Really, is this real?!?!

Nurses General Nursing

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Hi, I am a new nurse who graduated in May. I graduated with honors (this was not easy, I had to work for it) and did well in clinicals. I have been working day shift on a cardiac step down unit since July. I truly love nursing...I am just not sure I love where I am at. I feel like I am being run over but when I mention something casually to other nurses all I hear is "this is day shift" or "it is what it is" or my favorite "Management doesn't care". I also fear some of these feelings may be because I went to school and did clinicals in a large city with a very up to date hospital who treated their employees excellent. It was a CHI and magnet facility. Now, I know most may say well, go somewhere else, however, I live in a rural area with only two hospitals where everyone knows everyone so word of mouth travels faster than the speed of light around here. I am just unsure if this is what nursing is really about, will it get easier, or am I being taken advantage of as a new nurse???

I started working in July with a preceptor. First issue, I was told I would get 12 weeks of training. Immediately, management started balking until I went to higher management and demanded my full training. This didn't set well with me. Second issue, I was told I would have one dedicated preceptor...the forth day of having someone different I balked again and demanded what I was told. Another flag. From there things did seem to improve but were always hectic. However, I must mention that the hospital says they are a cardiac step down unit but will not make that official because they do not want to lower nurse to patient ratios. We also are a catch all floor as well. Basically, everyone on our floor is not sick enough for the unit but too sick for a med surg floor. It is standard, every day, without fail, I have at least 6 patients if not 8!! WHAT!?!?! This is insane. I had one patient the other day on Cdiff precautions, had a rectal tube, chest tube, stage four pressure ulcer, suprapubic catheter, peg tube, tube feeding, as well as non speaking and confused, who went to dialysis 3 days a week, plus 6 other patients just as complicated. It is nothing for each patient to have 10 to 20 meds due at nine am, 3x a day dressing changes, etc. We as nurses here are also responsible for getting our on blood sugars and passing those food trays!!! EVERYONE is a blood sugar check!!! These are all scheduled for 11 am...but they will schedule my lunch at 11 am and then get mad because I'm late going to my scheduled lunch. It is not uncommon for them to give me four patients who know they are being discharged at 6am and then give me 4 direct admits back to back who all have to have UA's, IV's, Cultures, etc and all of their information enter!! Again, when I complain I am told to "buck up" or "this is the big leagues" or some other smart comment that just completely defeats me. At this point I am ready to quit! This is so overwhelming to me. I get to work early, write down my meds, my labs, etc and none of this helps with me with my time management. I try to delegate to my CNA's but there is absolutely no team work. They are always busy or will ask you very rudely, "Wasn't you just in there, why didn't you do it!" And telling management is a joke. For instance the other day I had a patient who didn't receive her 11 oclock tray because I had an emergency in another room. With 7 other nurses and four techs and two secretaries not one person took her the food tray! When I asked two hours later why this patient wasn't taken a tray, I was told "she's not our patient!" Financially, I can't quit, I have to work but I hate this..I dread work every time I'm scheduled. Because I know it's going to be hell. Hoping for some insight.

LibraSun, I recently put my name on the petition for nurse to patient ratios and have been trying to learn more and more about my facility. I do not want to be a hassle or perceived as such...I honestly, believe that these men and women work like this because they do not know that it is different any where else. And I am not saying these aren't educated talented nurses...just saying they are not aware. I want to be informed before I make any decisions which is why I am learning more and more each day about my hospital and posted in here to see what other's thought. Thank you for your suggestion ;)

Specializes in OB.
I do not want to be a hassle or perceived as such...I honestly, believe that these men and women work like this because they do not know that it is different any where else. And I am not saying these aren't educated talented nurses...just saying they are not aware.

That's very likely. Conditions don't get that horrendous unless people stay and tolerate them.

Specializes in Critical Care.
We can have up to 8..I have never seen anyone have more than that. I have never had less than 6 meaning at one time...not I have three and discharge 3. Usually, if I have six I have two empty rooms who usually get filled giving me 8 or if I am able to keep 6 it is because we were graciously given a float nurse. We do take CP rule outs and pre/post cath patients as well.

8 is a lot for cardiac tele, although I'm still not clear if you've got all of those patients at once or if you're counting your discharges and admits cumulatively.

There are a wide range of "cardiac step down" floors, also sometimes call intermediate care or progressive care. When CP rule outs and pre/post cath patients get thrown into the mix the ratios usually go up since these tend to be pretty low-labor intensive patients (although they can be a lot of work they go bad), and 1:5 or even 1:6 is not unusual. You mentioned you take "fresh" open hearts but I sort of doubt you're landing hearts from the OR?

As you're noticing, the amounts hospitals have to pay for patient care vary widely. Some, like teaching hospitals and major urban hospitals that high a lot of high margin services (lots of reimbursement for little work) tend to be pretty plush when it comes to staffing. I worked at one where not only were my ratios pretty nice, but there was a "rover" nurse, IV team, resource nurses, etc. Outside of those hospitals money is much tighter and nursing is a whole different deal.

