nursing practice?

There is quite a difference between the "nurses having to work" and being too busy to take a pee in 12 hours. I am embarrassed on your behalf for making the inference that nurses are lazy.

If you think that the situation you described your workplace to be is safe, then you are not a prudent nurse, and I wouldn't want you to care for me or my family.

Seems you think that the big, bad nurses are overpaid, and that the poor widdle hospitals are the victims. Sorry chief, that one doesn't fly either.

Clearly, you don't mind being a butcher--seems you are proud of it, but personally, I do mind neither of us have any business taking assignments like this.

OrthoRN09 · Apr 14, 2009

In my facility (on a busy ortho trauma unit), day ratio is 1:3 and night ratio is 1:4-6 depending on acuity. I make well over $10/hour and we are not union.

BradleyRN · Apr 14, 2009

I'm not sure how not being able to give someone dilaudid, sometimes up to 8 mg at a time, every hour on the hour, represents a frazzled mind, lack or knowledge or lack of empathy. Especially since these patients are often written for pain meds q4 or q3 hours on the floor, and usually at much lower doeses. Futher, I don't see how concentrating on patients who are dying represents a lack of knowledge on anything, considering that fact that dilauded does not prevent sickling and therefore is only thereputic for pain manangement.

the fact is that if 8 ED patients are manageable, then certainly 8 floor patients are manageble.

I only suggested that i hoped you were frazzled by a high pt load rather than lacking empathy. "God forbid" a pt in sickle cell crisis would have to wait for their pain meds certainly seemed like a point of view that only a battered nurse could have. Now, you wonder how the pt could have the "audacity" to want pain medicine?? Certainly the Dilaudid is "only therapeutic for pain management". That is the whole point! Dont stand here and tell a med surg nurse that they should be able to handle 8 pts since you can in the ED, because clearly you CANNOT! If you call an inability to deliver antiemetics and pain meds in a timely manner "manageable", then you clearly dont know the meaning of the word. Ask the pt in pain and the other that cant quit throwing up if they thought you were managing. Ask their loved ones the same question.

My question has been answered. "The fact is that if 8 ED pts are manageable", and your description is "managing", then you have set quite a low bar for quality. You may want to warn your patients when they walk in the door so they dont accidentally trip over it! :down:

blondy2061h, MSN, RN · Apr 14, 2009

Hey Mickey, have you ever done oncology?

BradleyRN · Apr 17, 2009

I am embarrassed on your behalf for making the inference that nurses are lazy.
If you think that the situation you described your workplace to be is safe, then you are not a prudent nurse, and I wouldn't want you to care for me or my family.
Clearly, you don't mind being a butcher--seems you are proud of it

Indeed...i dont know why anyone would be proud of having to pick who to neglect next, and how they could call such a situation "manageable". Unbelievable!

MikeyBSN · Apr 17, 2009

Indeed...i dont know why anyone would be proud of having to pick who to neglect next, and how they could call such a situation "manageable". Unbelievable!

I suppose one could employ some intellectual dishonesty and refer to the key nursing skill of prioritization, heavily tested on the modern NCLEX, as "who to neglect next." That doesn't change the fact that prioritization is a part of nursing, and that you are never going to be able to treat all of your patients at once. I'm sure that your patients always get their 9am meds at 9am, and not 9:15, 9:30, or even 10am. I'm sure your patient in room 10 and her tummy ache never has to wait for her pepcid because another patient is sicker. Oh wait, that's your point. I guess we should hire 15 nurses so that you have 15 nurses on a regular floor over night so that bed 10 will always get her pepcid at exactly 9am, and then all of you are done passing meds for the next 8 hours. Yes, it all makes perfect sense now.