This is just too much

Published

I've been on a busy (as if there is any other kind) med surg floor for three months, working nights, and it seems like every week they manage to add another nursing responsibility to the pile (with no more staffing).

When I started, the patient ratio is almost always 7-8, if not more. It can go as high as 10, and many are freshly postoperative - heparin drips, insulin drips, you name it. We almost never work fully staffed. We often work without techs or CNAs because they get pulled to other floors so that means I'm doing q4 vitals, chem sticks, I&Os, etc. Now we're being asked to do IV push meds (we're not a tele unit, so this means taking vitals, pushing over 5 minutes and taking vitals again - a little time consuming given the load and I'm not really comfortable with the idea), blood cultures, and they just announced they're pulling our phlebotomists who draw am labs, which will add at least another hour of work since almost every patient has blood ordered. This, in addition to each nurse have at least 2 admissions a night. The floor manager is someone who is just holding things down in the interim while they look for a new person, so the floor is almost always lacking equipment or supplies. It's a disaster, every single day. Every week, there's another inservice about another thing we're expected to cover. Next week it's wound care - apparently they're getting rid of the wound care nurse.

I know med surg is busy and crazy, but when I hear about this 5:1 and 6:1 ratios it sounds like a vacation. I know I'm a new grad and "time management" is a big thing, but I honestly feel like I'm pretty solid at managing what seems like a regular patient caseload of 6:1. Is the workload par for the course for most med-surg floors?

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Specializes in MICU, SICU, CICU.

That is ridiculous and unsafe. I don't know how you do it. If you can hang in there for the next nine months, you can do anything. Start building good relationships with other units and a good professional reputation for yourself as a conscientious worker. Dont complain to others. It just makes you look whiny.No gossip. Keep your professional persona at all times. I hear you about some new task added in

every staff meeting. We have to do screening on admission for nutrtion PT OT Cards rehab CM and yet no one sees them until it is an md order anyway.

At close to twelve months ask to job shadow in another unit that appeals to you and put in the transfer paperwork after your yearly evaluation. Good luck.

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I don't know how I do it either - just barely most days! I'm constantly being told by coworkers and management that this is a "normal" workload but that doesn't seem feasible, nor does it seem like the norm. I don't feel like my patients are safe and I don't feel safe - a patient with dementia grabbed me recently and tried to hit me, and there wasn't even anyone on the floor who could hear me if I had screamed for help. I'm not sure I'll make it 9 more months without the aid of very strong medications and/or a mental health leave.

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Specializes in Med/surg, Onc.

Wow! That's crazy! I can't believe I have such a different floor. Similar patients as yours plus oncology too. We max at 6 over night with 1-2 aides with 18 beds.

I'd be in tears every night with that load you have to deal with.

I'm so thankful that my floor isn't like that, I'm really sorry you're dealing with that. I'd be looking to shadow and transfer as soon as you can.

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Specializes in MICU, SICU, CICU.

The great older nurses were chased away so that they could be replaced by young moldable nurses who would accept dangerous workloads, all to reduce staffing costs. I told the management they need to hire a balance of experience and new nurses. Most M/S units these days are like this mainly new nurses. You know who suffers the most the patients. We also have docs who want all of their pts in icu or pcu due to the lack of experience on the general floors. Its a mess.

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Specializes in MICU, SICU, CICU.

I worked in one hospital and a ms nurse told me everyone in my unit is on an antidepressant. Is anyone studying the long term effects of this kind of staffing pattern. Or are we only as good as our last good day of work.

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Posts like this make me so glad I no longer work a stepdown/med-surg/tele floor. I can basically feel the anxiety returning, and our staffing wasn't as bad as what you describe. I felt like I was constantly juggling too many things. I have less than stellar days now (I'm in the OR), but at least I'm faced with one patient at a time. It can be a hot mess too, but I don't have to juggle 6 hot messes at once...

I agree with a previous poster. Make the best of it, be professional, be as safe as you can - and make for the exit when you can/after a year. Good luck!

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Specializes in Med Surg.

That should not be normal anywhere. We go as high as 7 on nights and that feels unsafe most nights even with a tech. Our patients are very sick and we have many fresh post ops. It truly sounds like your facility wants to have bad patient outcomes the way they staff you.

If you can stick it out for 6 months, start looking at other jobs, but a year would be better. My best advice would be to develop a good life outside work. Embrace your hobbies and friends and never pick up an extra shift, so you're there as little as possible.

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Specializes in Quality, Cardiac Stepdown, MICU.

I wouldnt' stay another 9 months, or even 6. For your own health, sanity and the sake of your license, start looking for another job now. Med-surg is busy and hectic, but what you're describing is insane. I live in Florida, with a huge (old) patient population and hardly ever enough nurses, and I've never heard of more than 7 on a MS floor.

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Specializes in OR.

If your hospital has similar nurse patient ratios with these same requirements and responsibilities on all units; perhaps you need to seriously consider leaving the institution - not just this unit. I have worked med - surg floors for years, but have been in the OR for the past 28 years. I would not even consider going back to floor nursing now!! I have worked for several different hospitals throughout the course of my career, and there are huge differences in the philosophies of the nursing administration and their treatment of the nursing staff from one facility to another. Good luck!

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Specializes in OR.
I'm not sure I'll make it 9 more months without the aid of very strong medications and/or a mental health leave.

If you've only been there 3 months, is it possible to look for another job on the premise you've not held this one? I've read other threads where people have suggested the same. I don't know how legal it is (disclaimer) but when I applied for my current job I didn't realize I'd handed in a slightly out of date resume until it was too late. I verbally corrected my error, but no one seemed to care regardless.

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Specializes in Cardiac.

This is horrible, and NOT normal for medsurg.

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