Patient Ratio 1:8 and no tech!

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After doing med/tele for 3 years in one facility, I decided to try travel nursing. I am two weeks into my first contract and I am kinda worrying about their ratios. They are 1:8 on med/surg and med/tele floors and last night I had 8 patients and no nursing aid. I was doing q4 vitals blood sugars and cleaning pts. 4 of these 8 were admissions that were given maybe 30 mins apart... I was so overwhelmed. One was on a drip and I refused to handle the drip bc I signed up as a med surg nurse and specifically said I have never done drips. They still gave me the patient but the charge handled the drip. Am I being too sensitive for complaining about this or is this wrong? Charge tried helping out but she was also a monitor tech and charge for the ICU... I didn't chart til I finished giving report and didn't eat all night or drink water. Please comment!!!

Specializes in oncology, MS/tele/stepdown.

You will also learn to read between the answers they give you. If they tell you 6 patients you will have 7. Go ahead and let them try to be pissed that you are staying late to chart! They need you more than you need them.

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I'm from Wyoming and we do not have legalized ratios. Our policy, however, states that med/surg 5:1 maybe 6:1 on a bad day; PCU/Neuro is 4:1 but often is 5:1 b/c of staffing; ICU is 2:1 on a bad day we will be asked to take a team of three this is not the norm. I think I would look twice at staffing ratios and make sure that it is in your contract. We all agree this is unsafe but legally you have another issue. From a legal standpoint you may as well be saying, "I am okay with this. I got this. I am perfectly capable of taking on full medical care with full competency & responsibility of EIGHT pt.s at one time." You accept this - you will be held legally responsible to anything done, not done, missed etc. I can't imagine that I could wrap my brain fully around eight pt.s. At 5 pt.s my brain goes into task mode and critical thinking suffers. Not to mention ADL's with no help. YUCK!

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Travelers have a contract with an agency. The agency has no control over hospital policies such as staffing ratios and cannot put it into the traveler contract.

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That sounds unsafe for you and the patients. A contract is just a piece of paper, what are they going to do give you a spankin? It would cost way too much money for them to try and sue you so at worse you're looking at them trying to assess a financial penalty that would come out of your check. But if you can schedule yourself correctly you can see to it you're paid and quit before there's any hours worked for them to dock you for. 1:8 AND no tech, that's no good. As long as nurses stay and let them do that they'll keep doing it

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A contract is just a piece of paper? Perhaps Allnurses needs an anarchy forum. This country could not operate without contracts. You are right that it is costly to take a traveler to court, but there are lots of other negative possibilities. One is wrecking your work history and making any future employer cautious or reluctant to hire you, no matter your back story. Bad references. A traveler breaking their contract could be blackballed from working at a number of hospitals, especially if the contract is performed at an HCA hospital (or other chain hospital), or contracted through now commonplace vendor managers (third party handling contracts for hospitals). Agencies can withhold the last paycheck, and even claw back the prior paycheck from your bank account. These actions are potentially illegal, but now it would have to be the traveler initiating a costly legal action. The agency can also bill the traveler for contractual penalties for breaking the contract (could be five figures), and then send it to collections if not paid, and then wreck the travelers credit report. Not good business in my mind for most contract disputes, but unfortunately legal and there is little recourse to undo these actions.

Super bad advice. Travelers should always try to complete their commitments, no matter the work environment. Learn and grow strong from adverse events. It is only 13 weeks, versus the possible negatives, and that is a no brainer. It can just be difficult for stressed travelers, especially new travelers, to see that and have good judgement going forward in the middle of it all. We are here to help them not make really bad choices.

