On Wed. when I went into work for my 12hr. shift I was greeted by the night shift nurses at the elevator (not a good sign). It turns out that we had 1 RN call out which left us with only 2 RNs for 20 patients, so I wound have 10. I had 1 Natrecor and Lasix gtt, 1 patient had to get 1 unit PRBC and 4 units FFP with ER shiley placement for dialysis, 1 patient was dying, 2 were combative and confused, 1 Amiodarone gtt, 1 Cardizem gtt, and 3 were semi-ambulatory. Mind you all were on tele, I/O's, etc. I was so overwhelmed I cannot even describe the state of mind I was in. We can have up to 7 patients with drips, tele (we have to read our own), etc. but 10 is unsafe to say the least. My nurse manager was on the floor and didn't seem to see the problem. Personally I feel she should have taken an assignment. The other nurse and I pulled our manager to the side and told her that we cannot work like this, that it is unsafe, tele alarms are going off, patients are practically being neglected, and she told us we just have to prioritize. I wanted to run when she said that. Prioritize! Was she serious? The answer was to get another nurse. Later on in the morning, a nurse who lives 2 blocks from the hospital dropped in to say hello and had no idea what was happening b/c they never even called her to come in(I come to find out that 4 RN's that I talk to outside of work were never called to come in either so I wonder if they even tried to replace the call out). When she asked if she could stay and take an assignment our nurse manager told her no they are doing fine. I cried the entire way home and even harder when I got home. I have never had such a terrible day in my career (mind you I have only been a nurse for 8 months but still this topps all) We generally have staffing issues but never in the entire 8 months that I have been there has things been that bad. Does anyone else think this is unsafe? Am I overreacting? All we needed was a code and that was it. They would have been doing CPR on me. Any advice on what I can do going forward to help prevent this? (Our chief nursing officer doesn't even know we are short staffed per our head cardiologist) Any advice would be appreciated. Thanks for reading.
that situation is totally unacceptable. Not only is it unfair to you, but, to your patients as well. I left my last job because of the same reason. My philosiphy was....No job is worth losing my license over and I do not want to be responsible for causing injury to a patient because I'm way overloaded with the pt assignment. If this keeps happening, then, I can only suggest that you document, notify the director of nursing, make copies, (one for yourself included) and then start looking for another facility it work at. The problem is, once we start putting up with this type of staffing, then, management will think it's ok to continue to jeapordize pt safety this way. It will only continue to get worse. The last place I worked, I was up to 8 pts . 75% of them were fresh angioplasties with and with out sheaths. It was too scary for me to continue working that way. I now have a job where I usually on get 4-5 pts. Love it!!! I now here that at my previous employer, the nurses are up to 10 pts a piece 3 x a week or more. SO, the cycle just continues, you see?
WOW! I can only reiterate what others have already said. RUN. That is unsafe to the extreme. It puts both the patients and your license in serious danger. I would also write a letter of objection to your immediate supervisor and those above him/her describing the conditions you had to work in and outlining the dangers of it. Attached to that would be my letter of resignation. No one should be expected to work in those conditions.
The people need to know how their lives are engdangered if they are admitted to your hospital until they staff safely.
Would your fellow nurses sign a statement the hospital is responsible for any harm to a patient due to managements unsafe staffing. The licensed nurses need to be able to prove they notified the hospital that this assignment is unsafe. Then the choice is whether to stay and do the best you can or to leave for your mental health.
Perhaps your cardiologist and/or other physicians will sign it too.
On our telemetry unit we use two minimum ratio numbers. Each RN is assigned to five stable patients with continuous cardiac monitoring. A certified nursing assistant is assigned to two RNs on nights for a total of ten patients. There is a monitor tech at all times. When he or she goes on a break the charge nurse or an LVN observes the monitors.
The charge nurse has no direct assignment.
Step down patients are staffed at 1:3 per RN with an LVN to assist two RNs. The LVN can suction and do trach care and such. Each LVN may have six step-down patients or 8 with 3 step-down and 5 telemetry. All patients assigned to an RN. If one patient is step-down the RN may not be assigned more than three patients per our written staffing plan.
Unstable patients include those with nasal bipap or mechanical ventilation, titrated drips, agitation or fall precautions, or potential unstable vital signs. A patient is classified as step down when the direct care RN in consultation with the charge nurse determines the patient is potentially or currently unstable.
We had to use ratio numbers because our management does not understand flexible staffing accirding to the acuity of individual patients.
Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
10 patients on a day shift???? :uhoh21:
run, forrest, ruuuuuuuuuuuuuuuuuuuuuuunnnnnn!!!
i'm with angie on this one...find other employment...fast!!
what you describe is nothing short of criminal on the part of your nm and staffing coordinators. i'm sure it happens to nurses all the time, though...and that's just pathetic.
kudos to you for not going crazy when everything around you was!!
Would my typical assignment be in accordance with the acuity based staffing laws? My facility has yet to comply.
I think your acuity is high even for a step-down unit. You certainly are not caring for stable telemetry patients! You should never have more than four patients, a momnitor observer, and nursing assistants as needed for each individual patient.
Department of Health Services. Click "Regulations effective January 1, 2004:
Hospitals shall provide staffing by licensed nurses, within the scope of their licensure in accordance with the following nurse-to-patient ratios. Licensed nurse means a registered nurse, licensed vocational nurse and, in psychiatric units only, a licensed psychiatric technician. Staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system.
No hospital shall assign a licensed nurse to a nursing unit or clinical area unless that hospital determines that the licensed nurse has demonstrated current competence in providing care in that area, and has also received orientation to that hospital's clinical area sufficient to provide competent care to patients in that area. The policies and procedures of the hospital shall contain the hospital's criteria for making this determination.
Licensed nurse-to-patient ratios represent the maximum number of patients that shall be assigned to one licensed nurse at any one time. “Assigned” means the licensed nurse has responsibility for the provision of care to a particular patient within his/her scope of practice. There shall be no averaging of the number of patients and the total number of licensed nurses on the unit during any one shift nor over any period of time. Only licensed nurses providing direct patient care shall be included in the ratios.
Nurse Administrators, Nurse Supervisors, Nurse Managers, and Charge Nurses, and other licensed nurses shall be included in the calculation of the licensed nurse-to-patient ratio only when those licensed nurses are engaged in providing direct patient care. When a Nurse Administrator, Nurse Supervisor, Nurse Manager, Charge Nurse or other licensed nurse is engaged in activities other than direct patient care, that nurse shall not be included in the ratio. Nurse Administrators, Nurse Supervisors, Nurse Managers, and Charge Nurses who have demonstrated current competence to the hospital in providing care on a particular unit may relieve licensed nurses during breaks, meals, and other routine, expected absences from the unit.
The licensed nurse-to-patient ratio in a step-down unit shall be 1:4 or fewer at all times. Commencing January 1, 2008, the licensed nurse-to-patient ratio in a step-down unit shall be 1:3 or fewer at all times. A “step down unit” is defined as a unit which is organized, operated, and maintained to provide for the monitoring and care of patients with moderate or potentially severe physiologic instability requiring technical support but not necessarily artificial life support. Step-down patients are those patients who require less care than intensive care, but more than that which is available from medical/surgical care. “Artificial life support” is defined as a system that uses medical technology to aid, support, or replace a vital function of the body that has been seriously damaged. “Technical support” is defined as specialized equipment and/or personnel providing for invasive monitoring, telemetry, or mechanical ventilation, for the immediate amelioration or remediation of severe pathology.
(10) The licensed nurse-to-patient ratio in a telemetry unit shall be 1:5 or fewer at all times. Commencing January 1, 2008, the licensed nurse-to-patient ratio in a telemetry unit shall be 1:4 or fewer at all times. “Telemetry unit” is defined as a unit organized, operated, and maintained to provide care for and continuous cardiac monitoring of patients in a stable condition, having or suspected of having a cardiac condition or a disease requiring the electronic monitoring, recording, retrieval, and display of cardiac electrical signals. “Telemetry unit” as defined in these regulations does not include fetal monitoring nor fetal surveillance.
n addition to the requirements of subsection (a), the hospital shall implement a patient classification system as defined in Section 70053.2 above for determining nursing care needs of individual patients that reflects the assessment, made by a registered nurse as specified at subsection 70215(a)(1), of patient requirements and provides for shift-by-shift staffing based on those requirements.
The ratios specified in subsection (a) shall constitute the minimum number of registered nurses, licensed vocational nurses, and in the case of psychiatric units, licensed psychiatric technicians, who shall be assigned to direct patient care.
Additional staff in excess of these prescribed ratios, including non-licensed staff, shall be assigned in accordance with the hospital's documented patient classification system for determining nursing care requirements, considering factors that include the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan, the ability for self-care, and the licensure of the personnel required for care. The system developed by the hospital shall include, but not be limited to, the following elements:
(1) Individual patient care requirements.
(2) The patient care delivery system.
