Hi everyone!! I have found myself in what seems to be a weird situation. I was hired on a med surg floor to work nights 7 p.m. to 7 a.m. Right now I am in orientation. My orientation is only 6 weeks. At nights patient load is 6 patients per RN... the one CNA that I have goes home at 11 p.m. So I have six patients with no CNA for the whole night. Right now they're working me up to get to having six patients. I had four patients yesterday... one which was a 300 pound lady. Who was incontinent and needed changing every couple of hours. And also she slid down in the bed and have mobility issues. Several times I have to call my preceptor to help me push her up...pulled her IV out, blood gushing everywhere.. another patient had uncontrollable pain.. My concern is once I'm off orientation the only other people on the unit are the other nurses who also have six patients..
During my break yesterday, I was talking to a float nurse who told me that the hospital has a huge turn over rate. Which I knew. Most of the nurses who work at my hospital are new grads. And it's been said that my Hospital likes to hire new grads because we are cheaper to pay...
My preceptor pulled me to the side and told me that tonight was a very easy night. And that it can get very crazy.
Nurses out there, does it sound like a lot to handle six patients plus no CNA as a new grad? Just would like your opinion... I am not a quiter but also want to be wise.... I dont want to disappointment my family... but I am starting to feel the depression and dread setting.... as a new grad I know I should be happy with basically whatever I can get. Ugh
Specializes in Tele, Interventional Pain Management, OR.
It is assumed that most of the patients will be sleeping during the overnight shift, thereby creating less work for nursing staff. Of course, any experienced night shift nurse knows that is often not the case.
Haha! I am just seven weeks into orientation on nights (new grad, cardiac/med-surg) and I can already see that the whole "they sleep overnight" rationale for staffing and ratios is a bit inaccurate...
To the OP: Our nightly patient-nurse ratio is 6:1 with one CNA (unless s/he calls in), a charge nurse who also takes a patient assignment, and a unit secretary. For reference, our daytime patient-nurse ratio is sometimes 5:1 but generally 6:1 with 2-3 CNAs, a charge who doesn't take patients, and a unit secretary.
I can tell you that as a new grad, six patients will keep you busy all night! Whether you're directly attending to their needs or just charting, there's no shortage of work to be done. My advice is to lean on your preceptor while you have him/her available--but to balance that with growing your independence each and every shift. Also, learn which nurses you can ask for help. Not everyone is a team player, even in an environment that requires teamwork, so figure out who will have your back when you're off orientation.
And it's never too early to be a team player yourself--if another nurse asks you for help with a quick task such as turning or witnessing med waste, the answer is always "Yes" unless you're rushing off to something truly critical.
Also--don't worry too much about how your manager "seems" when you talk to her. The goal is to get through orientation and succeed on your own, right? So, even though it's hard, just heed her words rather than her tone. She's trying to tell you the information you need to move on to that next step.
More advice: Do keep track of patient situations you need to know more about, as well as tips/tricks/tidbits passed along by your preceptor. Each shift, I keep a blank sheet of notebook paper behind my brain sheets to jot down things that I need to 1) know for next time, 2) ask about, or 3) independently research later. For example, I recently cared for a pre-CABG patient whose surgery was suddenly in jeopardy due to his TEG results. I had no idea what a TEG was, so I wrote it down, tended to my other patients, and used my facility's resources to educate myself about the what/why of TEG r/t cardiac surgery. Then it all made sense (for the most part, haha).
Try to hang in there, OP. As other posters have mentioned, my main concern with your situation is the length of orientation. I'm fortunate enough to have 13 full weeks with a preceptor plus nurse residency classes/skills labs. You might ask for a couple of additional orientation weeks if you get toward the end and feel like you need more time. However, don't beat yourself up for not being perfect or even proficient yet. What you're feeling is normal. Keep at it and I bet you'll do great!
Im a new grad as well (4 months in hospital setting) I can start off with anywhere from 5 to 8 patients plus any admissions throughout the night. So most ive had is 9 on my med surg unit which is very tough!
I think 6 patients at night seems pretty standard on a med-surg floor, unfortunately. Is it an optimal ratio? Definitely not!! But it's hard to answer if this is a safe ratio, as this is highly dependent on the acuity of the patients and the resources at your hospital. If you are doing things like insulin infusions, narcan infusions, q30 min trach suctioning, etc. then I would argue that no- this is absolutely not a safe ratio to have. Do you rate the acuity of your patients with your charge nurse? This helps to ensure that assignments are balanced and extra staff are called in when necessary (it gives management a numeric score to quantify the expense of extra workers.) Maybe this is something you could bring up eventually.
As far as sticking it out, it depends on how stressful you are finding the situation and how competitive the nursing market is where you live. Sorry to say but only you will know yourself what is the right decision for you. Personally, I would most likely stick it out. Your time management skills will become fantastic and I'm sure you will learn a lot. However, if your health and relationships are being significantly negatively impacted, I would seriously consider some different options. Best of luck!
It's not so much that the patients are all going to sleep (although, I've worked probably 40 overnight shifts in my 2 years and I've never had every single patient on my assignment be awake all at once before) but rather that patients are generally not leaving the floor for tests that require nurses to be pulled, there are few if any new orders being placed, day shift (at least at my facility) is more or less expected to do all dressing changes, there are no meals on nightshift and much fewer blood sugar checks, and most of our patients have "do not disturb" orders, meaning they only have vitals taken at 20:00 and 04:00.
My new hospital, however, has the same ratios for days and nights because we also take stepdown patients. The ratios at my new place are also much lower than the average medsurg unit around here, and while I love only having 4-5 patients, there are days where I would gladly send a nurse home and have 6 patients each just so we could use some of that money towards equipment that actually works!
