7 Patients Feels like Too Many

Nurses New Nurse

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I am a new nurse - I've been off orientation only about 6 weeks. I am working nights on a busy med-surg unit. For the most part, I have great co-workers who are helpful and really know their stuff. I feel like I'm learning a lot. So, the problem is that I usually have 6 patients which is managable most nights, but sometimes I'm assigned 7. On those nights I have 7, I feel like I am so busy that I am on the verge of being unsafe. I am worried that I am going to miss something (I am not able to check on all 7 patients every hour) or that I'll make a med error. This week when I had 7, I literally had no time to check for critical labs on anyone. What if something important had come in?? I am just moving so fast, trying to get it all done. And of course, I am never done on time, I usually work at least an hour OT in the morning charting. Sometimes 2 hours, on a really bad night.

So what I am looking for (besides venting of course) is tips on what I can do on these super busy nights when I feel overloaded. What do you do?

The Aiken study from JAMA in 2002 is worth a look... She addresses nurse-patient ratios.

Managed care and the way our health care system works today isn't doing nurses or patients any favors as far as staffing.

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Specializes in Psych.

Thanks for all the specific suggestions. I am learning to group tasks together, for example, bring the midnight meds in with me when I do assessment. Thank goodness 7 patients is not our norm, it is usually 5 or 6. When I interviewed at 4 hospitals in this area, I specifically chose this one because it had the lowest ratios. The other places I looked at said 8 patients at night--I can't even imagine. Well, I guess I can, things just go undone. They have to.

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Specializes in Telemetry/Med Surg.

I work a med/surg Tele floor and my norm is 7-8 patients.

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WOW! i feel so jealous, envious with everyone posting here that they only get 7 patients at night...meredithT, which hospital do you work? i am also a new grad and just got off orientation and started on my own last january, 2008. I ALWAYS have 11 patients on a very heavy medsurg floor with 2 admissions and one transfer from other unit that just got stable. isnt that nice!??? i thought that was always the norm on night shift. but then again when i read this post, i feel so bad now....:scrm:

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Specializes in IM/Critical Care/Cardiology.

Brings back memories of working telemetry (thank God for that invention), having ICU send up patients left and right as there unit(s) were getting flooded. Only my 10 patients had walls between them, and 4 with chest pain all at once. But of course that was 20 years ago, with a severe nursing shortage where you were given 3 sick days a year, period.

Welcome all new nurses!!!! You are needed, no lie!:bow:

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Specializes in Urgent Care.

It's so refreshing to see this post! I am orienting on a med-surg floor, and although the hope is to hve a 5-1 ratio, we have had up to 7-8 on the day shioft and it scares the crap out of me! I have only been there 3 weeks, and I have had up to 4.

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I am precepting on a Stroke Step-Down unit where it is the norm to have 6 patients on day and afternoon shifts. Sometimes we don't even have an aide to help. It's crazy and I don't know if I'll ever feel that I can deliever safe nursing care to this many people at one time!

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Specializes in Certified Wound Care Nurse.

Don't get me started! LOL...

I am a new nurse as well - three weeks out of orientation. I, too, work on a busy tele/med-surg unit. I've been assigned 6 patient at my own insistence and sometimes 7 - with the occasional admit patient.

I have found that I can simply roll with the punches and try my best to get my meds passed and assessments done in a timely manner (easier said than done...) and/or try to change the system so that there are more reasonable nurse :: patient ratios. That will require nurses working together for real change in the workplace.

Here's an example of the patient load I had the other night:

Six patients, 1 had low O2 sats all day, requiring constant monitoring, she had a rebreather mask that she refused to keep on. Patient two had a stroke, right side hemiparesis and was non verbal, on restraints. Patient 3 was suffering from chest pain and ETOH abuse - was having DTs, dr had prescribed ativan every hour on the hour and assessments. Patient 4 was in a veil bed, wouldn't remain clothed, dementia and required bed changes through the night - CNAs weren't always responsive, saying, "I just won't change him again." I changed him several times - wanting to prevent skin breakdown. Patient 5 had a Hx of stroke - care on this patient was easier. Pt 6 returned post-op, requiring an assessment, vitals q 15 min, then 30 then hourly for the first three hours, and corresponding assessments of the dressings.

Whew! Busy night.

I feel that five patients are completely manageable by a nurse, six is more hectic depending on the acuity - 7 is nearly too many.

Anyone have any ideas on how we can improve the nurse :: patient ratios?

Take care,

Shawna

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