Non-acuity based Cardiac Floor

[SjoeRN]

Just wondering if anyone else has these kind of problems. I had 5 patients last night. 4 out of the 5 were "ringers". Patient 1 had dementia, would call out because she was worried no one was there. Patient 2 had MR and needed help to the potty chair four times, wouldn't use the call-bell, would just starting yelling, off and on throughout the night for help. Patient 3 was confused and would hit the call bell often for no reason at all. Patient 4 was flaccid on her left side and called to be put on the bedpan to pee about 15 times during the night. I ran all night, and was dead tired the next morning. Four of the patients had FSs with one of them being every 4 hrs. CAs don't work at night, the clerk leaves around 900pm and the charge nurse leaves at about midnight. And to top it all off, another nurse that i often help out when she is busy came up to me about 4 hrs into my shift and asked if I was doing okay since I had more patients than everyone else. Two of the nurses had 3 each, another 4 and at least one of them also had 5. WHAT? I talked to my manager about instituting some kind of acuity based system and he just said that they had done it years ago and that it didn't work. "If we did that you would have about 8 patients apiece." As it stand now, i come and get beds, say 20-24, and it doesn't matter what kind of patients are in those rooms. Is this normal? We are suppose to have at least one CA during the night if all of the beds are full but usually when I come in, there around 6 empty beds, which are soon filled by the middle of the night, so I have only seen a CA work 2 times at night since i started working there in November.

[FancypantsRN]

Have you tried asking the charge nurse about the assignment? Sometimes they just assign patients not realizing that 1 nurse is getting so many confused patients. A couple of places I have noticed, the charges do not get report on the patients on the floor (this is where I have noticed it happening the most).

The last place I was at, I had to do that a couple times. We got 7 patients on PCU, once I got to report #6 and realized that they too are confused, crawling OOB etc. Our assignments were scattered, not in a row. A giant T shaped floor and you could get all 3 corner rooms = impossible to keep track of your patients. The charges are usually pretty good about changing the assignment - they don't want a major safety issue on their watch.

Other places just assign in a row. Nurse A gets beds 1-5 and so on (like your place). I really don't think they do it by acuity. A lot if it is who was there last night, they want their patients back and spreading the empty beds out.

[LoveANurse09]

Sounds rough! I know on our unit we wouldnt get that many confused patients in one assignment,its not safe for the patient. We base our assignment on acuity AND location. Our unit is a large cirle shape (i hate it) so one nurse can be at one end of the hall and another nurse at the other and we might never see each other all night! Our manager has asked if we want our assignment acuity or location based and really it has to be both. Either that or they need to be mindful where they place the high acuity pts!

[SjoeRN]

I "vented" to my manager this week, about this issue, along with some others I have been having with how my floor works. Concerning this team of patients, all he said was, "yeah that was a pretty bad team." I questioned him about acuity based nursing and he said that it didn't work. "If we did that you would end up having 7-8 patients at a time." Instead of the 5-6 that I normally have. I told him that if acuity based nursing doesn't work, what we're doing isn't working either. This is my first nursing job, been there about 3 months, but I have thought about leaving because of this. I know everyone says to stick it out a year at least and then move on, but I feel that I have valid patient safety concerns. Trying to hit the year mark isn't worth it, if it costs me my license. This week I only had one confused patient but I had to sit outside of her room because of her wanting to get out of bed all night. She probably needed to have a sitter. I felt like my others patient were neglected.