Is this a normal work load?

[AddyRN07]

I work a weekend shift - Sat night and Sun night. I am an new grad and have been working for 5 months now. My patient load is 7 (usually I start with 6 and get an admit in the middle of the night). I work a trauma floor and there is a lot going on. This past weekend my 7 patients broke down like this -

1. PCA pump and orders for q1h dilaudid (which he called for every hour), NGT to wall suction, O2 per NC, abdominal incision with 2 penrose drains, central line with nurse drawing AM labs, and contact isolation.

2. Trach patient, contact isolation, quadrapeligic needing turned q2h, called q2h for pain meds, central line with nurse drawing AM labs.

3. Contact isolation, sterile dressing change, called q2h for pain meds.

4. NGT with TF, uncontrolled pain and called q1h for pain meds, central line with nurse drawing AM labs.

5. S/P open appy, Chest pain with Hx of MI, NPO but was trying to drink water anyway, central line with nurse drawing AM labs.

6. PCA pump, not much going on with patient other than recording pca med usage every 2 hrs.

7. S/P abdominal surgery, patient called for pain meds q2h. Not much going on other than that.

This is all in addition to giving scheduled meds and hanging IV fluids.

I was totally overwhelmed on Sat night, mainly because of the 5 AM lab draws, 3 contact isolations, and 3 PCA pumps (which have to be recorded every 2 hrs), and running all the PRN meds (i ran 24 PRN meds Saturday night). I talked with my supervisor and told her that was too much and I was overwhelmed. I requested that I not have all these patients again on Sunday night and that I would feel comfortable taking half of them. When I came in on Sunday I had every one of them again. She said "it'll be easier tonight because you already know them". Well it was not any easier at all. I ran 20 PRN meds sunday night - I guess she interprets that as easier??? Anyway, another graduate nurse that had a good patient load that was managable on Saturday night had half of his taken away and he got new patients. (note, his previous patient had not been discharged, she just changed his patients) Why couldn't she have changed MY patient load? We do have 2 techs - but they stay busy with their 19 patients each and can't really help much!!! I use my brain to manage my time. And on Sunday I decided to write out when I began a task and ended the task (medroom to exit pt room). I figured it up after my shift was over that I spent and average of 53 minutes an hour performing tasks and a total of 7 minutes charting. IS THIS NORMAL?????

Okay, I'm venting and my purpose is to find out if this in a "normal" patient load. This is the usual on the floor I work and I am thinking when my year contract is up I will be looking for something different.

[al7139, ASN, RN]

Good for you for looking at other options. I am a new grad on a cardiac/med unit. During the day shift, the nurses have 5-6 patients. On my shift (3-11pm) we get 6 patients, and the night shift gets 7pts most nights. Having worked all these shifts here (I will occasionally fill in or help out when the unit is short), I can see how these caseloads differ from shift to shift. Usually 7am to 3pm shift is the busiest, so the pt load is less, but if you have a tough assignment, it does not make a difference when you work. I have had night shifts when I have had 7 pts and I was bored. I have had 3-11pm shifts when I was lucky enough to have only 4 pts, but was there till 2am charting and playing catch up. And don't let anyone ever tell you that night shift (11pm-7am)is easy! This is when the "sundowners" come out to play, and the pt will code on you in a second! Let alone that call to the doc in the wee hours of the night, with a concern, and getting grief from them for waking them up!

The caseload is tough no matter what shift you work, but if you work on a stepdown unit, or ICU, 7 pts is WAY too much!

I had a load tonight I almost couldnt handle!

6 pts: 2 pts with AMS and high fall risks, one of which was combative. Said combative pt scratched me at start of shift and drew blood, so I had to do the employee exposure ppwk and bloodwork, etc. Threw my whole night off. Another pt who was having intractable pain that only had tylenol ordered, but I had to wait to talk to the doc, since he was in ICU on a code (I understood, the pt didn't!), and got a pt from PCU with an open abd wound with a specialized dressing I have never seen with orders for Q2hr dressing changes! (The day nurse had taken report, and never told me about this). We don't do Q2hr anything on my unit. When the pt was transferred, the RN left so fast that I didn't even see her face, let alone have time to ask her about the dressing! I went to my clin II who immediately called PCU and the PCS to let them know what was happening. Pcu got the order for dressing changes changed to PRN, and the PCU clinII came down to our unit to show me what to do, which was really nice of her, since she stayed past her shift to teach me.

