New agency nurse .. is 40 patients normal ?

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Specializes in Med Surg , ER , Psychiatric : float pool.

I was a float pool nurse at a hospital right out of school and this is my first week as an agency nurse. My first assignment was at a nursing home and when I got there I was told I had 40 patients on the evening shift.

So I had to do the 5PM and 9PM med pass for 40 patients plus dressing changes , fingersticks and insulin and tube feeds. I ran the whole time without a break ( I am used to this so I didnt complain). Meanwhile the patients have no wristbands so I have to ask the CNA's who is who and the patients were all sitting by the nurses station. I felt very unsafe doing this , the workload was insane , and plus giving meds by just asking the CNA's who the patients were is not something I am comfortable with. I was the only nurse on the floor so I just did what I had to as safe as I could.

So the next day I called my agency and told them I had 40 patients and if that was the norm . They said they would speak to the director and get back to me , meanwhile I had to be back at 3PM and it was around 1PM so I started driving there figuring she would staighten it out.

Once I was about 5 minutes away she said I would have 40 patients again and apoligized and said to just go that one day and see how it went. The staff is amazing and very helpful and said since they like me they would all be willing to help if I decided to come back.

The pay is great. The drive stinks. The place itself is nice. But I am just looking for an outside nurses opinion. Is 40 patients just plain unsafe to do 2 med passes on ? And should I find a new agency or is this just how it is?

I am in NY if that helps.

Thanks

:banghead:

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Specializes in Med-Surg, LTC, Rehabiliation Nursing.
I was a float pool nurse at a hospital right out of school and this is my first week as an agency nurse. My first assignment was at a nursing home and when I got there I was told I had 40 patients on the evening shift.

So I had to do the 5PM and 9PM med pass for 40 patients plus dressing changes , fingersticks and insulin and tube feeds. I ran the whole time without a break ( I am used to this so I didnt complain). Meanwhile the patients have no wristbands so I have to ask the CNA's who is who and the patients were all sitting by the nurses station. I felt very unsafe doing this , the workload was insane , and plus giving meds by just asking the CNA's who the patients were is not something I am comfortable with. I was the only nurse on the floor so I just did what I had to as safe as I could.

So the next day I called my agency and told them I had 40 patients and if that was the norm . They said they would speak to the director and get back to me , meanwhile I had to be back at 3PM and it was around 1PM so I started driving there figuring she would staighten it out.

Once I was about 5 minutes away she said I would have 40 patients again and apoligized and said to just go that one day and see how it went. The staff is amazing and very helpful and said since they like me they would all be willing to help if I decided to come back.

The pay is great. The drive stinks. The place itself is nice. But I am just looking for an outside nurses opinion. Is 40 patients just plain unsafe to do 2 med passes on ? And should I find a new agency or is this just how it is?

I am in NY if that helps.

Thanks

:banghead:

Unfortunately...I have had that same experience in a couple of the nursing homes I temped in. Having no med tech to do the med pass leaves you with no time to deal with any of your actual nursing responsibilitied, never mind charting! I complained to my boss at the agency, told them that if they were not going to at least have a med tech, I wasnt going back. NO its not safe! Its YOUR license on the line, and bottom line? No one is going to stick up for you if you make a med error because you are completely overloaded. Never mind, when do you have time to document? No, no all the assignments I have gotten have been like...but I would consider no accepting another assignment there unless they get you a med tech. Talk you your agency.

And remember how hard you worked for your license!!!!!!!!!!

I hated to give up the shifts, sure the pay is good, but is it worth it?

I decided not. JMO...

Good LUCK!!!!!!!!!!!!!!!

lvs

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Specializes in LTC.

Is it typical? Yeah, sometimes. Last evening I had around 40 but also had a med aide; even with the med aide, I did not receive any sort of report or even a brief orientation to the facility (what I mean by orientation is here are your Tx keys, there's the med room, etc.). It was crazy busy, and I had weird situations to deal with where I didn't know what facility protocol was. I was shocked when they asked for me back as I didn't have the first clue going in, just did my best. :chuckle I don't know what I would have done without the help of the med aide and the other staff nurse, who had enough of her own stuff to do but still managed to help me out whenever she could. They also had a really nice RCM who helped out until she left at 5:00.

Is it safe? HELLLLL no. If your agency is a good one and wants to keep you happy, they will respect your feedback and try to send you to facilities that have a lighter workload. And if you decide you do not want to return to a facility, a good agency should still be able to find you work elsewhere. Like somebody else said, it's your license on the line and only you can protect it.

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I am in Colorado and know that some of the LTC's here staff great = 1 nurse (LPN/RN) and 1 - 2 cna's (don't do med techs here) Others I won't step foot in - had 50 patients, 1 RN and 1 CNA for 8 hours!! Never go back - I feed my children with my license, don't you?

