So fed up:( Could use some help:(

U.S.A. Pennsylvania

Published

Hi All:)

I'm actually not a new poster, I've posted before but not for a while and cannot remember my old log in name so here I am again:)

Anyway, I just really need some words of encouragement, wisdom, advice, anything right now, before I crawl into a corner and literally cry my eyes out.

I've been a nurse for a about three years now. I just started working in a hospital on an oncology/ med-surg floor in June. The hospital is a catholic hospital, and pretty run down to say the least. Most of our patients don't have insurance and are on some type of medical assistance. I'll make a really long story as short as possible here...

About a month after I started the job, it was announced that our "plan of care" was changing to "Primary Nursing". The idea behind primary nursing is that they will give us four per nurse, but take away our nurses aides. The nurses are responsible for EVERYTHING. Vital signs, baths, incontinent changes, accu-checks, medication administration, dressing changes, feeding...etc. What they told us is that the doctors were complaining that patients were getting bed sores, and they think it was because the nurses weren't bathing the patients themselves so obviously werent doing good enough assessments.:rolleyes: They then assigned people in the hospital for us to page that would do our labwork and ekgs. Any and everything else the nurses are responsible for. This scared me when I first heard it. I thought, what if one of my patients goes bad? Its hard enough these days as a nurse WITH an aide to get what you need to get done, but now..take my help away?? The best part of it is...they kept our aides on the floor...the aides that dont have to do anything. They are there "if we need some extra help, but are not required at all to do what they were doing before." Needless to say...solitaire has become a popular game:madface: .

It has come to the point to where the aides..and not all of them, we have a few great ones on there, but yes sadly, most of them...love their new position, and I can't blame them. I'd love my job too if I was them.

Now heres the doozy...all the nurses usually have 6 patients. Or for example..last weekend I had SEVEN patients. The aide on the floor refused to do accu checks or vital signs for me stating "I dont have to do them." I called the supervisor and was told later "I can't make her do something shes refusing":angryfire One of my patients passed that day, another was put in restraints...it was just a horrible horrible weekend. My manager addressed the issue that week with the aide telling her that if I have that many patients she must help. But that was only one incident. Never have I had four patients since this plan of care started. Its usually 5-6, most of the time 6. I cannot keep up with my work, my medications are late, the pateints arent getting the care they deserve, the rooms are a mess (housekeeping is a whole other story), trash gets emptied three times a week maybe in patients rooms...I just cant do it, and its not my fault. None of the nurses can do it. Were all so frustrated. And the head of the nursing dept. who thought up this lovely idea stated that if we dont like it, we can walk...how nice

I work a 12 hour shift, at 3 pm alot of the staff leaves. We had a census of 20 patients today. At 3 pm, all that was left was another nurse and I...and one aide. They were about to give both of us 10 patients each. I lost it right then. I said "I am not taking 10 patients, I refuse to take 10 patients, I dont even think that's legal! If I'm givin 10 patients I am walking out of this hospital right now. That is a risk to my license and a risk to these patients." I was FURIOUS. My charge nurse who was also to leave at three was right there with me being as upset as I was. She was making calls everywhere to everyone trying to get answers...noone knew anything or what was going on. She even called the head of the nursing dept who thought up the lovely "primary care" idea....paged her three times. Surprise surprise, no call back. I then told the charge nurse that I wanted to know where the head of nursings office was because I was truly going to go there that second myself and demand support. I was then in the med room with my charge nurse and we were both talking about how upset we were about the situation. She then said to me. "I told the manager of the floor that you are going to leave..she said if you do shes going to report you to the state and get you for abandonment of patients"

:sniff: :banghead: :( :banghead: Right then it hit me. Shes right, I am abandoning my patients..this isnt their fault. But its a catch 22 here. She was right, but on the other hand I was SO ANGRY that I was threatened..and not offered any type of support. TEN patients?? O and did I mention the other nurse on the floor with me just passed her boards last week and it was her FIRST day on the floor? How is that safe? How can you tell me that youre going to give me ten patients with one aide for the whole floor and think thats okay? They know its unsafe, they know its unfair, they know its dangerous. But after what my charge nurse just told me my manager said ...they know they can do it to me...I cant abandon my patients.

