Looking for Advice-New Grad, 8 patients?

Specialties Med-Surg

Published

Hello,

I recently interviewed for a position that would be for nights on a med-surg floor. One of the floors may even be telemetry (interviewed for multiple open med-surg positions). I was told that during nights I will have up to 8 patients. I am guessing on busy days it may be even more. Orientation would be for at least 6 weeks (on days) and could be extended if needed. Do you think this can be handled by a new grad? Did anyone else start off with ratios like this? Thoughts? Suggestions? I really value everyone's opinion on this board! Thanks!

Specializes in LTC, Medical, Telemetry.

Don't fall into the habit of understanding patient assignments in terms of numbers. Focus more on accuity and appropriateness of patient assignments to determine safety, not merely the number of patients you are responsible for.

If it was mentioned during the interview, its likely they told you the higher end of pt ratio to gauge your reaction and confidence. 8:1 is a little high, but I have done it before safely. If all 8 patients are stable, A+O, walkie-talkies; it can be done. If 3 are immediate post-op, 2 total cares on contact precautions, 2 demented/ETOH withdrawal, and one who is crashing from a cardiac event - this ratio could be a BIG problem.

Play it by ear, pay attention to the morale of floor staff. If you are brand new, I am sure (I hope anyway) they will ease you into it and not throw you in a situation that is unsafe. Besides, patients sleep all night anyway so you won't actually be doing a whole lot :rotfl::rotfl::rotfl:

For the haters, I work nights and the above was indeed a joke. :smokin:

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Specializes in MS, ED.

Second the above post - numbers don't mean much when you don't know how sick these patients are or how helpful (or not) your coworkers will be. My floor (as a new grad) had 1:6 days and 1:7-10 at night. I went to nights after a few months off orientation and regularly had 7-9 patients...

but IME, it was hell. Our floor was 'general surg' but in the last two years, due to declining patient census, started to gradually take anything that rolls down the hallway. Head injuries, detox, ortho, trauma, renal, onc, hospice...OY. I felt unprepared for some of the patients we received - mostly written for hard tele or step-down but no beds available, so 'downgraded' to us, conveniently - and my coworkers were pretty brutal. We frequently only had one (or no) tech to 40+ beds. Too much work for one nurse, period. I spent the last year holding my breath and thanking my lucky stars for a few really tough (but kind) nurses on our sister unit who helped me when patients went bad. I put in my time, it toughened me up, and now I'm awaiting a transfer. Hopefully things will go better for you!

I agree with the previous post that suggested you shadow if they will allow it. Meeting some of your coworkers, asking some key questions, (i.e., "what do you feel are the challenges of working on this unit", etc), may clue you in to the culture of that particular floor. In any case, good luck!

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I agree that it depends more on the acuity than the number of patients you will be assigned, although 8 still sounds a bit excessive. I worked on a M/S surg floor with a patient to nurse ratio of 4:1 on days, and although that sounds great, our patient acuities were very high. I agree that you should request to shadow an RN at the facility before agreeing to take a position, especially if this will be your first job after nursing school.

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Specializes in Triage, MedSurg, MomBaby, Peds, HH.

Eight patients, even at night?? On our Med-Surge floor we complain if we have five.

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On days, average 6-8 and no techs, or maybe 1 tech for the whole floor.

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Specializes in Utilization Management; Case Management.

wow...memories! I've lived that life. Had 10 patients once in my life...in 2011 btw no lpns or anything like that. A floor of 30 patients with 3 RNs... Most nights it was 4 RNs 8 patients a piece, 2 CNAs but 1 gets taken bc we need a sitter and no secretary. It's crazy bc now that I'm training on days I still have the habit of putting in my own orders. I'm in Critical care now, just finished a rotation on an ICU step down unit and now I'm doing my ICU orientation. I'm glad I had the crazy medsurg experience I had and at times I'm still running as if I have 8. That was the norm for my hospital tho. The girls on my old floor say the staffing has been WAY better lately so they have had 5-6 maybe 7 some nights. But yea, that 8 patient thing was my life for almost a year. Most nights I wanted to start with 8 bc if I started with 6 thats 2 admits and trust me, the DID come, lol. And I can laugh now bc it made me get my multi tasking and charting and time management pretty good for being a pretty new RN. Bottom line, depending on your acuities it's not safe but I've seen many great nurses cranked out of the floor I can from so I guess what I'm saying is boot camp can pay off...

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Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.

I've had 8 on nights before, but only when I get floated to other floors :eek: Where I usually work, I have 5, 6 maximum.

That being said, we are capped at 5 during days and evenings. Since I work 12s, if I get floated to the general med surg floor, I'll start with 5 and get three more patients at 11:30pm. I've learned to work hard to be ready to accept those three, and now that I know that's coming when I work that floor, I try to be really organized and prepared.

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We generally have our team OR in some instances are pulled for 4 hours out of a 12 hour shift. That assignment is generally 5-6 pt even on tele. Sooooooooooo you have those 6 to chart, pass med and ect, then you go back to your home floor for 8 hours after those 4 and get another team of at least 6, plus if you discharge, or admit others. Sometimes by the end of the day on day s lik that you have had 12-14 .

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Specializes in m/s.

A job it is and take it if you must. But former new grad that was in your shoes, my experience was bad. And the director wasn't kidding when they said 8:1. It was routine. Don't get me wrong; I learned alot in the hairy five months I was at the position. Mostly how NOT to do things, how to worry an ulcer into being and how to slipshod care for patients. But also got enough experience under my belt as an ADN to apply at a better facility close to home where I could refine my practice and actually provide quality care to the people for whom I am responsible.

I do not envy you your decision; best of luck.

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Just finished orientation at my hospital on a Med/Surg floor. Days gets 4 - 5 pts. On nights we get 5 - 6. I would never want 8! Also, we got 12 weeks of orientation. I cannot imagine what my nursing would have been like taking 8 at only 6 weeks of orientation as a NG! That is ASKING for trouble! Scary.

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Specializes in LTC, medsurg.

Heck NO, I wouldn't take 8 patients. Unless you're desperate for a job and even then, you may be risking your license.

Where I work, we get 5 mostly, 6 at the most. And 6 is hard! Good luck.

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I feel your pain, same thing happened to me with my first new grad position. I absolutely hated my hospital experience. I currently do homehealth and I am thinking I never want to work in a hospital again...DONT miss the stress or the 12 hr shifts!!!

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