(3) Generally accepted standards of nursing practice, as well as elements reflective of the unique nature of the hospital's patient population.
(2) The record of the actual registered nurse, licensed vocational nurse and licensed psychiatric technician assignments by licensure category for a minimum of one year.
(e) The reliability of the patient classification system for validating staffing requirements shall be reviewed at least annually by a committee appointed by the nursing administrator to determine whether or not the system accurately measures patient care needs.
(f) At least half of the members of the review committee shall be registered nurses who provide direct patient care.
(g) If the review reveals that adjustments are necessary in the patient classification system in order to assure accuracy in measuring patient care needs, such adjustments must be implemented within thirty (30) days of that determination.
(h) Hospitals shall develop and document a process by which all interested staff may provide input about the patient classification system, the system's required revisions, and the overall staffing plan.
(i) The administrator of nursing services shall not be designated to serve as a charge nurse or to have direct patient care responsibility, except as described in subsection (a) above.
(j) Registered nursing personnel shall:
(1) Assist the administrator of nursing service so that supervision of nursing care occurs on a 24-hour basis.
(2) Provide direct patient care.
(3) Provide clinical supervision and coordination of the care given by licensed vocational nurses and unlicensed nursing personnel.
(k) Each patient care unit shall have a registered nurse assigned, present and responsible for the patient care in the unit on each shift.
Thank you everyone for your advice. I want to let you know an update on what has happened since then. A few nurses and I went to our CNO's office and told her what happened. We also attended a forum we have quarterly with the president of the hospital. Our CNO was shocked and wanted to "walk in our shoes for a day". I am not sure what will happen when she comes to work with me but I am chosing a day when we have 3 nurses so she can see how it really is. She told us that our nurse to patient ratio should be 5-1, and not 6, 7 or 10-1! Just wanted to give an update. I will post again after she comes to the floor. As far as the president of the hospital he was useless. :trout:
Thank you everyone for your advice. I want to let you know an update on what has happened since then. A few nurses and I went to our CNO's office and told her what happened. We also attended a forum we have quarterly with the president of the hospital. Our CNO was shocked and wanted to "walk in our shoes for a day". I am not sure what will happen when she comes to work with me but I am chosing a day when we have 3 nurses so she can see how it really is. She told us that our nurse to patient ratio should be 5-1, and not 6, 7 or 10-1! Just wanted to give an update. I will post again after she comes to the floor. As far as the president of the hospital he was useless. :trout:
Good for you!I hope your CNO can convince the President of your hospital that the purpose of the hospital is nursing care.
Every other service is available as a n outpatient or in a hotel with room service.
If you dont need nursing care you are not admitted to a hospital.
SO ensure safe staffing!
You nurses are advocating for your patients. That is your obligation and therefore your right!
Specializes in CTICU, Interventional Cardiology, CCU.
Hi everyone,
On Wed. when I went into work for my 12hr. shift I was greeted by the night shift nurses at the elevator (not a good sign). It turns out that we had 1 RN call out which left us with only 2 RNs for 20 patients, so I wound have 10. I had 1 Natrecor and Lasix gtt, 1 patient had to get 1 unit PRBC and 4 units FFP with ER shiley placement for dialysis, 1 patient was dying, 2 were combative and confused, 1 Amiodarone gtt, 1 Cardizem gtt, and 3 were semi-ambulatory. Mind you all were on tele, I/O's, etc. I was so overwhelmed I cannot even describe the state of mind I was in. We can have up to 7 patients with drips, tele (we have to read our own), etc. but 10 is unsafe to say the least. My nurse manager was on the floor and didn't seem to see the problem. Personally I feel she should have taken an assignment. The other nurse and I pulled our manager to the side and told her that we cannot work like this, that it is unsafe, tele alarms are going off, patients are practically being neglected, and she told us we just have to prioritize. I wanted to run when she said that. Prioritize! Was she serious? The answer was to get another nurse. Later on in the morning, a nurse who lives 2 blocks from the hospital dropped in to say hello and had no idea what was happening b/c they never even called her to come in(I come to find out that 4 RN's that I talk to outside of work were never called to come in either so I wonder if they even tried to replace the call out). When she asked if she could stay and take an assignment our nurse manager told her no they are doing fine. I cried the entire way home and even harder when I got home. I have never had such a terrible day in my career (mind you I have only been a nurse for 8 months but still this topps all) We generally have staffing issues but never in the entire 8 months that I have been there has things been that bad. Does anyone else think this is unsafe? Am I overreacting? All we needed was a code and that was it. They would have been doing CPR on me. Any advice on what I can do going forward to help prevent this? (Our chief nursing officer doesn't even know we are short staffed per our head cardiologist) Any advice would be appreciated. Thanks for reading.