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A contract is just a piece of paper? Perhaps Allnurses needs an anarchy forum. This country could not operate without contracts. You are right that it is costly to take a traveler to court, but there are lots of other negative possibilities. One is wrecking your work history and making any future employer cautious or reluctant to hire you, no matter your back story. Bad references. A traveler breaking their contract could be blackballed from working at a number of hospitals, especially if the contract is performed at an HCA hospital (or other chain hospital), or contracted through now commonplace vendor managers (third party handling contracts for hospitals). Agencies can withhold the last paycheck, and even claw back the prior paycheck from your bank account. These actions are potentially illegal, but now it would have to be the traveler initiating a costly legal action. The agency can also bill the traveler for contractual penalties for breaking the contract (could be five figures), and then send it to collections if not paid, and then wreck the travelers credit report. Not good business in my mind for most contract disputes, but unfortunately legal and there is little recourse to undo these actions.

Super bad advice. Travelers should always try to complete their commitments, no matter the work environment. Learn and grow strong from adverse events. It is only 13 weeks, versus the possible negatives, and that is a no brainer. It can just be difficult for stressed travelers, especially new travelers, to see that and have good judgement going forward in the middle of it all. We are here to help them not make really bad choices.

How predictable, I foresaw you reading in to it and chiming in with some sort of counterargument. I'm assuming the OP is smart enough to deduce what I was saying which is, if the problem can't be resolved and it's a dangerous situation don't put a contract ahead of patient safety and their license.

"Super bad advice" is telling somebody to complete their commitments no matter the work environment. We're not talking about being stressed out bagging groceries at the supermarket man we're talking about the lives of human beings.

Which is worse? Being black balled from one hospital chain and staffing agency or being black balled from nursing because that patient on the nitro drip you don't know how to run died?

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You realize you are proposing that every staff member quit here as well? Because all of their licenses are in jeopardy? That's preposterous. Frankly, I don't think patient abandonment by one or many is a good solution to understaffing.

Yes, we make commitments and sign contracts that should be kept if at all possible. That should always be the first line advice, not that your legal commitment is "a piece of paper". Glad I'm not your agency or facility.

Obviously, do not accept an pt assignment you are not qualified to do. If you do, then and only then is your license 'in jeopardy'.

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You realize you are proposing that every staff member quit here as well? Because all of their licenses are in jeopardy? That's preposterous. Frankly, I don't think patient abandonment by one or many is a good solution to understaffing.

Yes, we make commitments and sign contracts that should be kept if at all possible. That should always be the first line advice, not that your legal commitment is "a piece of paper". Glad I'm not your agency or facility.

Obviously, do not accept an pt assignment you are not qualified to do. If you do, then and only then is your license 'in jeopardy'.

Did every staff member log in and express a desire to quit? Did you read anywhere a suggestion that this nurse walk out on their patients during a shift or without handing off care to another nurse?

I'm confident everyone else is using common sense realizing not only the sarcasm but that my point was to put things in perspective, not encourage them to frivolously breach contractual agreements because it's Tuesday and they feel like it. C'mon man.

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Did every staff member log in and express a desire to quit?

It would be a rare employee that doesn't express a desire to quit. They don't do it here because they are staff, not travelers. My point is that if the traveler is endangering patients by working at this facility, so is every staff nurse.

I'm confident everyone else is using common sense realizing not only the sarcasm but that my point was to put things in perspective, not encourage them to frivolously breach contractual agreements because it's Tuesday and they feel like it. C'mon man.

A traveler who wants to quit will grasp at any straw to do so, including your bad advice. They are not going to see sarcasm.

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This is why even though I don't like my state I am scared to move. Arizona is very strongly not a union state and yet my hospital would never do that (yet). We get mainly 4 in the day but sometimes 5 but that is it (nights is typically 5, less rarely 4 or 6). There is always at least one aide for 32 patients but normally 2 and sometimes 3. Unless you happen to be the unit that always gets 3 PLUS a HUC, no idea how they manage it. Granted more and more support services are going away but I literally can't comprehend how you care for 8 patients and I am a pretty strong nurse with great time management.

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Was this the staffing grid or were they just running short staffed during that shift?

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