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!!

[Kooky Korky, BSN, RN]

On 12/14/2020 at 10:55 PM, NurseL20 said:

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

Muno is usually right on but do not take her advice on restraints.  A restrained person needs a 1:1.  What if something happens between checks?

Follow your good judgment, follow your facility rules and you will never have t explain why you didn't.

[SarahMaria, MSN, RN]

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

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.  

In my state, we always have a 1:1 sitter while a patient is in restraints/seclusion.  

[MunoRN, RN]

19 hours ago, Kooky Korky said:

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?

 

18 hours ago, Kooky Korky said:

Muno is usually right on but do not take her advice on restraints.  A restrained person needs a 1:1.  What if something happens between checks?

Follow your good judgment, follow your facility rules and you will never have t explain why you didn't.

Ideally hospitals would use sitters far more often for patients in restraints to facilitate medical treatment, since that would often negate the need for restraints, but in reality that doesn't happen.

Patients in restraints related to a violent and/or psych indication typically are required to also have a sitter, although this is the minority of restrained patients in the hospital (despite that many patients restrained under a medical justification may also be violent.

6 minutes ago, SarahMaria said:

In my state, we always have a 1:1 sitter while a patient is in restraints/seclusion.  

There are no states where all patients in restraints are required to also have a 1:1 sitter.

[JKL33]

On 12/16/2020 at 1:34 AM, TheMoonisMyLantern said:

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.

The conversation itself might put one into an early grave or at least cause some kind of brain damage. I still remember the day that I tried to explain (to an authority figure I absolutely should not have had to) the concept of behavioral restraints and that none of the restraint situations in that particular facility qualified as behavioral restraints.

The OP situation almost sounds like one where people have decided that because it's too confusing for them then it's too confusing for anyone, so let's just make one rule and say that it has to be followed always. Waste of resources and by far not the first time I've seen it. They get away with it because it is this individual RN and that individual RN who get blamed when they can't do everything.

This is a simple example of the wayward thinking. Yes, restraints are a big deal, as they should be. But making additional/unnecessary work shouldn't be expected to increase the likelihood that restraints will be managed properly. (?!)

[Chicarolla]

In 1975, I left my first RN new-grad (med-surg hospital with 70 beds) position due to a few factors but mostly because I was required to cover the ICU every night for the supper break, something I had never been told during orientation. It really scared the heck out of me. I was asking myself the same question, is this normal? This also sounds ridiculous but there were so many codes there that I learned to not be frightened of them and to go calmly and do my part well.

I moved to a 30-bed med-surg unit in a large hospital which I absolutely loved but, although there was more support, especially from my nursing colleagues, it was the same thing...never fully staffed, doing constant doubles, and loads of RN complaints. Not realizing this was kind of the norm, after staying there for over 3 years I left and did some agency work for a while. I saved money and took a cross country trip with my best friend, also a new RN. We were both similarly disillusioned.

Eventually someone suggested I try home care. I loved it and stayed with it but at times it also had similar understaffing issues. Take 10 patients? Uh, OK. Ask a 20-year med-surg nurse to go out and evaluate a sick newborn? Uh, no. Or, when it finally became something that could be done in the community, to administer chemo in the home before having had the proper training to do so? Uh, no. You do have the right to practice safe nursing. 

I have concluded after all these years that short-staffing is generally the norm. There are many different factors involved but it  hasn't really changed much, at least in my experience, sorry to report. 
Don’t give up, find a niche you love and stick with it if you can. The more experience you have under your belt and the more skilled you become the more comfortable you’ll feel in appropriately discerning the safety (or not) of patient-load assignments.

Always make it your business to know and follow policy and procedures. There are good reasons they are in place. If you can’t, call your supervisor for support and make them help you. Don’t be afraid to work by the book, even if others tease you. It’s good practice and safer for both you and the patients in the long run. Yes, there are some grey areas where taking a risk may be necessary in the moment but it shouldn’t become your norm. 

Good luck! Nursing can be a great profession. 

[gcupid]

On 12/15/2020 at 8:53 PM, CaliRN2019 said:

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. 

the going over ratio is bs too.  If you show the money, the nurses will be there.  Unfortunately, many of the hospitals are deciding to not share resources with frontline workers.