New Nurse - Unsafe Hospital

[NurseL20, ADN]

Any advice appreciated.

I started working at the hospital as a nurse 2 months ago; prior to that I worked as a CNA. I work on a med-surg tele floor. My current patient ratio is 7 to 1, with the nurse taking full responsibility of 1 patient (so no tech). I am nearing the end of my orientation, and am totally disgusted with this hospital. On my last shift, I had 6 patients with 1 patient on restraints; is that a common situation for anyone? As a CNA I have always seen patients in restraints with 1:1 (either nurse or sitter).  I just feel like the hospital puts so much on the nurses, but does not offer adequate support. I've seen so many wrong things, but I don't know if it's because I am a new nurse and this is how it is done in real life, or because this place is just that horrible.

Anyone with common experiences or advice? 

Thank you!!

[Sour Lemon]

On 12/11/2020 at 4:25 PM, Loprev said:

Any advice appreciated.

I started working at the hospital as a nurse 2 months ago, prior to that I worked as a CNA. I work on a med-surge tele floor. My current patient ratio is 7 to 1, with the nurse taking full responsibility of 1 patient (so no tech). I am nearing the end of my orientation, and am totally disgusted with this hospital. My last shift I had 6 patients with 1 patient on restraints, is that a common situation for anyone? As a CNA I always seen patients in restraints with 1:1 (either nurse or sitter).  I just feel like the hospital puts so much on the nurses, but does not offer adequate support. I've seen so many wrong things, but I don't know if it's because I am a new nurse and this is how it is done in real life, or because this place is just that horrible.

Anyone with common experiences or advice? 

Thank you!!

It's a little bit of everything. My new grad ratio was 1:8 with an LVN to cover, and the LVN had 8 also. Our CNAs were always short staffed, too. We might have had 1 or 2 CNAs for 40 something patients, so some patients were assigned as total cares for each nurse. There were HIGH acuity patients. Anything that went wrong was the fault of "the supervising RN" (that's you!).

As new graduates gained experience, they were able to move on and look for greener pastures. I ended up in California where five patients are the max in med/surg, and it's relatively heavenly.

When I first applied for work here, one of the higher-ups had actually worked in my hospital system in the other state. When she heard where I'd come from, she actually said, "This will be an easy job for you."

So ...the good news is that you'll be able to handle anything if you survive there. It's almost like disaster nursing.

Good luck!

[NurseL20, ADN]

On 12/11/2020 at 5:13 PM, Sour Lemon said:

It's a little bit of everything. My new grad ratio was 1:8 with an LVN to cover, and the LVN had 8 also. Our CNAs were always short staffed, too. We might have had 1 or 2 CNAs for 40 something patients, so some patients were assigned as total cares for each nurse. There were HIGH acuity patients. Anything that went wrong was the fault of "the supervising RN" (that's you!).

As new graduates gained experience, they were able to move on and look for greener pastures. I ended up in California where five patients are the max in med/surg, and it's relatively heavenly.

When I first applied for work here, one of the higher-ups had actually worked in my hospital system in the other state. When she heard where I'd come from, she actually said, "This will be an easy job for you."

So ...the good news is that you'll be able to handle anything if you survive there. It's almost like disaster nursing.

Good luck!

Thanks for the response. How long did you stay at the first job before leaving?

[speedynurse, ADN, BSN, RN, EMT-P]

Is it safe? No. Does it happen? Absolutely. The med surg floor at my hospital has the same ratio as yours. I remember having all kinds of unsafe situations in the ER.....but try to get the experience, be as positive and make relationships with other units when you can, and become familiar with the transfer policy ?

[MunoRN, RN]

There are places with better ratios, but what you describe is not at all unusual.  I'd be careful about assuming the grass is greener everywhere else.

I've worked at a hospital where med-tele was 6:1, but that was with no CNAs on the floor at all, otherwise it's been 7:1.  

It's not actually all that common to have a patient both in restraints and with a 1:1 sitter, typically a patient in restraints doesn't also have a sitter.  

I'm not sure what you mean by "My current patient ratio is 7 to 1, with the nurse taking full responsibility of 1 patient (so no tech)"  The nurse typically has full responsibility of all their patients, so I'm not sure what you mean.

This can be a harsh introduction to the reality of healthcare for new-grad nurses.  It's important for nursing schools to teach you how things would work in a perfect world, it's unfortunate though that they often don't qualify that by pointing out that such a world doesn't actually exist, and in today's world of healthcare, is very far from it.

[Jedrnurse, BSN, RN]

On 12/12/2020 at 12:43 AM, MunoRN said:

I'm not sure what you mean by "My current patient ratio is 7 to 1, with the nurse taking full responsibility of 1 patient (so no tech)"  The nurse typically has full responsibility of all their patients, so I'm not sure what you mean.

I took that to mean that the preceptor is taking one of the patients on the assignment and that the remaining six (including ADLs which may usually be handled by a tech) are solely being cared for by the orientee. I get it; depending on the personal care needs and the medical acuity that can be a lot. Unusual? No. But still a lot.

[Sour Lemon]

On 12/12/2020 at 12:43 AM, MunoRN said:

I'm not sure what you mean by "My current patient ratio is 7 to 1, with the nurse taking full responsibility of 1 patient (so no tech)"  The nurse typically has full responsibility of all their patients, so I'm not sure what you mean.

That means that the tech will not do anything for those patients. They won’t take vital signs, they won’t help clean them, and they won’t even get them a glass of water. 

[Sour Lemon]

5 hours ago, NurseL20 said:

Thanks for the response. How long did you stay at the first job before leaving?

I stayed about two and a half years. I anticipated leaving the state eventually, so I wanted a nice solid block of experience. 

[NurseBlaq]

Sounds about accurate to me. Nursing has been that way for a while, well for me it has. Is it safe, sometimes not always but you learn to maneuver through the day as time goes on. Should you have to? No, but that's the nature of nursing these days.

[OUxPhys, BSN, RN]

For many large hospitals that is not the norm. However, on Thursday we all had 6 pt's on day shift do to extreme staffing needs throughout the hospital.  It didn't last long though because thankfully a float nurse came in at 11 and took a pt from each nurse, so staffing ratios went back to normal (kind of). 

[JBMmom, MSN, NP]

Many facilities are dealing with patient loads they haven't seen before due to pandemic related issues. And some facilities have had similar issues in the past anyway so it may or may not be the norm at your hospital. It is certainly overwhelming at times as a new nurse in any new setting, so I can see how this would seem unreasonable.

You asked about restraints and 1:1 observation/sitter. That will probably vary by facility but I know that for my facility a patient does not need 1:1 due to restraints unless they are in 4 point restraints. They also need 1:1 observation if they are on a suicide watch. Other than that, patients can be restrained for safety without 1:1 observation. 

As far as the nursing student view vs real world nursing, yes, that can also be a disappointing reality check to see what's actually expected of nurses and what an assignment and patient care actually looks like. I remember when I was on orientation and started with two patients, my preceptor told me to do less teaching and looking up resources for my patient because I would never be able to do that when I had a full assignment. I was shocked at first but came to realize that she was absolutely right. Hard to be the nurse you want to be with the pressures that are put on you, but you'll find a way to do what's best when you can, and just do what you have to when necessary. 

Good luck!

[TheMoonisMyLantern, ADN, LPN, RN]

In the 15 years I've been a nurse, I never worked a job where the floor was adequately staffed. In my are non profits have better staffing but still short compared to the need. However, I live in Southern state that doesn't allow nurses to unionize so it's up to the facility to determine how many nurses they need.