is this what nursing is supposed to be like?

Lovely_RN, MSN · Sep 2, 2011

We have 6-7 on nights, 1 aide per 7 to 8 pts, and no LPNs.

Marisette, BSN, RN · Sep 3, 2011

wow. incredible to me, but I don't work the "hospital". I wonder if this is generally occuring in all states or if nurses that are unionized in some states, like California, have it better in the medical surgical areas.

neuronRN · Sep 3, 2011

I have only been a nurse for a few months now and will start practicing this month. However, I have worked in hospital settings for a few years. I believe there is a thin line between safe staffing and unsafe staffing. I've been in hospitals where there are various different roles; RNs, LPNs, CNAs, and PCTs. Giving the nurse so many responsibilities and duties as you described is definitely burdensome and may cause an error in care. What if a code or emergency occurs requiring your assistance who will monitor your other 6 or so patients?

I remember working on a unit where something similar occurred. The hospital was going through a change (renovating units and moving around), because of this occurrence, staff had to be floated. One unit ended up with the short stick; having 2 RNs and no aide to care for a large group of patients. They also had to deal with going to another unit to use a pyxsis and get supplies because that units pyxsis was down. One of the RNs called the RN supervisor to address the issue and bring up concerns and when it was said nothing couldd be done the CNO was called. Again the same stuff was brought up and the RN pointed that JCAHO mostly likely wouldn't like this.

Perhaps you can follow your chain of command and bring up this issue and concerns. Maybe even form a committee or force with others nurses who share the same ideas (nurses are very known for speaking up and raising hell for patient care from what I remember in school).

xtxrn, ASN, RN · Sep 3, 2011

What stands out in my mind is the fact that hospitals are a business and that they act just like every other business in the world. Staffing at the hospital floor I work at is not ok. Nurses are going home crying after their shifts due to the stress from poor staffing and fear that they will make a mistake. Management is aware of this and says staffing is ok despite the fact that our patient satisfaction scores (on a general med-surg unit) are lower than the ED's scores and our staff satisfaction is the worst in the hospital. In fact, management is sending our staff away, floating them to other floors and staffing us with the bare minimum. I have worked here for 2 years and am one of the most senior nurses on 2nd shift. Course, the 2nd shift Clinical Manger has only been a nurse for 2 years...
I have never worked anywhere else, so my question..is it this bad everywhere? Is this just what nursing is? Having no aides or LPNs to help out.... each RN expected to work the floor, assess 7 patients, give meds to those patients, perform all patient care, pass dinner trays, feed patients, perform wound care, walk the halls with patients, take out discharges, etc.
I have heard stories of hospitals that have multiple CNA's and LPN's to help with care & med pass but I wonder if they are true. Is the grass really greener on the other side? I am considering leaving my current job but don't want to go through all that to find more of the same. Advice would be appreciated : )

YES...... this is what nursing IS- it doesn't matter what it could be - and this is much better than it was 26 years ago, and 30 years ago, etc.... trust me- you would have walked out with staffing ratios of the past- and the "patients are sicker" only goes so far....a coma is a coma is a coma on a neuro floor- this year or 30 years ago. They just take longer to die now, thanks to the brilliant technology :) !!

You are still new- and probably that contributes to feeling overwhelmed (not saying things couldn't be better- but not having more experience adds to that ). That will get better :)

Your manager is as powerless over upper management as you are over him/her. It is business- that is the bottom line- and the bottom line will always be the most important thing. Nurses are disposable- if you don't want the job, there are 100 who will snap it up in a heartbeat. What really stinks is that people don't find this out until they've gone through school.

I loved working- and wish I still was able to....Yeah- it's hard, and frustrating. If nurses are going home crying, maybe some EAP help would improve coping skills (everybody goes home crying at some point). It's a hard business- and it is business. You can improve it by giving the best care you can- do YOUR part- the rest is too big for any one person, and if you can find enough people who aren't fried, to tell the CEOs they don't really need so much money (that covers the uninsured, and underinsured) go for it :)

Good luck- and deal with what is- not something that was dead and buried decades ago.... you'll save yourself some frustration :up:

xtxrn, ASN, RN · Sep 3, 2011

I have only been a nurse for a few months now and will start practicing this month. However, I have worked in hospital settings for a few years. I believe there is a thin line between safe staffing and unsafe staffing. I've been in hospitals where there are various different roles; RNs, LPNs, CNAs, and PCTs. Giving the nurse so many responsibilities and duties as you described is definitely burdensome and may cause an error in care. What if a code or emergency occurs requiring your assistance who will monitor your other 6 or so patients?
I remember working on a unit where something similar occurred. The hospital was going through a change (renovating units and moving around), because of this occurrence, staff had to be floated. One unit ended up with the short stick; having 2 RNs and no aide to care for a large group of patients. They also had to deal with going to another unit to use a pyxsis and get supplies because that units pyxsis was down. One of the RNs called the RN supervisor to address the issue and bring up concerns and when it was said nothing couldd be done the CNO was called. Again the same stuff was brought up and the RN pointed that JCAHO mostly likely wouldn't like this.
Perhaps you can follow your chain of command and bring up this issue and concerns. Maybe even form a committee or force with others nurses who share the same ideas (nurses are very known for speaking up and raising hell for patient care from what I remember in school).