Lauren
wow that sounds EXACTLY like the floor I work on. I work Interventional Cardiology and I too work 7p-7a. we are constantly under staffed. When a good nurse manager is on they take 4 pt's. but there are certain nurse managers I have that take maybe 1 pt. I had posted before about situations I have hada. Like I was in the middle of a code, bagging a pt. and my manager came in and tole me I was getting an ER admitt:confused:. That was on top of the other 5 pt's that I had which were s/p PTCA, S/p STEMI, and I can't remember the other 2. I said "NO you are gonna have to give the admitt to another nurse I am in the middle of a code" :flamesonbIt is unsafe, I agree. I hate nights we have a House MD and a tele resident and that's about it and there is a list of doctors that the House MD covers and I swear I always have at least 2 pt's that the house MD dosen't cover, so I call the Tele resident and I am lucky if they even bother to listen or even come eval:plsebeg:. the pt since the house MD won't do it. I have even called the pt's cardiologist at 3am and woke their butt up b/c they are not covered by house MD and the resident basically told me that she had better things to do then come eval the pt:beercuphe, umm yea pt's O2 SAT is at 79-80% on 2L NC, pt is dyspnic, ST on the monitor, BP is in the toilet:bluecry1:, I call a RRT my nurse manager ignores me:banghead:, 3 more time I call for an RRT and I still am ignored So I SCREAM at the top my lungs for a CODE b/c no one would listen to me:vdgmg:, finally ot somone's attn. pt is also s/p STEMI with CK in the 4000's and troponin at 0.20 and pt just came from the cath lab 1 hour ago at 2 am:eek:..for a 650 bed hospital that is AWFUL. So I called the pt's cardiologist at 3am b/c no one would give me orders:argue:..yes he was miffed that I woke him up BUT he understood only b/c he is young and he said we can call him anytime day or night if it's one of his pt's..hehe let's see how long that lasts..If you call a RRT or a Code at like 4am, 3 people show up..the House MD, the tele resident and the Respiratory therapist. but If you call a RRT or a code during the day >10 people show up and then some.I am getting my one year in and going to another unit..Every night I work I think is tonight the night I am going to put my license in Jeopardy.:grn:.I have talked to my director, managers and educators and I get the same crap that cames out of their mouths..."well if it's to much tell the night manager and they can change your assignment..." :scrm::scrm:OK like that's going to happen, cause even if my assignment is changed I am still going to be dealing with the same b.s.:flmngmd: Drips out the wazoo..Primacore, Dopamine, Cardizem, Natrecore, PRBC's, Heparin. OHS pre-op pt's which require a ton of work, pre- PTCA,ICD,TEE,LHC/RHC,STENT. S/P STROKE,STEMI, S/P PTCA with a 6 fr. Arterial Sheath that has to be pulled by me..which I love doing espically when you are susposed to be off orientaion for 6 months b/f you pull your first sheath:sfxpld:..umm I was one day off orientation and pulled 2 that night:selfbonk:. I have pulled bout 20 A-Lines(Femoral Arterial Sheaths) and I am just 6 months off orientation. My educator flipped when she found out I am pulling sheaths..well I told her what was going on at night as soon as I started on night shift:redlight:, she shouldn't have been shocked and she even had the nerve to yell at me..I said maybe if you clean the $&*! out of your ears, you would have heard me say that I pulled my first sheath my first night off orientation:smiley_ab..but I am 8 months into it and I have a love hate relationship with my job. I just recntly learned to stick up for my self and say NO. any way thanks for listening to me rant. :hpygrp::spbox:sorry about all the animation but I worked 13+ hours and the educator thought it would be funny to have my critical care classes at a diff. hospital that is an hour and a half away and start at 8am. OK worked Sunday night got home 9 am monday morning and have to be up at 5:30 am tuesday morning for a class. I decided to forgo sleep today and just stay up and go to bed at 8pm. :lol_hittithank god it's my last class!
