am i reasonably resigning?

Nurses Safety

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Hi there :)

I graduated from nursing school in May and have been working as a med-surg nurse since September. I just hit my six month mark and am brinking on seven. I love being a nurse. I love my coworkers and my patients. However, I can't shake the sense that my job is unsafe and I need to get out of there.

Our staffing is horrendous (which I know is like most places), but when I say horrendous, I mean that two days ago I had eleven patients on PM shift. I was "protected" for the first six months of this job cuz the newbies are only allowed six patients at a time. Now that I suddenly broke my six month mark, though, suddenly I found myself being one of two nurses for twenty-two patients. I couldn't keep track of anybody and I did not feel safe on the unit. The average runs at about eight or nine patients, but I have seen nurses at ten or eleven patients often enough in the past who were still expected to take admissions.

A week or two ago, I had an admission who died (but not on my shift thankfully) and it was a patient with whom I had a good rapport. Finding out that patient didn't make it felt awful because he died of some minute thing. All I could think about when I had eleven patients is how I was praying no one else coded because I would never have known. It just feels like I'm gambling with people's lives and it's not worth it. I didn't have time to catch the little things and, as we all know, the little things can be so important. My coworkers tell me that "you have to make room for human error," which I get, but I want out.

I'd been planning on handing in my two weeks notice tomorrow, but now I'm second-guessing myself. I don't have another job lined up and I pay approximately $1000 a month for my nursing loans. However, that uncertainty seems minute when compared to playing with the safety of someone's parent, grandparent, sibling, or child. Am I crazy for quitting without another job lined up?

Please let me know what you think :)

What kills me here is so many nurses are saying, well, back in the day I had.... Today's med-surg floor is so different! In my 7 years of nursing acuity has soared! Med-surg almost always has tele now and very very sick people. 11 is not safe! Run!!

Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Most of the time I don't post any responses if I don't have anything nice to say. However, this time I will bite because it strikes me as being part of the pervasive nursing culture problem, that instead of being outraged and indignant over the unsafe practice of institutions burdening nurses with unrealistic patient loads, posters here are regaling their own tales of institutional nurse abuse with the implication that "I did it, so why can't you?".

For in-patient hospitalizations, a one nurse to 10-12 patient load is wrong. Period. Just because a nurse makes it through a shift without any major mistakes doesn't make it right. Eventually a mistake WILL be made and the nurse will be hung out to dry as if his/her nursing skills are the problem instead of the unrealistic and inappropriate expectations placed upon the nurse.

This is one of the areas of nursing that I hate so much. The "suck it up" mentality, doesn't work for me. But hey, of course that just my opinion. We all have one.

Wakeuptothesun86, do what you have to do that makes sense to you. Personally, I wouldn't work there, but I have no idea what your situation is currently.

This post is RIGHT ON. I was always the squeaky wheel on my unit. It probably would have done more good, too, if nurses weren't their own worst enemies. "Oh, I don't need breaks." "This is nothing like back in my day." "Well, I don't like to complain."

We don't seem to get that by advocating for safe staffing levels, we are advocating for our patients. We are so busy trying to show our "positive attitudes" that we miss the point. Didn't someone say something about "...till I wasn't able to physically do it anymore"? BINGO.

Specializes in Oncology; medical specialty website.
What kills me here is so many nurses are saying, well, back in the day I had.... Today's med-surg floor is so different! In my 7 years of nursing acuity has soared! Med-surg almost always has tele now and very very sick people. 11 is not safe! Run!!

Those nurses who say, "Well, back in the day..." are still working under the same conditions you are. We're more than aware of what the current climate is in nursing.

Specializes in Oncology; medical specialty website.

OP, get in touch with Esme here. She has all sorts of "brain sheets" that you may find helpful to streamline your work.

Don't quit your job without having another one to go to. You have serious debt with your student loans, and they must be paid.

I don't think the comments others made about their experiences working with high ratios was meant to tell you to "suck it up." Rather, it was to say, yes, it can be done. Was it terrible? Yes, but they made it using good teamwork. We should be working for better ratios, but that doesn't solve your immediate problem.

But do get in touch with Esme. I think the "brain sheets" will help you.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

Those nurses who say, "Well, back in the day..." are still working under the same conditions you are. We're more than aware of what the current climate is in nursing.

I'm one of those nurses who said "back in the day" and I'm still working. I'm well aware of the current climate in nursing. Unlike most of the posters on the thread, I've seen the trend from the last 40 years or so leading up to today. I realize, though, that in this ageist group, my opinions probably don't count for much just BECAUSE of have such a long view.

