pt/nurse ratio?

[emsboss]

This may turn out to be a vent also...BUT... For the past week I have had a 3 pt assignment. Was wondering if this was the "norm" in other units or just in our facility? We have 2 eight bed units that we "float" back and forth from. Due to staffing shortages, we are "capped" at 12 pts between the two. Last week I started with 2 pts, both on vents, Propofol, pressors, fluids, insulin gtts with hourly blood/glucose monitoring, and one was recieving blood. The house supervisor strolled in and told me I was going to get an "easy" pt that telemetry had no bed for. After a short "discussion":angryfire , I lost and had to accept the pt. And now there were three. Within 15 min. of recieving this third, his pressure bottomed out (50/doppler) was intubated(he decided he was to tired to breathe any more, I guess) and now HE was on ventilator/pressors. I survived the night, finished charting about 0930 and went home with relief. When I went back that night, I had the SAME THREE PTS:angryfire . I tried to refuse the assignment, but was told that since I had had them the night before, I was familiar with them and to just accept the assignment. I had these pts for 4 nights in a row. Am now mentally/physically exhausted even after my stretch off:uhoh3: . I guess my question is...Does anyone ELSE have to put up with this?

BTW...I have been an R.N. since 2 February'05. THANX for allowing me to ask/vent. signed...A Disillusioned R.N.

[Zee_RN, BSN, RN]

That would not happen in my unit. It may have happened in the *last* hospital I worked in however. And that's one of the reasons I left. I've been at my current hospital for 2 years now and we very rarely get a three-patient assignment and you'd NEVER (never!) get three vents!! I have a really sucko schedule at this place but I wouldn't leave simply for our stance on a 2-patient assignments. Really gotta respect our manager for that!

[-Emma-]

This is extremely unsafe practice. If this happens again where you feel that your assignment, that you cannot change, is unsafe for your patient's, make sure that you are noted to have protested the assignment. If your manager or supervisor says you have to take the unsafe assignment, say that this is unsafe practice and you want it documented that you are protesting the assignment. Also, you can go up the chain of command. Go to someone above your manager to tell them of the unsafe practices going on. I believe that you can also anonamously report the hospital to the state. If I had them all 3 days in a row and then knew I had one more day to work, I'd call in for a personal day that forth day.Your patient's are losing their right to safe nursing care. Good-luck. Don't get discouraged, get assertive and know your and your patient's rights.

[ICURN_NC]

Where I work, we never have more than 2 pts- and will make many a 1-1 if need be for several reasons. Now, in a real pinch, we will double a 1-1 (like a CV or an insulin gtt) with an easier assignment. I have often seen it when 1 of the "easier" assignments start heading south, nurses will shuffle other assignments to help out if need be. Also, I don't think I've ever seen a nurse "forced" to take back patients if they didn't feel up to it or had family issues.

Geez, I feel bad for what they did to you and happy for the people I work with. I say def talk to the nurse manager and see where to go from that. Also, my hospital has an executive position, assisgned to an RN, called the Patient Safety Officer. If you have something similiar, I'd contact them, too.

Good Luck!

:wink2:

Sharon

[emsboss]

THANX for all the input...I have another question...If I go check the assignments BEFORE I clock in...then leave...Is it abandonment if I document why? In our computer system we have what is called a PRIME report. not sure what the initials stand for. Kinda like a computerized incident report to report unsafe/dangerous equipment, med errors ect, so it is possible to report it. Just aking.

[PJMommy]

Your employer may say you've abandoned patients if you don't show for your shift but, legally, you cannot abandon patients for whom you have not taken report. Once you've taken report, you are legally responsible for the patient until you give another nurse report.

BTW...only time we are 3:1 is when 2 or 3 of the patients have transfer orders to the floor and are just awaiting a bed. Otherwise, we are always 2:1 or 1:1.