What a crazy night! But I have also had nights with 6 pts when I was wishing for the book I was reading at home, so it depends on the pts.

Amy

[HappyJaxRN]

Wow. That's a heavy load. As for the people on the PCA's, you shouldn't have to give them extra pain medication unless it's break through medication. If you have to keep giving breakthrough medication, you can up the dose of pain medicine being delivered if the order is written that way, if not, I would get an order.

Wow....you guys have to check the PCA usuage every 2 hours? Ours is twice a shift, if we're lucky. If there are other things going on, it doesn't get done. If I don't have time, I just eye ball the syringe and make sure they have enough. I order another one in case they run out. That is one of the first things I do after checking my patients.

You just had too many high accuity patients. That doesn't seem fair. Was everyone else busy like that??? Personally, I don't think it's supposed to be like that, but I work on a speciality floor and the most we get are 4. We normally get 1, 2, or 3 patients. Our patients are ventalitated with or without VADs. Some on tube feeds, some with PCA's....but NEVER all three patients on all of that. YIKES! We draw blood from those with central lines and it may mean, all 3 or 4. I don't stress out about it. I'm only one person. I used to get upset, but I don't anymore. You are only 1 person. I would have to say something to my nurse manager about that one if it keeps happening. It just doesn't sound right.

[callmekipling]

Darn it, you used the "q" word didn't you!

I'm a CNA - but I see a lot of nurses, if you catch my drift round here, three or four's the standard. Seven sounds about right for my assignment (vitals qshift/q4h depending, changes & errands PRN).

I say it's the standard because sometimes you just don't have the people to cover.. could be they're looking frantically for another RN to put on nights and ease your load.. but if they were, it makes sense that they'd tell you, and we all know how mgmt decisions make sense..:trout:

Were I you I'd talk to your supervisor, see if there are any actions being taken to alleviate the problem, and if patience will mean things improving.

We used to call it cockroach syndrome at the LTC - you run around like a nut, hoping only to get as much done as you can before you get smooshed

[AddyRN07]

Nope, they are not looking for another nurse. We are "overstaffed" they say. We have 2 extra nurses scheduled for that shift and guess what, they either get called off or floated. So I don't have to ask if they are looking for someone to help out....I know the answer. I will say this however, I have almost perfected my time management skills in the last 5 months - I had too! It was sink or swim.

Well, I'm out the door in a couple hrs to do it all again! I'll update you all and let you know how this weekend went.

[bubbly]

I'm sorry you have such a hectic patient load, but I admire your stamina and time management skills! I think most new grads would have drowned. Congratulations for sticking through it! How much longer do you have left on your contract before you can try something new? :)

[rainfallrx]

It's heavy and it could have been solved by having PCA's with basal dosing along with the demand dosing- to heck with prn pushes that the RN has to do- that defeats the purpose of a PCA.

I agree with that!!!!!

[Danycejw2006]

That is a heavy load. I have heard of 7:1 on med-surg nights but I don't know about trauma units. Normally the highest is 6:1. So 7 is still pretty heavy.

[PedsED-RN]

I know how you are feeling. I am on an Ortho/Neuro unit, usually 5-6 patients during the day shift, sometimes 7 ( I have never had the joy of that yet). I have been there since August, (new grad), and sometimes wonder how the others do it. We have mostly surgical patients, some med/surg overflow. PCAs or PRN pain meds constantly, dressing changes, etc.

My first day off orientation and on my own I had the worst 6 patients possible, even for a seasoned nurse. Included a crani with a CSF drain in his forehead, he was in wrist restraints, with TPN in a single lumen portacath, and tons of IVP's and IVPB. So, everytime I had to disconnect the TPN and flush, admin, flush, re-hook TPN. MD's didn't want a periph. line, (understandable, but a pain).

I was stuck in that room the majority of the time, plus trying to keep up with 5 others, 3 were in contact isolation, (C-diff, so poopin all day too), everyone had multiple IVPB meds, etc.

I never thought I would make it through the day. It usually isn't TOO bad now, I have settled into a flow. I still wonder if acuity is taken into account at all though.

It is one thing to be busy, but SAFETY is my concern. How can appropriate care be given when the whole day is spent tasking? Days like that one I am unable to anticipate what may happen next, let alone be prepared for it.

