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?
I work in CA and we have staffing ratios and are union, so they're not allowed to give us more than 3:1. I'm on a stepdown med-surg. Is there anyone you can complain to? Very unsafe!
Oh my gosh! That is so unsafe! Have you ever thought about writing an email to the nursing director of the hospital or the doctor that oversees operations? I work on a tele floor and we also have step down beds, our ratio is supposed to be 4-1 with step downs patients and 5-1 without. On nights we can take up to 8 which doesn't happen often but it does happen and that is also extremely unsafe when you're dealing with various drips and meds. I could never imagine having a 10 patient assignment, I would probably look for a new job if I were you because it's your license on the line if something happens even if the environment was unsafe in the first place. I'm sorry that this your first experience as a nurse.... They aren't all that bad. Let us know what happens!
This is just confusing. Our med surg floor does tele, iv push meds, but we usually have 5 pts at night, can flex up to 6 but it's not often. We have phlebotomy, and we do not do insulin drips! I won't complain anymore.... I would feel very unsafe in your position and want to get out ASAP!
My former med/surg/tele unit: on nights as of today, the most senior nurse has 6 years experience, and 2nd in seniority has just 18 months. I would have been 2nd most senior had I not left with almost 3 years experience. I also left them without any male nurses remaining on the night staff. Nothing against my former coworkers personally, but I would never want to be patient on that unit.
Specializes in Certified Med/Surg tele, and other stuff.
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.
Oh Hell to the NO that is NOT normal. I have been a med/surg nurse..since forever...and I can tell you for certain it's not the norm. My crap hospital had a ratio of 7:1, and usually no more than 6:1 That was horrible. My current place of employment runs at 3-5:1 with a CNA per 10 pt's. It's a very nice place to work. Your hospital is cutting costs to the detriment of you and the patient. It makes me angry for you.
IMO, I would get out now, or at the very least start looking and get out when you can. Please keep us posted.
Specializes in Certified Med/Surg tele, and other stuff.
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.
I would be totally honest about why I left. If I was a manager I would hire this person on the spot. If she/he can manage 10 pts without going postal, I know they must be very well organized! :)
Specializes in Certified Med/Surg tele, and other stuff.
Another thing that rankles my hide is the discontinuation of the wound nurse. Wound nurses exist for a reason! Are they expecting you to now know which dressing belongs to what wound? That's a job within itself!!
Ah, that's another thing -- sometimes the most senior nurse has less than two years of experience. I'm not knocking her skills, but that's insane and not safe!
Management is aware that this is a problem, is fighting us tooth and nail in negotiations because they claim nights dont do anything, and they just hired a couple more new grads to throw on the pile because, to them, any warm body will do.
I'm looking, but I've been told by other nurses that no one will touch you without at least six months of experience, to show you made it through probation.
Thanks for the support everyone, I suspected my hunches weren't off, no matter how many times management told me otherwise.
I would also leave. I have left a few places in the past few years because of unsafe working conditions. Places that are understaffed with high patient acuity either in an ICU, Home care, and the last being a Skilled rehab long term care center. In the rehab center at night was one nurse, either an LPN or an RN. There were one or two CNA's for 34-40 patients. Acuities were high, pain meds and meds were outrageously many, treatments, fall risks (at least 4 per week) IV antibiotics and PICCS, and you never even had half the supplies you needed to work with... What is going on in health Care? Who does one call to ask about acceptable levels for staffing? Where can one go to complain or advocate for the patients? It seems so unsafe in many hospital environments due to over crowding and understaffing. This just doesn't seem to be a problem that will go away on it's own.
Nurse_Lily, RN
55 Posts
I work in CA and we have staffing ratios and are union, so they're not allowed to give us more than 3:1. I'm on a stepdown med-surg. Is there anyone you can complain to? Very unsafe!