8 is a lot for cardiac tele, although I'm still not clear if you've got all of those patients at once or if you're counting your discharges and admits cumulatively.

She's saying that she has six patients at once, sometimes up to 8.

We can have up to 8..I have never seen anyone have more than that. I have never had less than 6 meaning at one time...not I have three and discharge 3. Usually, if I have six I have two empty rooms who usually get filled giving me 8 or if I am able to keep 6 it is because we were graciously given a float nurse.

That is crazy dangerous for step down-dangerous for the patient and dangerous for her license.

Specializes in Critical Care.
She's saying that she has six patients at once, sometimes up to 8.

That is crazy dangerous for step down-dangerous for the patient and dangerous for her license.

I think it's an important distinction that this is not a patient load of step down patients. CP rule outs, pre/post cath are not step down, many those are obs patients.

Specializes in MICU, SICU, CICU.

These ratios are typical at for profit hospital corporations such as HCA and CHS.

Specializes in Med-Surg, Emergency, CEN.

OP, get out. Find somewhere else.

Yes, this is for real. Regardless of who is right or wrong, it sounds like bridges have been burned in both directions.

Specializes in Med-Surg.

With those insane ratios, I wonder what the patient outcomes look like on the OP's unit?

I am really boggled at this. Three fresh CABG patients at once? In addition to 3-5 more patients? All the while doing your own vitals and passing meal trays? I live in Texas and would activate safe harbor daily with that kind of staffing and ratios.

Did you say if a transfer to a different unit is possible for you? I could not/would not work in the unit you have described. It's begging for a disaster to happen with some kind of sentinel event. It does not sound safe at all. Nursing does not have to be this way. I wonder if nurses at your workplace are tolerating this because there are few job opportunities in the area? Just because they don't balk at the crazy ratios and work environment does not mean it's normal or okay! That is not SAFE. Patient safety is priority. You have described patients that at my hospital, would be in ICU with a 1:2-3 ratio.

I would get out of at all possible.

Specializes in Critical Care.
With those insane ratios, I wonder what the patient outcomes look like on the OP's unit?

I am really boggled at this. Three fresh CABG patients at once? In addition to 3-5 more patients? All the while doing your own vitals and passing meal trays? I live in Texas and would activate safe harbor daily with that kind of staffing and ratios.

Did you say if a transfer to a different unit is possible for you? I could not/would not work in the unit you have described. It's begging for a disaster to happen with some kind of sentinel event. It does not sound safe at all. Nursing does not have to be this way. I wonder if nurses at your workplace are tolerating this because there are few job opportunities in the area? Just because they don't balk at the crazy ratios and work environment does not mean it's normal or okay! That is not SAFE. Patient safety is priority. You have described patients that at my hospital, would be in ICU with a 1:2-3 ratio.

I would get out of at all possible.

It doesn't sound as though are actually "fresh" hearts, yes that would be ridiculous if they were.

Specializes in Telemetry.

That does sound awful. I would like to know what you mean by "fresh CABG" - do you mean POD 2-3+ or actually straight from the OR?

We get them post op day 1 and they refer to them as "fresh". And just two days ago I had three "fresh" CABG patients, a day 3 CABG, a walkie talkie, and two AVR's. 7 patients who all require so much of my time. As a new nurse I know time management is a weaker area for me but this insane. I had a heart to heart with my preceptor after I was on my own and she told me there are numerous days she doesn't get all of her charting done or something on the task list because of the work load. I do not want to be the nurse that doesn't do her work nor do I want to treat my patient's that way. I am terrified of a sentinel event, etc so I always do my charting, etc. I am just stressed out. I know that working at a large hospital spoiled me...there was an IV team, there was float nurses all the time, they would send tech's home at $10 an hour and keep a nurse to do the tech's job but pay the nurses's regular salary...they really treated their employees well. I am not asking for an IV team, I am not asking for tech work at nurse pay...I'm just asking to have safe patient ratios. My preceptor agrees that they are not safe but continually says "what can you do, you know? We gotta work." And this is all hear say but I have been told that telling your director you want to leave your unit because of said problem...ensures that you do not get a job anywhere else. Because there is no way she's going to tell another director my floor stinks and she doesn't want to work here so the nurse always ends up looking bad, doesn't get the transfer, and is still miserable...just now she has another issue...the mad director. Again, that may be false but it's pretty intimidating to even think about. I did not sign a contract but was "asked" by HR upon hire to stay in my department for six months before requesting a transfer. My six months is at the beginning of December...and as excited as I am for it to get here I am terrified all the same.

I think it's an important distinction that this is not a patient load of step down patients. CP rule outs, pre/post cath are not step down, many those are obs patients.

I guess it just depends. I have had CP patients that were on nitro drips with constant titration, post cath lab patients with femoral sheaths and coming off doses of reopro that had q 15 groin checks and ultimately pulling the femoral sheaths and applying the femstops, all labor and monitoring interval intensive. And a "fresh CABG," obviously not straight from the OR could still be really hairy, especially if you had 3 of them!

I wouldn't do it. But I live in a major metropolitan area with a lot more options than the OP.

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