Nurse/Pt ratios in the critical care setting

[AnonymousRN]

I am curious about nurse/pt ratios is ICUs/CCUs. I am routinely assigned 3 pts in CCU. In fact, I have to work tonight, 7p-7:30a, and the sense of dread I feel right now, is overwhelming. We have mountains of paperwork to complete, and little ancillary staff to assist us in bathing, turning, etc. And, the ancillary staff we do have is (I hate to sound harsh) as useless as the day is long. It is not unusual in my facility to be assigned three pts, 2-3 of which are vented, with 1-2 swans. Night staff is responsible for all line changes, IV bag changes, dressing changes, total bed baths, lab draws, and room setups. With q4h head-to-toe assessments to complete and document, q1h vs and I&O, multiple flow sheets from hell, a policy resistant to utilizing restraints, even on vented patients, and an administration more concerned with "winning," once again, JC accreditation with commendation than it is with quality patient care, we are all going crazy. Needless to say, although we are hourly employees, management is extremely resistant to paying overtime. Their feeling on overtime is, there is something wrong with your time management skills if you are unable to complete your work within the time constraints of your shift. In fact, it was told to us that if we continue to sign out late, it will be noted on our performance evaluation that we are unable to effectively manage time. I have tried very hard to rise to the occasion, to push myself harder and harder to meet the demands of the job. And, guess what, I have succeeded. However, the cost to me has been too high! I am stressed out to the max and crispy fried. My plan right now is to leave the hospital setting and pursue home care. I really do love nursing, but the "cutting corners" occurring in hospitals today (read not providing what I consider to be adequate pt care)gets to me. You know what I mean by cutting corners: maybe your pts don't get turned enough or at all; flush lines (are you kidding me, who has time for that); not cleaning pts properly (or at all); letting them sit in their diarrhea for "just a little while longer" while you attend to something else; oops, the ancillary staff didn't take the temps at 8p and 12mn and now it's 4a and you just noticed it in your hectic shift, well just make them up; maintaining sterile technique (I'll try but really, who are we kidding); pharmacy didn't send the pts colace, just sign off that you gave it because it takes too much time to refax the order, enter notification in the computer and call the pharmacy 2-3 times, and after all, it's just colace; etc., etc. Personally, I feel a moral imperative to provide adequate patient care. Does anyone else have this experience or am I the only one? Is this the state of healthcare today? What are the staffing ratios in other hospital's ICUs/CCUs. I, for one, did not sign up for this kind of stress. And I find that anyone not involved in healthcare just cannot understand what it is like to have this kind of job and what it's toll is on a person physically, mentally and emotionally. On the RARE occasion that I get a 2 pt assignment, I find that I am able to provide excellent care, attend to detail, utilize my nursing judgment and critical thinking skills, effectively manage time without compromising care, etc., all without feeling as if I am drowning. Thanks for letting me vent.

[monica f]

I can understand your frustrations with staffing. I am currently a home health nurse, we too have lots of stress. Although we may not be stressed about patient load there are plenty of other things to worry about. Do you have all your meds...if not where are they and lets hope that you get them before tomorrow? One of the biggest problems with home health, espically with those whom recieve 20-24hours per day care, Who is my relief and are they going to show up??? I don't mean to sound negative but you should understand that you will encounter stress with any area of nursing. For every area there is a different type of stress. I hope that you enjoy home care and find it very rewarding.

[YADA-YADA]

I definately feel for you. ICU/CCU is a lot of work. Some people go to the unit thinking it will be easy with 1-3 patients and it is at times. Until one factors in that all the patient care is usually done by the RN, not ancillary staff.

If i had your assignment i would protest it however. Go to your manager and set her or him straight.

You are very brave most people would not tell the reality of nursing, sometimes things do get left undone. We can only do so much in a given time frame. The feet can only last for so long. The mind sooon gets tired and thats how important things, not colace, get missed.