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How many patients you guys take on your duty?
USA Anywhere up to 6 on medical/onco. 4 to 5 is usual. Granted, we also don't always have a tech. I've had 5 to myself before.
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Step down ratios
I work a fulltime job and a prn job at two different hospitals in med/onco. At both places, it is typically a 4 to 6 ratio with 4 being more typical. On one of my floors, chemo is hung frequently, patients go to PET scans, and patients often go to radiation. My other job is at a smaller hospital and radiation is not typically done unless we have to send them to the clinic to get it. Granted this isn't step down, but almost always i have four patients lately. At the larger hospital, the patients are usually a bit sicker, but ratio is the same.
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Are they exaggerating on sepsis or am i wrong?
Sepsis is definitely a word used a lot more frequently where I work. But it's mainly related to the MEWs vitals that we do. If someone's vitals are off to a certain extent, we fill out a sepsis screening tool and take vitals every 2 hours and the nurse has to be the one taking the vitals. If the vitals are out of limits enough; we have to call a rapid response or even a code sepsis which then gets the labs ordered and if they're not already on them, the proper antibiotics. If the lactic acid is off or the procalcitonin, we definitely start using that word more of course. I did have a patient once who i thought was for sure septic. Their vitals were off all day: temp high, Bp low, tachycaric. With multiple boluses, Tylenol, and vitals q2, patient was fine overnight then. turned out later that their port was infected.
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What do you call the tracking device nurses sometimes wear?
Is it bad that I have worn one for almost 3 years and don't know the name of it?! I am trying to figure it out. For ius, it has one color on when a nurse is in the room and another for the hcts. It flashes the colors outside the door when someone hits the call light and is solid when someone is in the room.
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Subtle deterioration on the floor
I feel like the Modified early Warning Score is a very helpful tool. We have to get our own shift vitals where I work and use it as part of our assessments. It is calculated using MEWs. This intervention has assisted me and others with catching that a patient's condition has changed. You can have the patient that may look okay (and you think you got it under control), but the MEws calls for a rapid response team to be called. They then determines to transfer the patient off the floor. When the score is a 3 or above, we do vitals every 2 hours, have to call the doctor, and inform the charge nurse. When the score is a 5 or above, we have to call the rapid response. It is very useful.
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Admissions!
Usually myself and a tech a bedside at time of admit. Sometimes, it's just me and transportation. Other nurses may come in if patient cannot walk and we have to slide patient over. Admit process takes around half an hour. Takes doctors sometimes up to an hour to see patient if they didn't see them in ED. There was one day where in the last 3 hours of the shift, every nurse got 3 admits each. There was definitely no help from other nurses that day.
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Nurses Humilated - Illinois
That exercise just sounds awful. That is not how you treat your nurses. I can say though that I do know a few people who work at this hospital. They have all said actually how well staffed the units are (well the med-surg units anyways) and seem to like their jobs. Doing this sort of exercise is one way to run people off, though.
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What is the Registered Nurse Patient Ratio at your hospital?
Illinois hospital I work on a medical/oncology unit and we take 4 to 6 patients. We never take more than 6 patients at a time. It is the same for the cardiac, surgical, and rehab units. PCU can have up to 3 patients I believe. ICU is 1 or 2 patients depending on acuity. We have a Behavioral Health where the nurses can have more patients than 6 each, but if they do; a medical nurse is sent to the unit to help out. We have decent staffing grids, but not always the staff to follow them.
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Secretaries who believe they rule the unit or hospital
I am very grateful for the unit secretaries I work with. The main ones I work with also were techs on the floor before moving to the desk so they also know the floor very well in all ways. They assist with making the assignment, faxing the assignment down, answering the phone calls and getting them to the right people, assist with patient care of all sorts since they have the tech background, ordering supplies, making follow appointments, assist with typing up discharge instructions, placing people in the bed on the computer, sometimes help get rooms ready for admissions, and do follow up calls with patients after discharge. They do a lot. Yeah one of them gets upset if people mess with her supplies of stuff, but it,is mostly so we don't end up running out of stuff. they also sometimes are secretary for multiple floors if there is a call-in and still manage to help on the floor. They definitely help make a very busy day run a bit smoother imo.
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What does CNA do, exactly?
Depends on where you work. I don't have personal experience as a cna. But this is a typical day for ours in the daytime (I have had a few days where I tasked and was essentially the tech If we were short one -baths and linen changes in the mornings -blood sugar checks -answer call lights -Assist patients to the bathroom -know the diet of patient to know if they can have food or need special precautions when eating -walk with surgical patients - our old school techs are awesome with getting I's and O's which everyone should keep track of -incontinence care -assist the nurse with turning patients who are at risk of skin breakdown and are unable to themselves -take out iv at discharge or take out Foley catheter once trained These are some of the things our techs do on a medical floor. One thing surprisingly that they don't have to do is shift vitals. Shortly after I started, they decided for nurses to do the shift vitals and that techs can do the q4s between the q8 vitals.
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Never Have I Ever Done That Before
In a little over 2 years of being a nurse, I have never done cpr. I have been part of a code, but was thrown into recording which was interesting for a first experience. I have never placed an ng tube either. We get them every so often, but I have never had to place one.
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Understaffed with a heavy patient load
I swear that sounds exactly like my floor. Usually we have 4 nurses and 1 or 2 techs for 18 patients (which is fully if we don't have the staff to double up rooms),but lately we have had 3:1:1. It is hard to get to everything done even for myself as a nurse. All you can do is your best. Grab your nurse when you are ready for to bathe a total too. Set your people up who can bathe themselves and while they are getting washed up, get the totals done, and go back to check on the independent people. Where I work they assign the tech 12 patients and no more, but then expect nurses to do total care for 2 patients if we have 3:1 staffing.
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Admit/Discharge RN?
Oh and the ones we had would help with iv starts and nursing tasks too if they had time. It's a lot more about doing the charting than anything else, but you still get some skills.
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Admit/Discharge RN?
We had an admission and discharge nurse for like 6 months and it was amazing. One day, I picked up an extra shift after they did away with it and did admits/dcs (we were very admit happy that day)for 5 hours and did like 12 admits in that time between 2 floors. And there were like 8 others I didn't even get a chance to do. When we had it, that nurse did the admit assessment, got a weight, height, and asked about the meds the patient takes, and so on. For discharges, they would do the paperwork, but we would still go in with it to the patient. Honestly, though our secretaries can type up the dc instructions while the nurses type up the next dose of meds, so usually our nurses just did their own discharges with the help of the secretary. That was my experience with it in the short time we had a nurse to do them.
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Accidently took home a patients' insulin!
I once made it home after working 12 hours, was sitting around talking to my roommates, and about four hours later I was getting ready for bed. It is 11:30 at night and something in me made me check my scrubs before putting them in the laundry. What do I find but the PCA key for our floor. I turned around and drove back to the hospital. Thankfully the one patient who was on a PCA hadn't needed it yet. Never did that again. Lol So it happens.