New Nurse - Unsafe Hospital

[NurseL20]

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!!

[911NURSE]

A restrained patient should absolutely always have a sitter for safety purposes. 

[NurseL20, ADN]

I appreciate all the responses. It’s very unfortunate reading so many responses saying the same thing, about the hospital never being properly staffed. It totally takes away from the reason most of us became nurses in the first place...

Honestly I think it’s crazy to be expected to have 7 patient with one being on restraints, requiring you to check on them every 15 minutes... 

I wonder... does this continue to happen because we become OK with being overworked and just go with the flow?? This is not right what so ever...

[MunoRN, RN]

6 minutes ago, NurseL20 said:

I appreciate all the responses. It’s very unfortunate reading so many responses saying the same thing, about the hospital never being properly staffed. It totally takes away from the reason most of us became nurses in the first place...

Honestly I think it’s crazy to be expected to have 7 patient with one being on restraints, requiring you to check on them every 15 minutes... 

I wonder... does this continue to happen because we become OK with being overworked and just go with the flow?? This is not right what so ever...

The most commonly used indication for restraints in hospitals doesn't require q 15 minute monitoring, maybe you could clarify.

[NurseL20, ADN]

7 minutes ago, MunoRN said:

The most commonly used indication for restraints in hospitals doesn't require q 15 minute monitoring, maybe you could clarify.

My hospital requires all patients in restraints have an integrity check q15 minutes and reassess need for restraints q2 hours. It does not matter which type of restraints they are, whether 5 point restraints or soft wrist restraints.

[MunoRN, RN]

12 minutes ago, NurseL20 said:

My hospital requires all patients in restraints have an integrity check q15 minutes and reassess need for restraints q2 hours. It does not matter which type of restraints they are, whether 5 point restraints or soft wrist restraints.

No such requirement exists, the frequency of checks and documentation is up to hospitals to determine.  That's not an unusual requirement for restraints in a psych unit, but it's something you should clarify if that's the frequency of assessment and documentation required in your facility.

[NurseL20, ADN]

7 minutes ago, MunoRN said:

No such requirement exists, the frequency of checks and documentation is up to hospitals to determine.  That's not an unusual requirement for restraints in a psych unit, but it's something you should clarify if that's the frequency of assessment and documentation required in your facility.

I want to clarify, are you trying to say no such requirement exists as a law or standard? or are you saying no such requirement exist in any hospital?

[MunoRN, RN]

2 minutes ago, NurseL20 said:

I want to clarify, are you trying to say no such requirement exists as a law or standard? or are you saying no such requirement exist in any hospital?

No such regulatory requirement exists for restraints for medical treatments purposes.   Facilities can chose their own time intervals for assessments of these patients, which is commonly every two hours.

[NurseL20, ADN]

21 minutes ago, MunoRN said:

No such regulatory requirement exists for restraints for medical treatments purposes.   Facilities can chose their own time intervals for assessments of these patients, which is commonly every two hours.

I figured, it seems unreasonable. I am used to seeing q15 min integrity checks requirement for 5 point restraints, but not for soft wrist. My hospital/floor requires us to do this for all restraints, (with 7 patients- it just seems unreal).... its a little frustrating, which is why I started this post

[gcupid]

if this were a male dominated profession, this foolishness would not exist. Just start refusing patients after 5.  They can't fire every nurse.

[CaliRN2019, BSN]

It doesn't make sense to me that a patient in restraints would also need a sitter and be a 1:1. In my hospital, patients are either in restraints or a 1:1, not both (unless they are a very extreme case which is rare). 

Also, right now we are in the middle of a pandemic and things are different. I am in California and our strict 4 patients to 1 nurse ratios are currently out the window because of the influx of patients needing beds and the crisis we are in. All our ICUs are currently 3:1 as well. We are also now keeping patients that normally would go straight to the ICU on our tele floor as long as possible. Many are dying but ICU beds are full, so there isn't anything else to do. This is extraordinary circumstances, so if your hospital has a large number of covid patients, things are going to look differently then they normally would. 

[TheMoonisMyLantern, ADN, LPN, RN]

Behavioral restraints usually do require a 1:1 sitter and q 15minute vascular/skin integrity checks. Non-behavioral restraints which are typically what are used on most medical units don't require a sitter and usually don't require as much intensive monitoring by the nurse. If your facility requires 15 minute checks on non-behavioral restraints then I would say that that policy is NUTS! As others have said, clarify this so you're not working yourself to an early grave when you don't need to.

I know how hard it is to work in a "bad" facility but the bright side is that if you spend some time there and get experience, you'll find you can work anywhere. The trick is that you have to keep your integrity, even if your facility doesn't have any.

[Kooky Korky, BSN, RN]

On 12/11/2020 at 11:43 PM, MunoRN said:

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.

Being restrained should mean the restrained person has a sitter.  This is to make sure the person doesn't choke, hang himself. or otherwise become injured or the D word.  (as in no longer among the living).

Restraints do not take the place of another person to tend to things like giving a sip of water, supplying a bedpan, tending to the restrainee's temp in the room, and to his social needs.  Being restrained is horrible and dangerous.  I guess you could maybe have 1 staff watch 2 restrainees if they are in the same room or right close together.  What is policy on that?