wow that sounds EXACTLY like the floor I work on. I work Interventional Cardiology and I too work 7p-7a. we are constantly under staffed. When a good nurse manager is on they take 4 pt's. but there are certain nurse managers I have that take maybe 1 pt. I had posted before about situations I have hada. Like I was in the middle of a code, bagging a pt. and my manager came in and tole me I was getting an ER admitt:confused:. That was on top of the other 5 pt's that I had which were s/p PTCA, S/p STEMI, and I can't remember the other 2. I said "NO you are gonna have to give the admitt to another nurse I am in the middle of a code" :flamesonbIt is unsafe, I agree. I hate nights we have a House MD and a tele resident and that's about it and there is a list of doctors that the House MD covers and I swear I always have at least 2 pt's that the house MD dosen't cover, so I call the Tele resident and I am lucky if they even bother to listen or even come eval:plsebeg:. the pt since the house MD won't do it. I have even called the pt's cardiologist at 3am and woke their butt up b/c they are not covered by house MD and the resident basically told me that she had better things to do then come eval the pt:beercuphe, umm yea pt's O2 SAT is at 79-80% on 2L NC, pt is dyspnic, ST on the monitor, BP is in the toilet:bluecry1:, I call a RRT my nurse manager ignores me:banghead:, 3 more time I call for an RRT and I still am ignored So I SCREAM at the top my lungs for a CODE b/c no one would listen to me:vdgmg:, finally ot somone's attn. pt is also s/p STEMI with CK in the 4000's and troponin at 0.20 and pt just came from the cath lab 1 hour ago at 2 am:eek:..for a 650 bed hospital that is AWFUL. So I called the pt's cardiologist at 3am b/c no one would give me orders:argue:..yes he was miffed that I woke him up BUT he understood only b/c he is young and he said we can call him anytime day or night if it's one of his pt's..hehe let's see how long that lasts..If you call a RRT or a Code at like 4am, 3 people show up..the House MD, the tele resident and the Respiratory therapist. but If you call a RRT or a code during the day >10 people show up and then some.I am getting my one year in and going to another unit..Every night I work I think is tonight the night I am going to put my license in Jeopardy.:grn:.I have talked to my director, managers and educators and I get the same crap that cames out of their mouths..."well if it's to much tell the night manager and they can change your assignment..." :scrm::scrm:OK like that's going to happen, cause even if my assignment is changed I am still going to be dealing with the same b.s.:flmngmd: Drips out the wazoo..Primacore, Dopamine, Cardizem, Natrecore, PRBC's, Heparin. OHS pre-op pt's which require a ton of work, pre- PTCA,ICD,TEE,LHC/RHC,STENT. S/P STROKE,STEMI, S/P PTCA with a 6 fr. Arterial Sheath that has to be pulled by me..which I love doing espically when you are susposed to be off orientaion for 6 months b/f you pull your first sheath:sfxpld:..umm I was one day off orientation and pulled 2 that night:selfbonk:. I have pulled bout 20 A-Lines(Femoral Arterial Sheaths) and I am just 6 months off orientation. My educator flipped when she found out I am pulling sheaths..well I told her what was going on at night as soon as I started on night shift:redlight:, she shouldn't have been shocked and she even had the nerve to yell at me..I said maybe if you clean the $&*! out of your ears, you would have heard me say that I pulled my first sheath my first night off orientation:smiley_ab..but I am 8 months into it and I have a love hate relationship with my job. I just recntly learned to stick up for my self and say NO. any way thanks for listening to me rant. :hpygrp::spbox:sorry about all the animation but I worked 13+ hours and the educator thought it would be funny to have my critical care classes at a diff. hospital that is an hour and a half away and start at 8am. OK worked Sunday night got home 9 am monday morning and have to be up at 5:30 am tuesday morning for a class. I decided to forgo sleep today and just stay up and go to bed at 8pm. :lol_hittithank god it's my last class!
That is insane you need to get out of there!!! What city/state do you live in?
.thumb.jpg.2605487e9a1cc011342d44bcf46e0b55.jpg){kind=small}
mamason
555 Posts
that situation is totally unacceptable. Not only is it unfair to you, but, to your patients as well. I left my last job because of the same reason. My philosiphy was....No job is worth losing my license over and I do not want to be responsible for causing injury to a patient because I'm way overloaded with the pt assignment. If this keeps happening, then, I can only suggest that you document, notify the director of nursing, make copies, (one for yourself included) and then start looking for another facility it work at. The problem is, once we start putting up with this type of staffing, then, management will think it's ok to continue to jeapordize pt safety this way. It will only continue to get worse. The last place I worked, I was up to 8 pts . 75% of them were fresh angioplasties with and with out sheaths. It was too scary for me to continue working that way. I now have a job where I usually on get 4-5 pts. Love it!!! I now here that at my previous employer, the nurses are up to 10 pts a piece 3 x a week or more. SO, the cycle just continues, you see?