What do I do? I ask because...this WILL happen again, I can guarantee it. How wrong was I? Theres got to be some type of nursing law in PA about a nurse patient ratio. If there is, can anyone tell me exactly where to find it because I'd like to keep a copy handy;) And...if there is a law, and they gave me over the ratio that is legal, and I did walk out because of it..could my license be taken away?

I came home in tears..I am beyond disgusted with what has been going on there the past month and I dont know how much longer I can take it. But I'm not one to just quit...I want to fight...how can they do this to us..how can they do this to the patients..how is that okay? Or ...is it? And if it is..I see why theres such a nursing shortage.

Can anyone please help me with my situation. I'm just so sick of coming home in tears, its truly starting to effect me outside of work. How do I fight this..or can this even be fought?

Thank you so much for listening everyone:( *hugs* I look forward to hearing from you.

Specializes in Trauma ICU, MICU/SICU.
Once again something was missed on this board. This nurse was finishing the last 4 hours of a 12 hour shift, she already had a patient assignment, she was picking up patients, in no way did she say she was changing assignments, This nurse had a right to refuse more patients but she could not leave the patients she had been assigned to for the previous 8 hours.

Actually, this board didn't miss it, you did :smilecoffeecup:

You would have not been abandoning your patients by refusing additional patients. Just continue to care for the ones you have and refuse additional.

See my post on the 2nd page of this thread. :)

Specializes in Trauma ICU, MICU/SICU.
Unless you are the supervisor in charge of the entire hospital / facility it is not considered abandonment. But, it is a good idea to quit if you are just plain walking out. Into my mandated third shift after and afternoon shift I had previously worked ---I was given 2 halls, 64 patients and 2 aids...I nearly ended up in the E.R. I quit at 4 a.m. with a blood pressure of 160 / 110. never had blood pressure issues before that night. But it nearly killed me to do the work. I was RUNNING to the rooms with no shoes on, my feet hurt so bad. (A dead nurse is of no use to patients). And honestly--it nearly killed me that night. I have been a nurse since 1980. No write ups or med errors ever. And I still have my license. I turned the facility into the state. It is on probation to date.

Wow! How awful....

For clarification, you are right that only the facility can be held responsible after the following, per the PA State Board of nursing.

(b) A registered nurse may not:

(6) Leave a nursing assignment prior to the proper reporting and notification to the appropriate department head or personnel of such an action.

(7) Knowingly abandon a patient in need of nursing care. Abandonment is defined as the intentional deserting of a patient for whom the nurse is responsible.

049 Pa. Code § 21.18. Standards of nursing conduct.

Pennsylvania does not have a nurse-to-patient ratio law. Nurses have been fighting to get one passed for over five years but certain politicians in Harrisburg have found all kinds of slippery ways to side-step the issue...I guess the hospitals have more pull (they don't want it). I believe the PA Board did issue an opinion a few years back that said it is not abandonment to leave if you have told a supervisor and turned over your patients (I'm not sure if formal report is required or not). Anyway, some hospitals follow their own set of ratios closely or follow ratios in an RN union contract.

You're not alone. My facility had the gall to schedule only 3 CNA's and 2 nurses for 50 people during dayshift on Christmas day...a day when residents get visitors that don't come in any other time of the year.

Specializes in Rehab, LTC, Peds, Hospice.

And they wonder why there is a shortage! I feel terrible for you and your patients. My prediction is that your facility won't be able to keep the new grad either. You are an experienced nurse that at least had a chance in h-- of being able to prioritize your care, (I'm not saying give good or even adequate care!) A nurse that just passed her boards has no buisness on her first day getting near that many patients! I feel so bad for her! Hopefully they didn't scare her out of nursing all together!

I've done primary care for 8 patients in a long term care setting (no CNA) It was very hard and all my patients were stable. No IVs ,no need to assess, etc. I can't even imagine doing that in a hospital setting.

Administration and lay people seem unable to comprehend how much time different tasks of nursing take. Whats 4 vs 6 or even 10 patients to them. For my facility I'm considering doing a time study that shows it is in their interest to keep good staffing ratios (ie unnecessary hospitalizations as I work in the sub-acute setting.) $ talk is what they seem to comprehend.

Unfortunately in our profession because we don't often speak up, the ones that do are labeled whiny, complainers and troublemakers. That's easier than facing up to the fact that are real problems that need to be addressed! I applaud your courage and wish you the best of luck.

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