I work on a telemetry unit primarily dedicated to post-op cardiothoracic surgery patients (hearts can come out to the floor as soon as POD #1, and lungs get recovered and then come to the floor a few hours after OR). If we have beds available, we can get surgical tele or regular tele admits. Most of our patients have chest tubes and pacing wires, and frequently have JP drains,epidurals and foleys. We are often giving blood, and can have cardizem gtts and renal dose dopa. We also have the highest rate of falls in the hospital and the highest acuity of all tele units. The generally accepted ratio has been 1:7 max on days and 1:8 max on nights.
Even with ratios as they are, we are stretched to the bone, dealing with all the complications and trying to get our general nursing obligations completed. Lately staffing has been worse (many days we have 2-3 nurses scheduled for our 26 bed unit). We were told today by our manager "You don't know what short-staffing is until you've had 14 patients".
I realize my generation can be a tad entitled at times. Having only been a nurse 2 years, I don't know if this is the standard elsewhere or if this is unacceptable. To me it seems highly unsafe, considering the acuity of our patients. But I am wondering if my manager is right and we are just spoiled, or if the higher acuity of many patients, combined with the added liability nurses have now as opposed to 20 years ago makes our frustration justified. Any advice please?? Thanks!
While staffing 'back in the day' meant less nurses per patient, patients also weren't as sick as they are today(for example your appendectomy patients would stay much longer than the current .5-1 day), so you really can't say that things are easier now because the ratio is lower than it was many years ago. Not too long ago your patients would have been considered icu status. This has nothing to do with entitlement and everything to do with patient safety and advocacy. As usual, management tries to put the blame for their decision to staff poorly on the nurses shoulders. Your manager is clueless - your staffing ratio is awful.
Wow. Geez I would be scared to death to have 1:7-8 of those sick pts! When I work Neuro Step-down (tele and some drips, fresh strokes), the ratios are anywhere from 1:3-5, with 5 being the max, days or nights. Even with 3-5 pt's I am still crazy busy alot of the time. There is no way I would be taking that many.
That sounds unsafe to me. You MAY get away with those ratio's in regular med/surg, but as a step down unit you shouldn't be having more than 4 pts really.
Everything everyone has said and more.....while nurses may have had more patients many years ago, technology has allowed people to survive with so many co-morbidities that just the accompanying problems suck the life out of a those caring for them. Additionally, lawsuit happy patients and their families want the world.
If I don't want more than 4 in the ER, I most certainly would not want what you are carrying! Be safe, find another job and let those who want to risk their licenses continue to do so.
Your not spoiled at all. My friend works on the PCU which is a step down/Tele combo. Depending on acuity she can have either 1:3 or 1:4 max. Granted we are in California. Stories like yours make always make me glad to be in Ca. I don't think CA Nurses are spoiled, we should be setting the example. I work in L&D and AWHONN just put out a statement that asks for even lower nursing ratios that what CA currently has.
That is definitely a step-down unit. Step-down units shouldn't have more than 4 patients. Although I've seen some with 5 or 6 which is already way too much on that type of floor. 7 or more with that acuity is setting you up for a lawsuit. If I were you I'd get Liability Insurance and start looking for another job as soon as you get one year in. Can you transfer to the CVICU? How many pts do they get? And you're not spoiled or feeling entitled in worrying about the safety of your patients. Once a patient falls, insurance doesn't pay for the any treatments r/t the fall. If a lawsuit occurs, they're coming after you and the hospital. Plus, your hospital can sue you the employee to recover any money lost as a result of a lawsuit. Find another job quick. If I walked onto your floor and saw that I had 7 or more patients of that acuity, I wouldn't even take report. I'd just leave and let the nursing office know I was leaving (not abandonment if you haven't taken report, not legally liable til you take report). We worked to hard to earn our licenses only to lose it b/c the hospital doesn't want to hire staff.
I'm not sure about my current hospital, but a unit similar to the one you described in my old hospital was 1:3-1:5 depending on acuity and shift (nights had more patients). Your assignment sounds INSANE and UNSAFE!
"The generally accepted ratio has been 1:7 max on days and 1:8 max on nights."
Your kidding right? Exaggerating? OMG that seems so unsafe. BTW this is not just a tele floor for those who haven't taken care of fresh heart and lung surgery patients. They are like you unstable medical tele patients. And they can go down the drain in an instant!
I worked on a similar floor a few years ago and I struggled with 4 of these patients, nevermind 7! We didn't do med tele just surgical hearts/lungs. On day shift we also had to get them OOB for every meal, walk them 3 times, our drips included, dopamine, amio, neo., (for the lungs who were often hypotensive post op bec of the epidurals). How in Gods name can you deliver safe care? There is no way! If you have any chance of changing jobs I would leap at it. It sounds like your manager has sold her soul to the corporate devil.
I work as a tech in an intermediate care cardiac unit. The staffing is 1:2 or 1:3, NEVER more. We get the same patient's you describe. I can not imagine the nurses having to take care of 8 patients, they are always very focused and busy with those they have.
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While staffing 'back in the day' meant less nurses per patient, patients also weren't as sick as they are today(for example your appendectomy patients would stay much longer than the current .5-1 day), so you really can't say that things are easier now because the ratio is lower than it was many years ago. Not too long ago your patients would have been considered icu status. This has nothing to do with entitlement and everything to do with patient safety and advocacy. As usual, management tries to put the blame for their decision to staff poorly on the nurses shoulders. Your manager is clueless - your staffing ratio is awful.