OK- "what if" can go on forever... focus on what's probable- not what "could" happen.....an asteroid could hit the hospital, but it probably won't :) Any code I've seen, other staff watches out for the patients...it's not like you're the only nurse in the building, are you?? :eek:

Bring up JCAHO to a supervisor, and expect to see the classified ads in your locker, with an invitation to check them out. Threats are not the way to go (and I understand it wasn't you).... don't like it? Find something better - all up to YOU to make your working life what you want it- nobody else's. If you feel you're not safe, move on- really simple. Make your own decisions- don't ride on the unions' back..... I have never, and would never work for a nursing union, because the whole goal is about the nurse- not the patient; argue that all you want.... I will never buy it. I never had a contract- so I never had to stay somewhere I didn't like. And if I didn't like the pay or benefits I was told when I was offered the job, I didn't accept....done deal.

Management has heard it all before- unless you can come up with a real way to fund your ideas, save your strength...

Figure out if the good outweighs the bad where you are- if it does, stay...if not, hit the road and find what is better for you :)

Isabelle49 · Sep 3, 2011

Remember that profit is the bottom line and most important in the business of Health Care!

nurse2033, MSN, RN · Sep 3, 2011

You work on a bad unit. Look for a hospital or unit that shows signs of staff working there a long time. I chose my hospital because most of the staff have been there a long time. That says a lot about management. Too many people put up with poor managers. You can either join them, or vote with your feet.

xtxrn, ASN, RN · Sep 3, 2011

Remember that profit is the bottom line and most important in the business of Health Care!

Sad, but oh, so true :)

carolmaccas66, BSN, RN · Sep 3, 2011

I've had many shifts where I've had no EENs/LPNs to help me. As nurses, yes we are expected to give out meals and help with feeding. In the ED/ER I currently am floated to, we have not EENs/LPNs on the floor. They are all RNs and higher at the moment.

You will probably have to get used to it, complain vociferously, or leave. Sometimes in the end, you have to look after ur own sanity first.

cindyloowho · Sep 3, 2011

Wow, that's crazy. My last hospital med/surg job had a patient/nurse ratio of 4/1, even on nights. The day shift always had CNAs on each pod, and they tried their best to give them to nights too. I currently do peds oncology and we are 3/1 with aids as well.

xtxrn, ASN, RN · Sep 3, 2011

Wow, that's crazy. My last hospital med/surg job had a patient/nurse ratio of 4/1, even on nights. The day shift always had CNAs on each pod, and they tried their best to give them to nights too. I currently do peds oncology and we are 3/1 with aids as well.

Some smaller towns are lucky to have staff at all - they have to make due. If the community is more of a retirement area, there are no people to build the work force...so fewer nurses and more patients.

The only time in the 19 years I worked that I had 3-4 patients was in peds - and coma stim - when I had the only vent patient. She was a 1:1 (and being stuck in one room drove me nuts). The general staffing ime has been 5-7 on days, 6-7 on evenings, and up to 14 (all acute care neuro) on nights. In med-surg/ortho , as the charge nurse, I was the only RN for 27 beds, with 3-4 LVNs from 7-11, and 3 LVNs from 11-7....a CNA if lucky. And it all got done. It was no big deal to have 4-8 fresh post ops divided up among the 3-4 LVNs. I had all of the RN stuff- assessments, orders, MD calls, MAR checks, death pronouncing, emergency stuff, etc.

The LVNs I worked with were incredible. My supervisors were also great to work with- we looked out for each other, and if something came up, nobody had to ask for help- just say they were getting swamped... IDK what happened to that concept. We had primary nursing, so that's no different. All lights were everyone's lights - but if someone needed meds, the assigned nurse got them. Turning was done in teams that we just 'did'- no official assignment- just knew that every 2 hours, we'd be going off in pairs to turn those who needed it.

I'd go back there in a heartbeat if I could still work- over a bigger city with the cliques and resistance to be team players (jme- but it's really stunk around here).

Work is what YOU make it.... it can be good, or stink. If you work with slugs, you're sort of sunk- unless you leave. But that, is also up to you :)