I tell myself it is just because I am new, but other nurses tell me it is just plain crappy some days, and that is that. ?????

Needless to say, not the place I plan to stay forever, but I am definately getting my feet wet! I am keeping my eyes open already, since I have no specified time commitment, plus there are other issues on our unit that I won't get into.

Hang in there, just remember that everyday ends at some point, and the next one is bound to be somewhat better than the last!

Good luck!

[Stepher Gale]

I had a very bad night on Tuesday. Had eight patients & started the night running. Had two patients on PCA's, one patinent wanting pain med q 2hrs on the hour. Two of the getting out of bed and alarms going off, and one of my patients stroked out in the early morning, and I didn't even catch it. I had given the patient 10mg of Ambien at about 2130, and the patient was out! I feel so bad because I watch my patient's like a hawk, but I overlooked the signs because I thought it was the Ambien. I am really starting to rethink this career choice working in the hospital at nights. However, the work load sounds very simliar to mine.

[joeld311]

Maybe they are just really confident in your abilities! :)

Joel

I work a weekend shift - Sat night and Sun night. I am an new grad and have been working for 5 months now. My patient load is 7 (usually I start with 6 and get an admit in the middle of the night). I work a trauma floor and there is a lot going on. This past weekend my 7 patients broke down like this -

1. PCA pump and orders for q1h dilaudid (which he called for every hour), NGT to wall suction, O2 per NC, abdominal incision with 2 penrose drains, central line with nurse drawing AM labs, and contact isolation.

2. Trach patient, contact isolation, quadrapeligic needing turned q2h, called q2h for pain meds, central line with nurse drawing AM labs.

3. Contact isolation, sterile dressing change, called q2h for pain meds.

4. NGT with TF, uncontrolled pain and called q1h for pain meds, central line with nurse drawing AM labs.

5. S/P open appy, Chest pain with Hx of MI, NPO but was trying to drink water anyway, central line with nurse drawing AM labs.

6. PCA pump, not much going on with patient other than recording pca med usage every 2 hrs.

7. S/P abdominal surgery, patient called for pain meds q2h. Not much going on other than that.

This is all in addition to giving scheduled meds and hanging IV fluids.

I was totally overwhelmed on Sat night, mainly because of the 5 AM lab draws, 3 contact isolations, and 3 PCA pumps (which have to be recorded every 2 hrs), and running all the PRN meds (i ran 24 PRN meds Saturday night). I talked with my supervisor and told her that was too much and I was overwhelmed. I requested that I not have all these patients again on Sunday night and that I would feel comfortable taking half of them. When I came in on Sunday I had every one of them again. She said "it'll be easier tonight because you already know them". Well it was not any easier at all. I ran 20 PRN meds sunday night - I guess she interprets that as easier??? Anyway, another graduate nurse that had a good patient load that was managable on Saturday night had half of his taken away and he got new patients. (note, his previous patient had not been discharged, she just changed his patients) Why couldn't she have changed MY patient load? We do have 2 techs - but they stay busy with their 19 patients each and can't really help much!!! I use my brain to manage my time. And on Sunday I decided to write out when I began a task and ended the task (medroom to exit pt room). I figured it up after my shift was over that I spent and average of 53 minutes an hour performing tasks and a total of 7 minutes charting. IS THIS NORMAL?????

Okay, I'm venting and my purpose is to find out if this in a "normal" patient load. This is the usual on the floor I work and I am thinking when my year contract is up I will be looking for something different.

[Anagray, BSN]

I think this work load is extremely heavy and I commend you for sticking it out through the whole shift without leaving a nasty resignation note to your boss.

I am wondering why a patient on PCA requires q 1 hr pain meds..doesn't this beat the whole purpose of having the PCA? If a doctor prescribing this pain management is aware that this is what you had to go through plus of the fact that the patient has been in constant pain all night, someone needs to intevene to look at this whole pain management issue, because from you post it looked like 5 out of your 7 patients had pain issues.

I am really sorry that you have to work in such a difficult environment having been there myself. This is why I now work in the ER where I can address my patient's issues immmediately vs calling sleepy attending at night.

Best of luck to you and I am definit that this experience will shape you into a tough, intelligent supernurse.

Love, Nat