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Specializes in LTC.
I am in Colorado and know that some of the LTC's here staff great = 1 nurse (LPN/RN) and 1 - 2 cna's (don't do med techs here) Others I won't step foot in - had 50 patients, 1 RN and 1 CNA for 8 hours!! Never go back - I feed my children with my license, don't you?

Didn't CO start a med aide program like a year ago? I wonder if facilities are reluctant to utilize them...

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Didn't CO start a med aide program like a year ago? I wonder if facilities are reluctant to utilize them...

Forget the med aides. Hire more nurses.

Lindarn, RN, BSN, CCRN

Spokane, Washington

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Specializes in LTC.
Forget the med aides. Hire more nurses.

Lindarn, RN, BSN, CCRN

Spokane, Washington

I have to agree...just wish it were that simple. The people in charge just don't listen. :(

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I love this kind of work, but 40 patients isn't fair or safe. Unfortunately here it is pretty much typical, so this takes away the option for me to work in this kind of environment - it is disappointing for both patients and nurses.

So, for now all of my agency work is in a hospital, but I love longterm end of life care.

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Specializes in LTC.

I just came off an assignment two days ago. I was given 27 patients. Doesn't sound like much but the acuity level was quite high for a nursing home.The entire unit was 54 patients. It was myself an LPN and 4 CNAs. It was one of those days when everything went wrong. I had several intermittent G-tubes. Several insulins. Caths with irrigations and a few very end stage Hospice patients with q 1hr and q2hr Mso4s. At 2 pm on a 7-3 I was still passing meds from the morning med pass.I wasn't able to chart ,do vitals let alone treatments. The shift end was at 2:45 and being Agency I wasn't permitted to stay over. I forgot to mention that there was an RN supervisor at the desk who sat all day and didn't lift a finger to help. I was at the point where I was in the middle of a melt down. I was so out of compliance with the med pass that I felt horribly unsafe and I have never felt that way in my 35 year career.. The sad part of it is that there was nothing I could do about. I got no slack from the RN Sup. just an ass chewing for not haveing all the work completed. Thanks for listening..I needed to get that out with out burdening my family with it. I send love to all my Nursing collegues. Aloha

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Specializes in LTC.
I just came off an assignment two days ago. I was given 27 patients. Doesn't sound like much but the acuity level was quite high for a nursing home.The entire unit was 54 patients. It was myself an LPN and 4 CNAs. It was one of those days when everything went wrong. I had several intermittent G-tubes. Several insulins. Caths with irrigations and a few very end stage Hospice patients with q 1hr and q2hr Mso4s. At 2 pm on a 7-3 I was still passing meds from the morning med pass.I wasn't able to chart ,do vitals let alone treatments. The shift end was at 2:45 and being Agency I wasn't permitted to stay over. I forgot to mention that there was an RN supervisor at the desk who sat all day and didn't lift a finger to help. I was at the point where I was in the middle of a melt down. I was so out of compliance with the med pass that I felt horribly unsafe and I have never felt that way in my 35 year career.. The sad part of it is that there was nothing I could do about. I got no slack from the RN Sup. just an ass chewing for not haveing all the work completed. Thanks for listening..I needed to get that out with out burdening my family with it. I send love to all my Nursing collegues. Aloha

What a nightmare!! So sorry you went through that. I feel horrible for both you and those residents. And shame on that RN who not only sat on her ass, but also didn't help! :argue:

The only consolation is that when we are faced with those types of facilities we have the option of not having to go back.

Hugs to you...

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^^ dreadful for you and for the patients.

I understand about the meds. and the problems with getting them out on time.

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Specializes in LTC.

OK my turn. I just got home from a facility where I've worked a few shifts at their LTC unit. Not my favorite place to go, 2 CNAs for 28 (which is noncompliant for my state), but only 1 trach and a couple tube-feeders. Time-consuming, but I've done enough shifts there that things are starting to go smoothly.

So I get there today and they tell me they need me on another unit. OK, I've walked briefly through the other unit and saw enough to know that it's high census and skilled plus has a few peds, which I have no experience in. So I call my recruiter and tell her the situation, and she is sympathetic and tells me they should not be putting me in any place that is beyond my skill level. She calls the staffing coordinator and the SC tells her that the unit that is new to me is pretty much the same as the one I've been working on. So I say OK.

I go to take report and the nurse there was kind enough to show me around and give me a very thorough orientation, which I thought was awesome. BUT. BUT. BUT. I have a census of 30, 19 of which are tube-feeders and 4 of which are trachs. SO NOT SIMILAR to the other unit. Turns out the reason they put me there is they had another agency nurse who had worked that unit before and would not work it again. :banghead:

I called my recruiter back and told her that the SC lied to her and I would NEVER go back. She understood and was angry on my behalf.

By the grace of God, I finished my shift on time, and nobody went downhill and I did all my meds and hung all my feedings on time. I am still steaming and am gonna turn the TV on, watch Lifetime, and eat half a pint of Ben and Jerry's.

Thanks for listening!

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