It's not just the assumption that the patients are sleeping, but the assumption that the workload is decreased because fewer diagnositic tests, surgeries, doctors' rounds and new orders are done during the night.
This is true. Ideally, patients should be sleeping at night. We know that doesn't always (or often) happen, but that's the general goal. Night shift has its own set of problems but is generally more calm.
I have worked days. I would never switch to full time days! It's chaos. Too many cheifs/management, physicians/new orders, family members, meals (insulin for 3 meals, feeding patients), just to name some of the crazy. No thank you!
As mentioned above, it takes good teamwork! I suggest buddying up with the nurse assigned to the rooms nearest to yours. Then go down the line to do all your q2h turns & bed checks for the incontinent/total care pts. The ortho floor I worked on rarely had a CNA when I started & this is how we would team up, especially when it came time to start the CPMs early each morning.
Plan ahead & cluster care so that you get everything done while in the room; just be prepared to have your plan get blown to #!@$! at any given moment.
Sometimes it's more about the mix of pts you get rather than the number. I've had shifts with 7 pts & no aide that was smooth as clockwork with lots of downtime & shifts with 4 pts & an aide that ran me ragged with no break.
Having done nights and days (currently) on the same floor, I do agree that days can 12 hours of nonstop controlled and sometimes less controlled chaos. The ratio stays the same for both shifts on my tele floor (4:1). Reflecting on my night shift days, I can say, I think, that 4 pts allows a good balance. You usually have at least one patient that is up all night, either with pain, or confusion, climbing oob every 40 mins.
But night is tricky. Some of these patients have family there all day to keep an eye out and advocate for their loved one, but nights, the family mostly goes home, and the patient can be different, not sleeping, no family to make sure they are not climbing around...you may have 4 elderly patients, all alone, and confused and disoriented by the solitude and environment, and these people are more challenging.
And days is just a different thing, where 4 patients and their families and every other hospital service is tugging at you all day. You might be on your feet all day and the support networks readily available can both drive you crazy and be lifesavers.
Then in the am, they sometimes perk up and resume the day time "better" behavior, with support of family and friends. So it goes both ways. I could not imagine that night shift ratio being any higher. But maybe it works...
I am a new nurse (10 months) on a med-surg unit and although it is regular when I did noc shift to have 6 patients, we almost always had an aide. It would be really difficult to prevent falls, manage sundowners, t&p q2 plus all our charting and admissions without our aide. On the plus side usually night shift nurses are very cohesive and help each other. If this is not the case it would be extremely difficult. Also 6 weeks is a short orientation for new grads, we had 12 weeks. If you feel depressed, start looking because its not worth it to be miserable and start to hate nursing. If you find that the support and teamwork is good, try to at least get that year in. It will be much easier to move around in acute care after that. Good luck!
i wouldn't worry about the pt ratio. i work in CA and i have 1:7 sometimes (i cover 2 for an LVN/LPN). your issue is acuity. my 3 can require more nursing care than your 7.
i've been a year on, but the veterans cringe when they have to get report from me. they tend to switch assignments IF it's ever a 1:1 exchange. and i have no aids. they constantly/consistently bombard me with these assignments.
my only advice is for you to remember this: you can/will lose your job over time mgmt issues... jobs are a dime a dozen, even in my CA market. but you WILL LOSE YOUR LICENSE over patient safety. never rush, cut corners to get out on time.
jena5111, ASN, RN
1 Article; 186 Posts
Haha! I am just seven weeks into orientation on nights (new grad, cardiac/med-surg) and I can already see that the whole "they sleep overnight" rationale for staffing and ratios is a bit inaccurate...
To the OP: Our nightly patient-nurse ratio is 6:1 with one CNA (unless s/he calls in), a charge nurse who also takes a patient assignment, and a unit secretary. For reference, our daytime patient-nurse ratio is sometimes 5:1 but generally 6:1 with 2-3 CNAs, a charge who doesn't take patients, and a unit secretary.
I can tell you that as a new grad, six patients will keep you busy all night! Whether you're directly attending to their needs or just charting, there's no shortage of work to be done. My advice is to lean on your preceptor while you have him/her available--but to balance that with growing your independence each and every shift. Also, learn which nurses you can ask for help. Not everyone is a team player, even in an environment that requires teamwork, so figure out who will have your back when you're off orientation.
And it's never too early to be a team player yourself--if another nurse asks you for help with a quick task such as turning or witnessing med waste, the answer is always "Yes" unless you're rushing off to something truly critical.
Also--don't worry too much about how your manager "seems" when you talk to her. The goal is to get through orientation and succeed on your own, right? So, even though it's hard, just heed her words rather than her tone. She's trying to tell you the information you need to move on to that next step.
More advice: Do keep track of patient situations you need to know more about, as well as tips/tricks/tidbits passed along by your preceptor. Each shift, I keep a blank sheet of notebook paper behind my brain sheets to jot down things that I need to 1) know for next time, 2) ask about, or 3) independently research later. For example, I recently cared for a pre-CABG patient whose surgery was suddenly in jeopardy due to his TEG results. I had no idea what a TEG was, so I wrote it down, tended to my other patients, and used my facility's resources to educate myself about the what/why of TEG r/t cardiac surgery. Then it all made sense (for the most part, haha).
Try to hang in there, OP. As other posters have mentioned, my main concern with your situation is the length of orientation. I'm fortunate enough to have 13 full weeks with a preceptor plus nurse residency classes/skills labs. You might ask for a couple of additional orientation weeks if you get toward the end and feel like you need more time. However, don't beat yourself up for not being perfect or even proficient yet. What you're feeling is normal. Keep at it and I bet you'll do great!