Nurse-to-patient ratio concern for new grad...

Published

Hello everyone. I am a recently licensed Registered Nurse. I am in the process of applying for jobs. I have applied for positions on various Medical-Surgical units & also for positions on an Intermediate Care Unit (a step up from Med. Surg., but a step down from Intensive Care). My concern about Med. Surg is the amount of patients an RN is assigned. One hospital has 6:1 on days & 7:1 on nights. Other hospitals have up to 10:1 on days, & up to 12:1 at night! I am wondering, should I stick with the IMC, where the patients are sicker, but the nurse gets 4:1 on days & 5:1 on nights, or go with Med. Surg., where the number of patients assigned is higher, but allegedly, they are not as sick? Seems like either way, it's not good: less patients who are VERY ill or MORE patients who are less ill.

I was thinking about it this way: If I work Med. Surg. & have 10 patients & one starts to go bad & of course a great deal of my time is spent with that patient, then I have NINE other patients that I have to play 'catch up' with once the other patient is stabilized or transferred...that's 9 patients with medication, charting, in addition to attending to whatever their needs may be, etc. HELP!!!!!!!!!!

Up Vote Up Vote ×
Specializes in tele, stepdown/PCU, med/surg.

I think 6 or 7:1 on med/surg is doable depending on how sick they are. Most med/surg units do have some really sick patients. They may not be unstable, but they might require heavy care.

The 10 or 12:1 is very bad. Of course it could be team nursing where you have an LPN and CNA helping you. If it's not team nursing then I would run from those ratios.

The IMC ratio seems appropriate. Are they cardiac patients or general? Is there a reason why you want to med/surg? If you think you like a little more complex patients, IMC may be the way to go. If you want to get a solid basis in med/surg, do that but find an appropriate ratio.

Up Vote Up Vote ×
I think 6 or 7:1 on med/surg is doable depending on how sick they are. Most med/surg units do have some really sick patients. They may not be unstable, but they might require heavy care.

The 10 or 12:1 is very bad. Of course it could be team nursing where you have an LPN and CNA helping you. If it's not team nursing then I would run from those ratios.

The IMC ratio seems appropriate. Are they cardiac patients or general? Is there a reason why you want to med/surg? If you think you like a little more complex patients, IMC may be the way to go. If you want to get a solid basis in med/surg, do that but find an appropriate ratio.

Thanks for your input. I did Med. Surg. as a student nurse & for a bit as a new graduate nurse. Honestly, I didn't really like it that much (sorry if I offend anyone). Well, I should say I didn't like the floor that I was on. It was always crazy. The floor was very unorganized. I want to do Med. Surg for a solid base, like you said. I found that when I worked in IMC, having that Med. Surg. experience really helped me.

For IMC, they are mostly cardiac patients. I worked there also as a new grad & I LOVED IT!!! But the manager & I had words because I was promised things & never got them.

What did you do?

Up Vote Up Vote ×
Specializes in Med/Surg, Ortho.

I do med/surg, but we do team nursing. I see regularly 8-10 patients on days, but do have a LPN and CNA with me on that team. It in no way lessens my responsiblitiy to have a LPN and CNA with me though. Absoutley no way can 1 RN have 8-10 patients by themselves giving meds, treatments etc. I'd run from that too.

If i have a patient that is declining, it does take time. Phone calls to Dr., documenting, monitoring the patient. If i have a patient that i feel needs more monitoring that what i can give and not totally abandon my other patients i will ask the dr for a transfer to ICU (we dont have a IMC). That is part of learning where your boundries are. Your evaluation of the situation and judgement of the patients condition tells you when you ask for the transfer for closer monitoring. That comes with time. Most Dr.s will trust that you know when the patient is needing more than you can give them and will agree with your decision.

Up Vote Up Vote ×
Specializes in tele, stepdown/PCU, med/surg.

Pie,

Are you and the IMC manager on OK terms now? After graduating school, I worked med/surg for about a year. (I never thought I would) Then I worked stepdown-tele which is what I love. I love cardiac patients so mcuh, they are truly fascinating.

Don't have your first job in a place where you won't have fun and learn. Good luck in what you decide.

Up Vote Up Vote ×

test

Up Vote Up Vote ×
Pie,

Are you and the IMC manager on OK terms now? After graduating school, I worked med/surg for about a year. (I never thought I would) Then I worked stepdown-tele which is what I love. I love cardiac patients so mcuh, they are truly fascinating.

Don't have your first job in a place where you won't have fun and learn. Good luck in what you decide.

No. I can't stand him. Basically, I went to him & told him about my concerns & he said to me, "Ok, you can leave because I am not going to sit here & be put down by a potential employee." I then said to him, "I am not putting you down. You asked me a question & I am tactfully answering it. Am I to understand that by asking me to leave, you are not willing to listen to my concerns?" When I did leave, I thanked him for his time, & he was all in a huff, & had the 'yeah whatever' attitude. Anyway, I really think I would like something like IMC or Telemetry. There are other IMC units here, which I may apply to at a later date. Today I was offered (and took) a Med. Surg. day position with a 6:1 ratio.

Up Vote Up Vote ×
Specializes in tele, stepdown/PCU, med/surg.

Med/surg isn't all bad and can be a great learning experience. 6:1 ratio is good too. See how you like med/surg and remember to keep IMC/tele in your mind and keep your eyes open for future jobs in that area hopefully with a more emotionally stable manager :).

Up Vote Up Vote ×
Med/surg isn't all bad and can be a great learning experience. 6:1 ratio is good too. See how you like med/surg and remember to keep IMC/tele in your mind and keep your eyes open for future jobs in that area hopefully with a more emotionally stable manager :).

Thank you so much for your feedback & thanks for responding so promptly.

Up Vote Up Vote ×
+ Join the Discussion