? about Pt. ratios and Registry LVN's

[Hoping LVN2BSN]

I'm a new grad, working registry in California. I've been working registry now for three months with no problems until last night. I arrived at a facility I worked many times for on a unit I've worked on twice. This facility is a Psych LTC, most people on this unit are pretty stable, however they are more frail, and needy with G-tubes and much more confused and many treatments than the other floors with the exception of Sub-acute which has trach's.

Anyway, the first time I worked there with another LVN 11p-7a, I had 18 patients (one of which kept crawling out of his bed and under his roommates bed) and fell really behind and it took me almost 2 1/2 hours to finish 6am med pass because there was so much to do, but I did it, the second time was similar. Last night, I worked there with an RN BSN (I say that because she let it be known she was a BSN immediately upon arrival.) I was receiving report from off going and she finished with her patients and she asked the RN where she wanted to split and she said I'll start at 19. Well this left me with with 18 rooms. 18 ROOMS WITH 31 PATIENTS and 1.5 CNA's:angryfire!!!! Now I've worked other units at this facility with 30-50 patients, but those pts. were only with psych issues with med pass and had little to no treatments. I told her politely what happened in earlier shifts and she told me well I'm the RN and I'm the House Sup. tonight so you have to do it, that's how it is always split (not true because I've worked there.) I told her once again politely, I think it is a safety issue for the patients and myself for me to have 31 patients on this unit, however if you would like to have one of the facilities regular employees take this unit and I will go to another, or I will split the patients in a more manageable load with you. She said now that's how it has to be, I have to make my rounds at night (rounds consists of picking up census sheets at the beginning of shift and asking everyone if they are ok at the end of shift.) At this point I called my registry and explained the entire situation to her and why I felt it unsafe, she was surprised and called the BSN back and asked her what was going on, and she told her that I didn't want to work because I had more patients than she did, and she offered to register mine and my registry's complaint with the DON on Monday. As I was looking through the facilities numbers on the wall, I found the DON's home number and gave it to staffing, while she was calling, the BSN offered me to work Sub-acute, now I have specific instructions form my registry not to work sub-acute, I can work any other floor, but not the sub-acute. I told her I can't do that I have instructions from my registry not to work on sub-acute. She says, you're registry you can do anything you have 10 seconds take it or leave it!!!!!! I said I will not take either of these assignments until the load is more manageable. She said we can't do that and I want a note from you saying you won't work to give to the DON, I said I will not write you anything for the DON my registry is speaking with her now. At this time the DON called her and miraculousy she decided to take 22 residents and I would take the other 22, I thought she couldn't do that?!!?

Although I felt better about my load, she made me feel like such a whiny baby by the end of this entire fiasco, I just wanted to get your take on this situation, did I handle myself appropriately or should I have just taken the assignment? Has this happened to any of you that are registry and how did you handle it? In the event that something like this happens and the site refuses to adjust your load, what do you do? I didn't mind having more patients, I just felt it unsafe on this unit, especially since one of her patients which would have been mine was found unresponsive during the shift.

Thanks for listening to my question/vent,

April

Disclaimer: I have nothing against RN's or RN's with BSN's. In fact I am working towards becoming an RN, so please don't flame me because I refer to her as the "BSN," seriously, she likes it. lol, I'm going to bed!

[caliotter3]

This is typical behavior toward registry nurses. Kudos to you for standing up for yourself and sticking to your guns. Also to your agency for backing you up in this. This individual will think twice before trying this on another of your agency nurses. However, you should have a talk with your agency and make certain that they brief any other nurses that are sent there to insist on a fair patient load so that the precedent of fair treatment is reinforced.