12 patients for a new grad to much?

Nurses General Nursing

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Hi all,

I was wondering if anyone felt 12 patients was a bit much for a new grad? I love caring for my patients, but after two weeks of orientation, the 3 days I have been on my own we’re not so great.

I had 5 long term care patients and 7 skilled nursing patients. (2 with Q4hr neb treatments, all had a dressing changes, 2 with tube feedings). I am not complaining by any means, but I did feel very overwhelmed to the point of tears on the 15 min break I got. I worked from 7am-11pm at night to help out. (We work 8 hour shifts. I worked a double) I am new to this site and have seen ignorant comments on others topics. Please try and refrain from that if anyone decides to respond.

Just looking for advice. Thanks all ?

7 minutes ago, River&MountainRN said:

I "tarnished" my reputation/resume in this tiny little community I work in, and I left that crummy facility with its 40-80 patients after about 4 months.

I would have 1-4 aides on overnights, but half the time they'd either pull a disappearing act or be forced to float. I never went to the bathroom, ate, or took a break. I came close to having a nervous breakdown.

I'd come in, get report, round on the patients with the off-going nurse (as I never wanted to accept responsibility for that large a census without laying eyes on them with an additional nurse present, plus we had to both verify the placement of patches), and then do count.

From there, a quick review of the MAR and treatment sheets. Dole out the creams into little cups, pull the 12 AM meds, get the VS equipment on top of my cart for anyone who needed temps (on antibiotics, recently ill, etc), and then start hustling.

11pm-2am and then 4am-7am (technically 7:30am, by the time 7-3 took their sweet time coming to the floor) were the busiest times.

2-4 am was dedicated to nightly 24 hour chart checks, summaries (that I really had no business doing because I didn't know the patients), edits and then changeover at the end of the month (used to kill me because there we SO many mistakes), Medicare documentation, PRN medications and followup assessments/documentation, glucometer checks, medication destruction, refrigerator checks, setting up the aide assignments for 7-3, etc. It wasn't a case of the individual tasks being onerous, but if something went wrong (a resident fell, became ill, had behaviors, had to be sent out, etc) it could set your entire night off kilter because of all the mandatory, "tasky" busy-work left to the overnight shift.

My supervisor was of absolutely no help, and actually came close to harming a patient simply because she didn't want to help me (and it wasn't over a "stupid" question that I, as a new grad, should have just researched better; it was a situation where I needed access to supplies that only she had the keys for and she refused to give the keys to me/wake up from her nap and walk down to get the supplies for me).

I hated every minute of it, but it was a good wake up call about what to be mindful of in evaluating potential jobs in the future...

You’re Supervisior sounds a lot like mine. I went and tried to get her help as a patient I had when she was admitted had a very high BP 170ish range/90ish range. I can’t remeber the exact number. I took it on both arms, she denied SOB, her lungs were clear etc. (trust me if she was in respiratory distress I would have just called the nearest person for help) This was not a patient that ever had a BP that high. I went and got my supervisor and asked her for her help with the situation. She acts irritated if I ask her any question as she would rather be gossiping versus help out. (Sorry not trying to be mean but that’s what she does) Long story short, yes I’m sure I looked like a moron, but I would rather look like a moron versus having something bad happen to a patient.

The way you went through you’re shift sounds very organized and I should try to do it that way. Giving out meds and doing the treatments last isn’t working for me as I’m to slow for that. If you don’t mind me asking what do you mean by tarnished you’re resume? It wasn’t good that you left after 4 months? It sounds like you were an awesome nurse to that facility.

23 minutes ago, JKL33 said:

The themes of "that's a lot better than what I endured" are troubling, especially since problems of substandard care in LTCs/SNFs are well-known and well-documented.

The idea of "if you can't handle the work someone else will have to do it" - is illegitimate outside of a clear assurance that the workload is appropriate to begin with.