Specializes in Oncology.

Ahem, as a brief clarification, do not for one moment think that having one or two very critically ill patients is somehow easier than having 10 not-so-critical ones.

Most of the folks on AN know how much I hate the conceptual task-ification of nursing practice (the "I can do anything a nurse does, I just don't have the credential" way of looking at nursing practice as a sum of tasks alone) , but for this brief moment you have to give me a pass on that. If you added up allllllll the "things I had to do" on a patient load of ten and all the "things she had to do" for a patient load of two, I think you would find a lot more equivalence than you think. Perhaps less equivalence, as in, the ICU nurse has more things to monitor, evaluate, intervene, communicate, and flat-out "do" than you think. But at least no less equivalence.

I work BMT where I have 3 fairly critical patients. There's no way I'm equally busy as someone taking care of 10 med surg patients. I've never done med surg and I've never taken care of more than 4 patients at a time, but I can't imagine just assessing and charting on 11 patients, much less knowing their backgrounds, tracking vital signs, ensuring they're all clean with fresh linens. I'm sorry, if you're comparing 1-2 critical patients with a sane ratio for med surg of 6-7 patients, I'm sure that's equally busy. When you're talking 11 patients, that's 50% more work than 6 patients and I'm guessing they are busier. Granted, I'm not used to having aids on a regular basis, as we have them less than half the time and they're not always reliable when we do have them, and the med nurse concept is totally foreign to me.

Wakeuptothesun86

your gut instinct is correct in my opinion. If you think you can't handle the job because of UNSAFE workloads then quit before something bad happens to your patient.

worry more about your patient safety than your student loans.

im afraid these people giving you financial advice here are not fully aware of the consequences about patient safety.

Wow.. so much drama from saying "Back in the day.." NO ageism here, respect your experience, but acuity is NOT the same as it was in the past, and so don't just suck it up and take it OP! It's not worth your mental health!

Back in the day the mentality was to suck it up or find another job. I am so glad that the trend is better staffing ratios leads to better patient outcomes. It kills me to see how many people are willing to continue to suck it up and be happy with "I made it through the shift". What about your patients? I could not sleep well after a shift of having 11 patients wondering if I missed something.

I recommend following the chain of command to let them know of your concerns. File safe harbor BEFORE taking on your assignment. Management will not be happy, but at least you are looking out for your patients well being and your license. As another poster said there will be repercussions.

Look to transfer within your facility. Otherwise it is easier to find a job when you have one. If you feel that strongly then by all means quit. The financial burden will always be there. Don't default on your loans. It will haunt you. Talk with your lender and let them know what is going on. There are some things that they can do to help.

I hope your situation has resolved by now. Best of luck!

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
File safe harbor BEFORE taking on your assignment.
Texas is the only state that has the Safe Harbor Law for nurses, and the OP is not in Texas.
Specializes in Post Anesthesia.

You stuck it out this long, I wouldn't turn in a notice unless you have another position lined up. It no new job turns up- it is much easier to put together a geographic change if you haven't been living off your savings for weeks or mos. I wouldn't wait. The staffing you describe is frightening. At the hospital I work for, night shift RNs average 5-6 patients each. I haven't seen an assignment of more than 6 patinets in 10 years. The days of admitting a healthy patient for a "work-up" are long gone. If a patient is in a hospital today they are sick enough to expect no more than 4-6 patients/nurse. GET OUT AS SOON AS YOU CAN- that place is going to kill you just as it is killing patients. You don't want to get to put a malpractice judgement on your resume. A hospital that staffs like you describe will surely hang you out to dry before they accept any responsibility for that problems that must occur in that dangerous staffing situation.

Thank you DragonPurr for your thoughtful and RIGHT ON post. To all of you who are saying, "I did 15:1 high acuity patient ratios" good for you. but i would bet that the average admission was a few days then, not the 12 hours I have to get my specialty-surgery patient 1. out of bed 2. foley out 3. regular diet 4. PO pain meds 5. dressing change teaching 6. discharge instructions etc etc etc......because the expectations are not realistic.

I have often said, how are you supposed to be a compassionate, friendly nurse to your five ICU step down patients while making sure there are no med errors, their gtt's are perfect, I/O accurate, VS taken and addressed, tube feeds, continuously assessed, no falls, hygiene/turns, OOB for walks when possible?

To the OP - you have to leave this place. do you work at a level one trauma/teaching hospital? if so those ratio's are completely unacceptable. if it's a nursing home or SAR, maybe it's ok. your debt is a huge problem, and but i disagree with previous posters. leave without a job lined up. because your license is on the line.

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