Staffing Ratios/Shift Length, NEW RN, What Is The Norm?

[xtina15]

Hello All,

Thank you in advance to all who take the time tor read this post.

Just a little background on me, I am a new nurse on a large telemetry floor in an inner city hospital in New Jersey. I have been there a little over four months now and am currently working night shift. Prior to this job I was a night shift float pool nursing assistant for three years so I was well versed in patient care and was relatively well adjusted to night shift work.

From day one I was leery of my new position on my unit. Nurses, nursing assistants, social workers, and clerks alike in more or less words actually told me to "run", "get your year in and leave", "this is hell"... it goes on and on. Not one positive comment was ever made about working on my unit. I wasn't entirely sure what to make of the situation and chalked it up to the fact that I was the new girl on the block and they were trying to intimidate me (which is a whole other issue). I should say that I pride myself for being an eternal optimist and have thick skin in regards to frustrating patients/situations/staff.

That all being said, I am finally beginning to understand why I was getting such negative feedback, and my question to you all, being that this is my first job, IS THIS NORMAL? Night shift and day shift on average work 14-15 hours (although we were all hired for 12) simply to finish documentation. I arrive early to work around 6:40 PM in an attempt to prepare myself for the night and get a jump on things, and it seems that no matter how quickly or efficiently I work, I never leave until 9/9:30 AM or later (latest has been 10:30) on a GOOD day. I should note that there are 10-20+ year experienced RNs working with me, who are also staying the same length of time. Our assignments are on average 6-7 patients, many of them with multiple drips (heparin/primacor/lidocaine/lasix) or receiving around the clock antibiotics, or are post procedure. It seems to be an absolute impossibility to maintain the quality of care, safety, patient satisfaction, and charting accuracy that is required of us without staying over each shift. And even then I KNOW that there are things I could have done better, documented more clearly, or even that I flat out forgot to do.

My question to all my fellow nurses.. have you experienced this as well? Or is my unit simple used to understaffing and now considers this the norm? I am by no means giving up on this job yet, but I am not able to provide the quality of care I would like, (meds are given late, I cannot read in the chart as in depth as I'd like, etc.) nor do I feel good at the end of the day about the care I provided. My eternal optimism is waning and it is taking a toll on my mind and body. Any advice/thoughts?

Thank you friends. Have a wonderful day.

[TheCommuter, BSN, RN]

Most major hospitals in my area of residence (Dallas/Fort Worth, TX) have nurse/patient ratios of 1:5 for telemetry, although the smallish facilities in the outlying towns have nurse ratios of up to 1:7 or 1:8.

Yes, your patient loads are rather heavy...

[Dobieb2009]

The staff to pt ratio on that type of unit is not doable. You don't mention the frequent discharges and admissions, but I'm sure it happens, so that you can start with 5, and by the end of the day, have 3 discharges and 2 1/2 admissions( I say 1/2), because sometimes it's just impossible, and you have to hand off half the admit to the oncoming nurse, just so you can get out at 10! I worked in a medium size city in tele, with 52 beds, split into 2 units, North and South. Our ratio started at 1 to 4, quickly went up to 5, and when I left, we were at 6. I too, could not give the care I felt the pts deserved, and they and their families did not understand that. So , yes, I think your ratio is too high. Great for learning, but can burn you out. People would say" tele is always the hardest". Having had experience in other units, I must agree. On the other hand, I am a stress junkie, lol, so I took it as long as I could. If it doesn't suit you, move on, it won't get any better. Good luck! [emoji27]

[calivianya, BSN, RN]

I'm wondering how often you are assessing/reassessing your patients if charting takes that long. With a 6-7 patient load, it is not reasonable to expect q2h or q4h assessments, or vital signs any more often than q4h unless your monitor is taking them automatically, which is what I hope is happening.

Someone needs to take a close look at your documentation practices and determine if everything you are documenting is necessary, because the process obviously needs to be pared down quite a bit.