1st 6 Months

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Hi Everyone,

I graduated from an ADN program and have been working in med/surg day shift for 6 months now. My floor is mainly ortho, but we get a mix of medical patients, and other general surgeries. Overall, I have loved my time learning on M-S these last few months but lately things are getting rather frustrating.

We can float to any unit (cardiac, neuro, hospice, general medical), and at anytime, without notice. Not a huge a deal, but it is guaranteed, one of our nurses will float elsewhere each day. What has become frustrating is our staffing... over the last month, our nurses are consistently having 5-8 patients each day. On the average 5 patients is no big deal, 6 can be tough if some are needy, but 7-8 has become increasingly more common. I can not keep up, I am always behind, and my clinical leader can only say sorry. In addition we have been down a secretary at times, and one of our aides (2 for 20+ people), are often pulled to other units.

What kind of patient loads do you others nurses have? I have come to a point where I can deal with what is on my plate, but my patients get ignored, get average at best care, and it is just not fair to them or myself. That is my rant. Thank you for reading, and your feedback is greatly appreciated.

-RN

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Specializes in Acute Care Cardiac, Education, Prof Practice.

My experience is in complex med-surg, nights for four years and days for one. We had a patient load of anything from post-MI obs to detoxes to every-infection-wounds-stroke-nonverbal-cdiff. On our floor nights carried 6 patients with maybe a 7th if the hospital was desperate. Once in four years I had 8 and it was awful.

On days we had no more than 5. Depending on the patients a day with 5 could be easy, where a day with 4 could be hell, just depends. I would say anything over five is greatly jeopardizing patient care, safety, and satisfaction.

I know it is hard to be the new nurse on the floor, but I would seriously consider going above your manager's head and looking for more support, or finding a safer job. In the end it is your license and your patients' lives on the line.

Best of luck,

Tait

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It is hard to disagree that patient acuity makes a HUGE difference on actual patient load. Yes, at times, I do think we are getting more patients than is actually safe. I never thought about how it is my license on the line... thank you for your input.

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Specializes in Critical Care, Education.

Yikes. Ortho is a really challenging area to manager high patient loads due to the inherent mobility needs of that population - and stress/strain of all the lifting. Please take care of your self & don't take chances with your back.

I know it probably doesn't make a difference, but this is happening all over the country. Hospitals are trying to gear up for the decrease in revenues that is looming (convergence of several legislative changes). Slashing the labor budget is the first knee-jerk reaction when this happens. Ironically, less staff will inevitably lead to declining patient satisfaction and probable issues with quality - both of which will also decrease reimbursement.... duh. But by the time that this is felt, the "leaders" who made those staffing decisions will be long gone, with their executive bonuses in hand. .

Have you tried talking to your manager to find out what is happening with staffing? Is this a temporary 'blip' due to vacancies or a permanent change in the patient ratio? S/he needs to be honest and inform the staff of what is going on.

In the meantime, does your state have any 'safe harbor' protections for nurses? In Tx, we have a process which enables a staff nurses to file a formal notification that s/he feels that the assignment has a potentially negative impact on patient safety - due to ____ (specific reason). The form is signed & given to nursing 'administration' - they are required to monitor & track these 'safe harbor' claims by integrating them into various quality measures. This does not mean the nurse is refusing the assignment. But if something does end up happening due to the issues that were identified by the nurse, the nurse is protected from personal liability &/or BON actions. This does not protect nurses from consequences of personal malpractice, negligence, etc... just problems arising from organizational/staffing issues.

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Specializes in Med Surg.

In the meantime, does your state have any 'safe harbor' protections for nurses? In Tx, we have a process which enables a staff nurses to file a formal notification that s/he feels that the assignment has a potentially negative impact on patient safety - due to ____ (specific reason). The form is signed & given to nursing 'administration' - they are required to monitor & track these 'safe harbor' claims by integrating them into various quality measures.

I'll bet THIS is popular with employers. It may (possibly, dependent upon the integrity of the state agency following up - wait, did I just say integrity and state in the same sentence?) save your nursing license, but I can't see that there'd be much room for advancement or longevity of employment at that workplace after that. Just sayin'

It's probably the "right thing to do," but seems as though it could backfire on the whistle blower... I dunno. Maybe (and hope) I'm wrong.

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I work on abusy surgery unit. We have 6 patients during the day, 9 in the evening and 13 at night. No need to say that we are going crazy!!

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