If you want to say, "My situation of 40 patients was not safe, but twelve is actually doable and should the be standard everywhere" - well that is something different and gives everyone a better idea how the OP should process this.

I hope that's what a lot of these previous posts meant to say.

OP, I would highly suggest not working doubles right now. The goal is not to get into to others' good graces by appeasing them - the goal is to learn how to safely provide care and then to actually provide excellent care. My observations have been that trying to appease others by any means necessary appears to be a dangerous road to travel overall - so I hope you will spare yourself some agony by not going down that road. ?

Thank you for all the advice. 16 hours of non-stop made me realize I should maybe start focusing on my health. I’ve seen nurses much older than me breeze right through it and I thought I was going to be on the floor by the end of it. I figured I would be learning more if I was there for a longer shift, but it was the opposite. Thanks again ?

5 Votes
Specializes in Primary Care, LTC, Private Duty.
39 minutes ago, Stitchcat said:

You’re Supervisior sounds a lot like mine. I went and tried to get her help as a patient I had when she was admitted had a very high BP 170ish range/90ish range. I can’t remeber the exact number. I took it on both arms, she denied SOB, her lungs were clear etc. (trust me if she was in respiratory distress I would have just called the nearest person for help) This was not a patient that ever had a BP that high. I went and got my supervisor and asked her for her help with the situation. She acts irritated if I ask her any question as she would rather be gossiping versus help out. (Sorry not trying to be mean but that’s what she does) Long story short, yes I’m sure I looked like a moron, but I would rather look like a moron versus having something bad happen to a patient.

The way you went through you’re shift sounds very organized and I should try to do it that way. Giving out meds and doing the treatments last isn’t working for me as I’m to slow for that. If you don’t mind me asking what do you mean by tarnished you’re resume? It wasn’t good that you left after 4 months? It sounds like you were an awesome nurse to that facility.

Unfortunately, nurses are---at the same time---expected to "vote with their feet" if they're working in a poorly run facility that prioritizes profit over resident, but they're also supposed to stick it out at least a year in their first nursing job. It hasn't mattered how long I've stayed elsewhere; I'm always stuck explaining that four month period and why I left when I did (and that's not counting how many jobs I've just immediately been passed over for and never had a chance to explain). However, there is also a fine line when explaining so that you're not seen as a "complainer".

17 hours ago, Jedrnurse said:

ARRRGH! I am not saying that short orientations aren't a problem. I realize that poor nursing has consequences and sometimes these consequences lead to a downhill slope that results in increased morbidity and mortality.

I'm saying that if you want to forcefully and successfully advocate for better conditions, you need to provide data driven proof. (Not that even having it always results in change, given other factors affecting healthcare economics.)

And that's Colonel Obvious to you, thank you very much... ?

You actually don't. There is nothing tied to reimbursement or any regulation that stipulates how long a nurse has to be oriented. That is facility specific. All the state and the Joint Commission cares about...is that there IS an orientation.

Not every facility is interested in doing the right thing.

Specializes in Dialysis.
17 hours ago, Stitchcat said:

What is the usual orientation? I’ve heard some nurses say 6 weeks, some say a week etc. What would an appropriate amount of orientation be?

In SNF usually 2 to 5 shifts. Look at the geriatric nurse specialty threads on here. They can be quite helpful and eye opening

Specializes in Community Health, Med/Surg, ICU Stepdown.

I have only worked as a CNA in a nursing home and was already super overwhelmed by the ratios, especially when someone called in and they never found a replacement! Only lasted 6 months! I can’t imagine having 12 patients let alone 40 or 80! Omg!! You both sound like amazing nurses making the best of a horrible situation. I don’t know if your end goal is acute care but I have worked with awesome nurses on my stepdown unit who started out in a SNF. They have such good time management. I would say try to stick it out for a year unless you feel your patients or license are at risk. Good luck!

On 2/22/2019 at 1:03 PM, Stitchcat said:

Hi all,

I was wondering if anyone felt 12 patients was a bit much for a new grad?

