New Grad with 2 offers, need advise r/t nurse pt ratio

[Vegan]

Hello all, need your advise asap. I just graduated and passed the boards in NY. After two months of job searching I obtained two interviews which went well, both for Med/Surg night positions. One is PT @36h/week other is FT, both with full benefits. My concern is nurse/pt ratio and CNA availability. Pay scale per hour is same. The PT is 1:7-8, FT is 1:4-6. Both locations have one CNA per two RNs. Which situation would provide the better learning opportunity? I sort of feel 1:8 would be more realistic prep for future, but on the other hand more $ for less stress is tempting. Any advise for New Grad starting out? Thanks! -CJ

[diane227, LPN, RN]

You should take the position with the lowest nurse patient ratio. A 1:4 or 1:5 ratio is hard. 1:7 is way to much, especially on the day or evening shifts. As a new grad, you just won't be able to handle it. After 31 years, I can't do it. A ratio of 1:7 or 8 is just dangerous and that is all there is to it.

[juleeRN]

I agree with Diane, when I started out my ratio was 1:7 usually that was due to a turnover in staffing, however we now have new administration and the ratio has changed 1:5, this is much better and safer!

jules

[valdtess]

1:7 is horrible! In local hospital where I volunteered, my floor nurses had a ratio close to 1:7. It was so busy that they allowed me to take sugar and vital signs (obviously among other things that I was allowed to do) ; I was a volunteer!

[Ayvah, RN]

If you are worried about learning less with less patients, think about it this way. Would you rather spend your shift only having enough time to do the tasks of iv starts, pill passing, toileting, etc with only a quick scratch-the-surface check of what is going on with the patient as a whole, or would you rather be able to get your tasks done in an optimal fashion, being able to explain things to patients without feeling rushed, and have time to analyze the situation of the patients - double checking that the medications they are receiving are optimal, looking at the lab trends to understand why the patient is doing as well or as poorly as they are, to fully appreciate their pathology, to be able to realize potential problems and put things in place to ensure they don't get bad, to be able to see that the patient could really use a social worker consult for this or that issue, or that they really need a pastoral visit. Maybe you'll even have time to sit with the patient and give them a decent diabetic teaching so they can self inject and understand their meds and rationale, instead of just throwing them metformin and injecting them with insulin and running out of the room again.

I can't count the number of times that I have known what the patient needed but simply didn't have the time to help them, whether it be additional teaching, calming anxieties, additional monitoring, checking physician notes to understand the patient situation better and thus give better care and a better report, or pick up on something that should be happening in the patient care that isn't. In some cases the nurse is honestly scared for the patient because she is stretched so thin.

It is far, far better to feel like you have extra time with a better patient ratio so that you can do your job and challenge your mind to help your patient in every way possible, instead of just scratching the surface of how they could have been helped. The ways that hospitalized patients can be helped is incredible. Doctors are usually taking care of multiple patients so nurses being able to take the time to check the doctor's work is very important as well. For example, one day a doctor asked me for help on someone else's patient to find a list of meds that they were given while in the hospital. Turns out the patient had been admitted for pneumonia 3 days ago and had not a single antibiotic ordered. The previous physician notes assumed they were already ordered and stateded "patient continues to get abx...". I'm sure the nurses of that patient were very busy with their other patients, and thought the abx was simply being given on the other shift, and didn't check for that. It is times like that where the nurse can make a big difference in the care of the patient by checking on things like that and calling the doc for an abx order. Similarly I once found on a physician note that he was going to start the patient on medication x but it was not ordered. So I called and got the order. But I don't have the time to look at doctor's notes for every patient every shift, so I know that there were probably other things missed, which decreased quality of care.

When you have your first patient go really, really bad on you, it is a horrible sinking feeling to think "I've been so swamped but could I have prevented this from happening if I wasn't?".

So really, the difference will be so vast between those two jobs. You want to feel good about the care you give. Go with the better nurse : patient ratio. You will be glad you did.