12 patients for a new grad to much?

Reginarus · Mar 10, 2019

Don’t feel bad. I lasted 5 months!? I had 36-40 patients, and did the same except of not much documentation. To work at such places are absolutely unsafe . Charge nurses are not helpful. Doctors on call do not answer, sometimes even voicemail box is full- you cannot leave a message. Sometimes there was no oxygen tank on the floor and yankauer suction at the cafeteria. And nobody knows where to get it. You are new and all alone. And there was a lot of abuse from the patients. Nightmare!

Long Term Care Columnist / Guide · Mar 11, 2019

As I was reading this I was thinking, I would have killed for a 12:1 ratio in SNF/LTC. The ink was barely dry on my nursing license when I started on a mixed unit (half skilled, the other half residents with dementia and other comorbidities) with a ratio of 28:1 with two CNAs on day shift. Since the aides had 10 each, I had to do total AM care for the other eight, along with passing meds, answering the phone, feeding, dealing with orders, doing wound care and tube feeds, and chasing Alzheimer's patients away from the unlocked doors. (No wanderguards in those days.) I had a grand total of three days' orientation.

I lasted three months.

However, the acuity was different 20+ years ago. Most of my folks were relatively ambulatory and some even had their wits about them; they just needed help with ADLs. Today you have people with vents, trachs, wound vacs, IVs, post open-heart surgeries, severe psychiatric issues AND dementia. People who would have been med/surg or even ICU patients a generation ago. So it's understandable that the OP feels overwhelmed. You'll get used to it and may even thrive in the long run, but for now, it's a lot to learn and you should avoid working extra hours until you've got a few more months' experience. Wishing you the best. Viva

**canoehead, BSN, RN** · Mar 11, 2019

On ‎2‎/‎22‎/‎2019 at 6:18 PM, Jedrnurse said:
I'm not writing this to be a smart$$$, but is this provable? I know short orientations for new nurses is a bad thing, but does it (beyond anecdotal stories) result in patient/resident death?

It would be difficult, possibly impossible to do a good study, because of ethical concerns. But common sense says that if a new grad bursts into tears on her break, we're pushing her too hard.

caliotter3 · Mar 12, 2019

On ‎2‎/‎22‎/‎2019 at 3:37 PM, meanmaryjean said:
SNF= Skilled Nursing Facility = Nursing Home. So 12 patients IS a rather light assignment.

Not light in the sense of the true definition of light, but light in the sense of what the assignment could be in LTC/SNF. I regularly worked a hallway with a census of 80 and was the sole licensed nurse in a facility of 52. Whatever happened in those venues I dealt with, good outcome or not. Not surprising that this fact of life contributed to me eventually leaving this area of nursing altogether. I doubt that I am the only one who left or will leave, partially because of this issue. Urge the OP to do the best they can until they can no longer do the best they can. That is about all one can say.

Kooky Korky, BSN, RN · Mar 12, 2019

I advise you to not do much in the way of toileting, feeding, and other work that the aides can do.

Just tend to your own RN duties for now. Once you are more confident and quicker with your own work that only a nurse can legally do, then you can try helping with the aide tasks. I know many nurses will disagree with this and I caution you that you should not say to anyone that this is your plan or try to be reasonable about it. People will notice soon enough that you are not going to run and answer the lights, grab bedpans, etc.

Still, I think your focus needs to be on quietly training your team to do their work while you do yours. They will not be punished for not doing dressing changes or passing meds, charting, following up on labs and VS, evaluating falls, etc. You will.

And quit doing doubles. I know you want to maybe pick up some money or please your peers and boss, but I think you also need time to just do your own work for a while. Do OT later. Don't burn out by working too much and doing too much non-RN work.

mrsboots87 · Mar 13, 2019

I think people here are forgetting what a SNF is. These are very low acuity patients. The busiest and hardest part of the day is the med passes since the patients usually have quite a few. Most of the dressing changes are basic dressings that take 10-15 minutes tops to do, and TF doesn’t take that long to administer once a nurse is proficient. The charting takes a bit to get used to but it’s a task heavy but otherwise low acuity job. (And yes I have worked at a SNF with what would be considered good ratios like this as a new grad and did just fine. No one died.)

Nurses in SNFs don’t provide much ADL and toileting and such like in a hospital. The CNAs do those cares. Therapy services provide more activity and care.

Tbise who haven’t worked a SNF should stop complaining about the comments of those who have. 12 IS a light load for a SNF. It just feels overwhelming for a new grad just as any other new grad job feels overwhelming. Because it’s new.

River&MountainRN, ADN, RN · Mar 13, 2019

10 hours ago, mrsboots87 said:
I think people here are forgetting what a SNF is. These are very low acuity patients. The busiest and hardest part of the day is the med passes since the patients usually have quite a few. Most of the dressing changes are basic dressings that take 10-15 minutes tops to do, and TF doesn’t take that long to administer once a nurse is proficient. The charting takes a bit to get used to but it’s a task heavy but otherwise low acuity job. (And yes I have worked at a SNF with what would be considered good ratios like this as a new grad and did just fine. No one died.)
Nurses in SNFs don’t provide much ADL and toileting and such like in a hospital. The CNAs do those cares. Therapy services provide more activity and care.
Tbise who haven’t worked a SNF should stop complaining about the comments of those who have. 12 IS a light load for a SNF. It just feels overwhelming for a new grad just as any other new grad job feels overwhelming. Because it’s new.

Respectfully, it also depends on what the policies are at your SNF. At one of my jobs, we were so short staffed with CNAs that the RN had to take an aide assignment of up to 6 residents. Plus, we had our own feeding assignments for mealtimes. It was a time management learning curve, but as much as I hated my 80-resident assignment, it certainly prepared me for my "easier" job with fewer residents but more overall responsibilities (getting 6 ready for bed, plus feeds, plus two heavy med passes, plus documentation, etc).