Yes. It is too much. You asked how we felt about the patient load and by extension perhaps if such a patient load is in the spirit of good nursing -- it is not.

A lot of people here are giving de jure replies about patient ratios and comments about the de facto state of SNF pt loads. I don't really understand that, because it's not what you asked for. You asked for a moral, ethical, and practice safety judgment.

Yes, it is too much. Yes, it is dangerous. Yes, it is wrong in the spirit of safe and high quality nursing. I advise that you move on as soon as you can.

2 Votes

If possible I would recommend NOT working double shifts as a new nurse. 16 hours and skipping 30 minute meal breaks regularly will exhaust anyone but as a new nurse you are also trying to learn your new role and multitask which will make you even more tired. This could lead to preventable errors that may occur because you are overwhelmed/fatigued and not thinking clearly.

20 years ago as a new grad who was also still attending college classes full time I wanted to work double shifts so that I could have a more flexible work schedule so I could attend my classes/study. My supervisor told me that she would not allow a new grad to work doubles until 6 months because they are still learning and that long of a shift would been too much mentally. While I didn’t like that I couldn’t have the schedule I wanted at the beginning, I completely understood several months later and was thankful that she had prevented me from doing so as a new nurse.

1 Votes
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
On 2/22/2019 at 3:37 PM, meanmaryjean said:

SNF= Skilled Nursing Facility = Nursing Home. So 12 patients IS a rather light assignment.

Yup! As for my experience: 45:1 memory care locked in dementia unit. 54:1 locked in long term psych. 16:1 locked in acute psych. 25-35:1 Skilled nursing / rehab. And now 5:1 med surg acute hospital.

On 2/22/2019 at 4:50 PM, Jedrnurse said:

It's disturbing that this is considered a "light" assignment. Honestly, say you're working a truly 8 hr shift. Twelve patients with dsg changes, 2 TF, 2 with nebs, and we all know about the plethora of meds you're passing. Not to mention all the toileting, ADLs and incidentals that come up as well. Yes, this number might be light relative to obscenely bad ratios, but it's still not good. Not if you're providing decent care.

I've come to despise the term "Skilled Nursing Facility" because it's exactly that service that is in such short supply in so many places. Not because of nurses's skills, but because of how much average time they can (in reality) spend with their patients.

I think that's exactly it, that's a lot of work to do in an 8 hour shift, but seems pretty decent compared to getting 40 SNF patients dumped on you, with 1 CNA, for a 13 hour shift. I don't think its a competition to see who has the crummiest staffing ratios.

All you can do is prioritize, ask for help, and delegate as best you can. Also, remember that you'll pick up little tips and tricks to speed things up as you progress and get more comfortable.

On 2/23/2019 at 4:12 AM, Jory said:

Yes, it is....when you don't teach a new RN the specifics of how to be safe in a particular healthcare setting, you are setting the stage for that patient to be harmed and yes, that can ultimately lead to their death.

So you don't think that a short orientation is nothing more than an inconvenience for the nurse and cannot possibly harm a patient? Wow.....just wow.

In regard to "short orientation:" I've never heard of an orientation being as LONG as 2 weeks in SNF and LTC. 2 weeks would have been pretty awesome.

I understand being overwhelmed to an unacceptable level with being given 24 residents. I'm not going to even touch on the ridiculousness of 40-50. But TWELVE? Of course it's going to be overwhelming to a new grad. But I find 12 residents, even with half of them being skilled, entirely reasonable with a CNA for ADLs. And I am a HUGE proponent/advocate for safe nursing ratios.

When I did sub-acute rehab, 12 was a decent day. And it was more acute than "skilled nursing." When that number jumped to 24, I bounced. I was done with the sickening unsafe ratios. I'd semi tolerate 24 with a mix of LTC and skilled, but not sub-acute.

1 Votes
Specializes in ICU / PCU / Telemetry / Oncology.

That is too much for ANY nurse!

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