New Grad RN... is this patient load safe?

kaylee. · Feb 17, 2016

A unit like this would require good teamwork to survive. How are the other nurses you work with? Is everyone helping each other readily? That still seems like a tough assignment. It wouldn't entice me to work there...

dishes, BSN, RN · Feb 17, 2016

I don't think a 6 to1 patient to nurse ratio on medical surgical unit is uncommon.

Nurse Leigh · Feb 17, 2016

When I left my hospital position I was charge, we all had 6 patients, often no tech, and no tele monitor. I'd been there nearly five years and OMG it was still crazy difficult.

Teamwork and a sense of humor got us through some rough spots.

Good luck to you, and I hope you have some good teammates.

KittyLuv · Feb 17, 2016

Yep that's a lot. When I worked acute care on the geri unit and then float med surg it was 4 to 1. Granted, some nights with 4 adults none of whom were confused or particularly needy it was pretty slow but most nights (and ALL nights of the 6 years I spent on the geri unit) that ratio was a handful.

I'll focus more on the geri unit. 20 beds, 5 nurses at night and two CNAs. Sounds good right? Same ratio during the day too, by the way..maybe one more CNA. If you know anything about acutely ill geriatric patients then you know they don't sleep, they need tons of attention, and bad things tend to happen at night. We had telemetry, IV everything except certain drugs restricted to ICU, extremely high fall risks, super confused ambulatory rickety old ladies, angry confused paranoid forgetful old men, orthostatic blood pressures, daily weights (at 4am), morning labs (again, 4am), central lines, feeding tubes, etc. You name it.

New-ish nurses had a very hard time keeping up and even us old dogs had frequent nights from hell with (possibly) a late discharge or even a death and probably averaging 6 admissions nightly on the unit. You always knew you were in for it when 2 of the 4 rooms in your assignment were empty at the start of the shift. The ER would begin dumping their patients right at shift change (usually trying to call the oncoming nurse report during the middle of your unit shift change report...ridiculous....and then reporting you because you asked them if they could call back in 15 minutes.) Or even better yet, when the offgoing nurse took report 10 minutes before the start of shift change and there they are rolling down the hall (with crying family following) toward your suspiciously empty room assignment.

So, yes. 6 to 1 is IMO too much especially for a new grad. Sorry for the rant :speechless:

Nurse Leigh · Feb 17, 2016

Yep that's a lot. When I worked acute care on the geri unit and then float med surg it was 4 to 1. Granted, some nights with 4 adults none of whom were confused or particularly needy it was pretty slow but most nights (and ALL nights of the 6 years I spent on the geri unit) that ratio was a handful.
I'll focus more on the geri unit. 20 beds, 5 nurses at night and two CNAs. Sounds good right? Same ratio during the day too, by the way..maybe one more CNA. If you know anything about acutely ill geriatric patients then you know they don't sleep, they need tons of attention, and bad things tend to happen at night. We had telemetry, IV everything except certain drugs restricted to ICU, extremely high fall risks, super confused ambulatory rickety old ladies, angry confused paranoid forgetful old men, orthostatic blood pressures, daily weights (at 4am), morning labs (again, 4am), central lines, feeding tubes, etc. You name it.
New-ish nurses had a very hard time keeping up and even us old dogs had frequent nights from hell with (possibly) a late discharge or even a death and probably averaging 6 admissions nightly on the unit. You always knew you were in for it when 2 of the 4 rooms in your assignment were empty at the start of the shift. The ER would begin dumping their patients right at shift change (usually trying to call the oncoming nurse report during the middle of your unit shift change report...ridiculous....and then reporting you because you asked them if they could call back in 15 minutes.) Or even better yet, when the offgoing nurse took report 10 minutes before the start of shift change and there they are rolling down the hall (with crying family following) toward your suspiciously empty room assignment.
So, yes. 6 to 1 is IMO too much especially for a new grad. Sorry for the rant

I know HCPs often round early and require lab results and weights but it sure makes it difficult for patients (especially your geriatric population) to get good healing restorative sleep when they get awoken at 4 am - if they were asleep to begin with. Their circadian rhythms are often out of wack anyway and don't forget sundowning.

I know not any good solutions but it can make for a difficult shift.

RNperdiem, RN · Feb 18, 2016

I worked med-surg with 6 patients, an aide and a unit secretary and I worked hard. Yes, without an aide, med-surg gets harder. Sometimes even if you do have an aide, they can get pulled into sitter duty and be unavailable. As a former med-surg CNA, just keeping up with the turns, help to the bathroom and keeping incontinent patients clean kept me busy most of the shift.

As a new grad, you will have to ask your fellow nurses for help and be willing to help them. Unless the majority of your patients are "walkie-talkie", your job sounds less than ideal, but you do have a job that can be a stepping stone to something else. You will learn to survive and develop juggling skills.

TheCommuter, BSN, RN · Feb 18, 2016

A nurse/patient ratio of 1:6 in med/surg during the night shift is normal in the hospital in the area where I live. You'll bust your butt working without a CNA or tech, but this patient load is not necessarily 'unsafe' or outside the realm of possibilities.

imintrouble, BSN, RN · Feb 18, 2016

I just had a similar night. Six patients no CNA. The other nurses had six, but had been nurses

I was exhausted and my new nurse co-workers were exhausted and demoralized. I just wanted to quit, and they wanted to cry.

To answer the question "Is it safe", of course not.

It's the new normal.

beckster_01, BSN, RN · Feb 18, 2016

I wouldn't say unsafe, ratios at my hospital range from 5-7 patients/nurse. They generally staff a tech overnight but maybe half the time on the unit I used to work on there was either no one on the schedule or they called in. No secretary. Nursing is a team sport and your coworkers should be receptive to your requests for help with turning, cleaning, boosts, etc. Don't let anyone pressure you into thinking that "single person turns" are a thing. But the reality of nursing is that it is really, really busy and physically taxing, and your preceptor is probably trying to prepare you for that.

The only unsafe thing I note in your OP is the length of orientation. I am a strong believer in my hospital's orientation program, which is 1 month for experienced nurses, 3 months for med surg new grads, 6 months for ICU new grads. Trial by fire is not a good learning atmosphere. Buuut I know that a 6 week orientation is common practice, I just think longer is better. At the end of both my floor and ICU orientations I was at the point that having a preceptor was getting annoying, and I think that is a good way to start.

Here.I.Stand, BSN, RN · Feb 18, 2016

I don't doubt it's hard work, but not uncommon for med/surg. I remember one night, having a CNA but with 7 pts -- two of whom had trachs, and 2 having lumbar drains. If you've never seen a lumbar drain the MD orders the desired hourly output, and you check them q 1 hr and lower the drip chamber if it doesn't drain enough/raise it if the output is too much. We'd also have pts on insulin gtts, heparin gtts, CF pts who were in 3-4 IV abx, eye pts who were on q 1 hr eyedrops....

Teamwork is a must, esp repositioning pts and mobilizing the weak/big ones. Your safety is important.

You'll get your workflow down with practice. You're still on orientation, so cut yourself some slack. Hugs!

Here.I.Stand, BSN, RN · Feb 18, 2016

And my favorite piece of advice: take your breaks, even if it's just 20 min to eat. You will not be a better nurse dehydrated and hungry. :up: