RN providing total care for 4-5 patients

[_littlemissBSN]

Hi, I just felt like I needed to vent and this site has always been the only place I know where to.

I work in an acute inpatient rehab hospital. It's a newly built 3-story facility. This week, our census hit the lowest with 20-ish and the census in the floor I'm assigned to is only 9. They want to "maximize" staffing, so what they're doing right now is putting 2 RNs on that floor, with 4 and 5 patients respectively, but no CNAs. They resorted to that because they don't want to have only one RN working on a floor even if there's a CNA with them. We usually have a maximum of 8 patients with a CNA.

So for the past two days, I'm having 5 or 4 patients and I'm the one doing total care for those patients (toileting, passing trays, setting them up to eat, feeding, etc-except showering). And it was tough, especially with the patient rooms being spread apart. They're all private rooms) and management does not want to move patients around. My colleague and I tried our best to work together, especially with the ADLs, and our unit secretary helps out whenever she can. Even then it's still hard for us. Having 8 patients with a CNA to do the ADLs is barely doable, though I can manage. But this? I find it ridiculous if I'm being honest.

I've never worked in other health care settings, but I know ICU RNs also provide total care for their patients. IMO though, that type of set up just isn't possible with 4-5 acute rehab, high-fall risk patients. These are the types of patients who need to be toileted, lifted, transferred from bed to chair/vice versa on a constant basis. It's too much physical labor for a nurse and we're already swamped with other demands on the medical side of things. Perhaps I'm just tired, but I'm having a difficult time convincing myself that this is supposed to be an "effective" staffing strategy. I did not feel safe for my patients or myself at all.

Am I just exaggerating? Is this actually feasible?

Thank you all for taking the time to read this.

[FarmherRN2017]

I too work on an acute floor where mgmt routinely sends the CNA home or doesn't schedule at all. I work in CA so I can have a max of 5 patients but.. total care done properly is impossible. Sometimes it is just the charge nurse and myself so if we are in a room using lift equipment, which requires two people, there is no one to watch the other four patients, answer phones and call lights, and keep track of visitors and people walking the floor. It's a bad situation but management is saving money! We have complained and cited examples and it all falls on deaf ears money talks!!

[Nunya, BSN]

45 minutes ago, FarmherRN2017 said:

I too work on an acute floor where mgmt routinely sends the CNA home or doesn't schedule at all. I work in CA so I can have a max of 5 patients but.. total care done properly is impossible. Sometimes it is just the charge nurse and myself so if we are in a room using lift equipment, which requires two people, there is no one to watch the other four patients, answer phones and call lights, and keep track of visitors and people walking the floor. It's a bad situation but management is saving money! We have complained and cited examples and it all falls on deaf ears money talks!!

And even something bad happens you'll be blamed. Keep track of all your complaints.

[booter512]

I worked on a Neuro/Tele Stepdown unit, and at night, we got 4 RNs for 20 patients. Yes, we were supposed to have an out-of-staffing resource nurse (me), but I was usually in staffing to as 1 of the 4 nurses. Yes, they tried to get us a tech, but often, one just wasn't available. They pulled our techs to sit most of the time, or there just weren't enough scheduled that day as the hospital hadn't hired enough. Even worse, sometimes we'd start with 12 or so patients, and get 8 admissions. If we didn't have 4 nurses and they couldn't get them, they'd cap us at 18 patients (6 for each nurse). The majority of our patients were stroke patients, 95% were on tele, many spent their entire night just trying to get out of bed. We didn't have a tech to sit with them as they had all been pulled to sit elsewhere. Then, they went and got rid of all the LPNs, and gave all the RNs 5 years to get their BS. Turnover soon approached 50%. How does this end? I retired. I have my thoughts though....