Is this too much or am I crazy...what are your units like?

Virgo_RN, BSN, RN · Feb 2, 2009

Sounds like too much to me.

JennRN65 · Feb 2, 2009

You had every right to be overwhelmed.

You had three ICU patients......Pt 2, 3 and 4. Then you had an additional 3 patients....

That was an very unsafe assignment.......

truern · Feb 2, 2009

We don't do insulin gtts on the floor...or anything that requires q30min VS.

ONCE I took a pt with q1h IV lopressor as a favor to the MD. Never again. Floor nurses just don't have the time with our patient loads

You're not crazy...that IS too much!!

studentgrl · Feb 2, 2009

i also work on a 40 bed tele unit in the inner city. i understand what your going thru, most day are "bad" days meaning super busy, having no time to pee or eat, giving report to day nurse when my stomach is growling like crazy, eating my packed meal in the car while im driving home in traffic, running out of blankets/applesauce/blank paper documents on the floor, sometimes we end up only having ONE freaking CNA for the night so we have to do some vitals!! i usually start out with 6 pts at night and one admission during the night. what kind of floor has no coffee on the floor? us! we have to go to the vending machine on a different floor and buy it ourselves. when i go home i cant even sleep cuz im replaying all this crazy stuff that went on during the night and what i could have done better or go online and study something i wasnt sure of. i definitely see myself having a heart attack from all this stress later when im older. its just so hard to get a job in the university hospitals that have better patient ratio because theyre on a budget freeze and not hiring outside the hospital and i started out as a new grad last year. so im planning to stay for couple years and go into a less stressful area of nursing like OR or maybe go back to school because the university hospitals pay for the tuition. currently my floor night shift have 4 openings. anywayssssss.......... gotta go to work now.

Virgo_RN, BSN, RN · Feb 3, 2009

Our protocol is anything that requires Q15 VS for more than 2 hours goes to ICU.

anonymurse · Feb 3, 2009

We are crazy. Everyone asks "How can you stand it?" We love it, we love the reputation our floor has, and the nights fly by. It might seem like we complain too much, but it's really bragging.

LadyTiger44 · Feb 19, 2009

On our unit it is against our protocol also to take anything with q2 hr or more frequent anything on the floor it either goes to the PCU or ICU. We dont take insulin gtts either. We take some gtts, but are limited. I think it sounds like a very unsafe assignment. Our charge nurse would have been calling the administrator about the drs who were saying the pts could be there when they needed ICU. We are also an inner city hospital, 50 something bed unit split on two floors with about 12 PCU beds.

Our normal nurse to pt ratio on days is 1:4, nights does take 1:5 but never more than that.

steelcityrn, RN · Feb 19, 2009

If you are unhappy with your job, find another one. When or if you have a exit interview, be sure to state why you were unhappy there.

MatthewRN · Feb 21, 2009

From what I understand, the tele units at my hospital don't take very many gtts at all. Several times in the past couple months we've gotten otherwise stable patients transferred to our CCU just because they needed an insulin gtt.

tdern · Mar 10, 2009

First off, sorry for the length and the spelling/grammar errors...its been a long night.
I work nights on a busy 33-bed telemetry floor at an inner-city nonprofit hospital. I am a new grad and have been on this floor for 1 year and 4 months and I just finished training for charge. Our administrators have been making a big push to consider our floor a CICU step-down unit (but so far without the national certification). When I began working on this floor I had 4-5 patients during nights. There has since been a high turnover of staff, many RN's are moving to CCU/ICU and I find myself some nights being the most senior person on the floor. We are in a budget crunch and now are staffed 1:6 at nights with 2 CNAs and 2 monitor techs. We are accepting more complex pts, more confused/total cares and pts with gtts we've never worked with. Ok I apologize regarding the following text if it makes little-to-no sense...I would just like your opinion on the acuity of my pts this shift. how many do you take and whats your acuity? Do you think I am crazy for thinking this is too much?
Tonight I started with 5 pts and then got an ICU transfer for a total of 6.
Pt1- chf exasc, leg ulcer, chest pain (frequently on the call light for pain meds, random tasks...one of "the needy types" as horrible as that sounds.
Pt2-my icu transfer, anemic h/h (7and 21), here with SOB/CP and CHF exas) on an insulin gtt (our protocol states chemsticks q 1 hr) and just finished her 1st of 3units RBCs when arrived on the floor. MD did not order lasix between units Paged MD, did not hear back. Pt initially, stable until 15 minutes into 2nd unit of blood, then her temp spiked, o2 sats down to 80s on 6Lo2, lungs increasingly coorifice. I stopped blood called MD, and demanded lasix, benadryl and that she be transfered back to unit
Pt3- chf exasc on a dobutamine gtt going at 7.5mcg/kg/ (our unit protocol states we can't take dobu >5 mcgs but CCU/ICU full and pt "stable" so MD allowed pt on my unit)
Pt4- heparin gtt and morphine PCA, s/p fem-pop and then an emergency thrombectomy...most likely going to lose her leg...dealing with low BP/urine output and tachycardia as well as pain thru HS... poss shock? should have been sent to CCU/ICU but only 1 bed left in each reserved for codes
Pt 5 32 y/o with CP, frequent requests for dilaudid, trops (-), ct abd, lungs and angio (-)
Pt 6 another young pt with CP, turns out was gastroparesis...my only pt that was low acuity except for the frequent requests for $ from her husband spending the night
What types of gtts and what pts do you see? We used to take a limited # of gtts (amio,cardizem, dobutamine, dopamine, insulin, heparin and protonix) and now we are getting alcohol gtts, lasix gtts, isuprel, higher rates of dobutamine) and pts who require q 30 min vitals, bed alarms, turns q 2 hrs, and more and more confused people. To top this all off our staff is almost entirely new grads at nights who need a lot of assistance. Is this what its like on your floors or am I crazy for feeling overwhelmed? Thanks for the input.

I work on an ICU sister unit/ step down unit. We only do heparin drips d/t a heparin protocol that's in place. We do cardizem drips, but only if it is a set drip that doesn't have to be titrated. Any other drips that require titration, frequent vs, are put in the unit where the ratio is 1:2. We have 5 to 6 patients each, and one CNA, and if we're lucky, a tele tech. I refuse to take any more than 6 patients. We have an acuity system which is supposed to correlate to the nurse's expertise level, which is how they "get away" with giving you 4 "high" and 2 "medium" acuity patients. The situation you describe was awful, and I'm sorry that you were exposed to that kind of mismanagement. I hope your situation improves quickly or I would be inclined to find another position. There are times I want to leave and not let the door hit me in the backside as I leave and our floor is nowhere near the disaster you described. And get this, our hospital just received Magnet status. Be safe, Be happy!!!

DaveMac · Mar 11, 2009

First off, sorry to hear about the load that you had here. As many nurses will say, been there, done that. :banghead: That does not make it better. I have left areas where this type of staffing have been the norm. With the units being so full, I can understand why the patients were on your floor. But at the same time, the load that you mentioned should have been covered by at least 2 nurses. :nurse: :nurse:

The cardio unit where I work we usually have only no more than 3 patients. There are times where we my go up to 5 for about 4 hours. :yeah:

Hope you find a good unit to work, it took me a few years to find one Don't give up and don't let them get you down. :typing