Unsafe loads

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Specializes in Surgical Specialty Clinic - Ambulatory Care.

So, got a new job 8 weeks ago. Was told there was a Tele floor and a med-surg unit and I would be floating between the two. Not a problem, I am comfortable with both. 6 to 1 ratio. Again pretty standard. However here is my last assignment.

1) Guy who was just stepped down from ICU. Came to the med Surg unit with a triple lumen femoral catheter and two peripheral lines. On continuous bipap and tele. Anytime I take him off the bipap to feed him and put him on hiflow at 12lpm it takes about 3 bites before he is in the low 80s. Getting bags of potassium and albumin due to electrolytes still off. Uroseptic and diabetic. Ax0x4.

2)  48 year old with metastatic cancer. Ambulatory and axox4 but having diarrhea. Also on electrolyte replacement.

3) A lady who is demented. Complete care. Has a family paid sitter at bedside who just charts everything I do but does not assist. Bilateral leg wounds with daily dressing changes, coccyx wound, incontinent, urinates but has residual ad us the cathed every 8 hours because family does not want Foley. 
 

4) malnourished man with G-Tube boils feedings and Trach in for Gram + pneumonia. Copious sputum needing suction every 2-4 have hours. Many I V atbx and electrolyte replacement. Axox4
 

5) New admit from ER of pneumonia after falling a week ago and breaking a rib. Axox4, ambulates.

6) In with CHF and Afib with RVR 160s. Overload is so bad that he is frequently requesting to be placed back on bipap due to SOB on 4-6 liters. MD ordering IV push digoxin. AXOx 4 can’t ambulate due to poor endurance.

 

So I really feel that 1,4 and 6 do not belong on a med-surg unit. That their conditions warrant a 4 to 1 ratio and closer monitoring. Trying to decide if I am going to be able to cut it in led Surg if this kind of patient load is the norm. Yes I had an aid, but she had 15 patients so I was pretty much 1 to 1 except for vitals. I feel like running but I’ve tried all sorts of nursing, there is no where to go.

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Specializes in Emergency.

And why are nurses leaving the bedside again? 

That is a ridiculously unsafe load and I suppose the other nurses on the unit have similar situations. 

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Specializes in Surgical Specialty Clinic - Ambulatory Care.
On 5/6/2021 at 11:31 PM, CKPM2RN said:

And why are nurses leaving the bedside again? 

That is a ridiculously unsafe load and I suppose the other nurses on the unit have similar situations. 

Yes. I have decided to report this facility to State. I had two near misses in one shift last week. I turned in my resignation due to that. The hospital is not willing to believe that their acuity is to high, just looking at the nurses to be responsible for the unsafe situations.

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Specializes in Med-surg, telemetry, oncology, rehab, LTC, ALF.

This could easily be a snapshot of the typical patient load on my med-surg unit. Seriously.

It wasn't always like this on my unit, which is why I've been there for so long. We used to have decent ratios and a dedicated charge nurse (which we haven't had in over a year). But COVID definitely made it worse. ICU and progressive care units are easily overwhelmed with the influx of COVID patients requiring ventilators and intensive care, so they send the "less acute" patients (meaning they're not on a ventilator) to med-surg. Med-surg is also forced to take every non-ICU patient that enters the ER, including all of the confused patients, psych patients, overdoses, detoxes, and falls. We also take care of chemo and oncology patients on my floor, so that's an interesting mix to add-in. It has gotten considerably worse in the last month, and I'm not sure if it's because of an uptick of COVID patients in my area or something else. 1:6 is the goal but lately bed coordinators have been pushing us to 1:7 and even 1:8 "when there's no other choice." That quickly becomes a daily ratio.

So yeah, things are bad. It's not just that unit. It's probably most med-surg units. And staff are leaving in droves, including myself.

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On 5/10/2021 at 4:16 AM, KalipsoRed21 said:

Yes. I have decided to report this facility to State. I had two near misses in one shift last week. I turned in my resignation due to that. The hospital is not willing to believe that their acuity is to high, just looking at the nurses to be responsible for the unsafe situations.

Sorry to hear that! But good for you. That sounds like bad & unsafe work conditions! I really hope you find something better. 

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On 7/26/2021 at 7:15 PM, caffeinatednurse said:

This could easily be a snapshot of the typical patient load on my med-surg unit. Seriously.

So unsafe and scary! I just ended up passing a job on a med-surg unit. I honestly never saw myself in that unit, especially now with Covid. ? I fear for my mental health and patients' safety. 

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On 5/4/2021 at 12:12 AM, KalipsoRed21 said:

So, got a new job 8 weeks ago. Was told there was a Tele floor and a med-surg unit and I would be floating between the two. Not a problem, I am comfortable with both. 6 to 1 ratio. Again pretty standard. However here is my last assignment.

1) Guy who was just stepped down from ICU. Came to the med Surg unit with a triple lumen femoral catheter and two peripheral lines. On continuous bipap and tele. Anytime I take him off the bipap to feed him and put him on hiflow at 12lpm it takes about 3 bites before he is in the low 80s. Getting bags of potassium and albumin due to electrolytes still off. Uroseptic and diabetic. Ax0x4.

2)  48 year old with metastatic cancer. Ambulatory and axox4 but having diarrhea. Also on electrolyte replacement.

3) A lady who is demented. Complete care. Has a family paid sitter at bedside who just charts everything I do but does not assist. Bilateral leg wounds with daily dressing changes, coccyx wound, incontinent, urinates but has residual ad us the cathed every 8 hours because family does not want Foley. 
 

4) malnourished man with G-Tube boils feedings and Trach in for Gram + pneumonia. Copious sputum needing suction every 2-4 have hours. Many I V atbx and electrolyte replacement. Axox4
 

5) New admit from ER of pneumonia after falling a week ago and breaking a rib. Axox4, ambulates.

6) In with CHF and Afib with RVR 160s. Overload is so bad that he is frequently requesting to be placed back on bipap due to SOB on 4-6 liters. MD ordering IV push digoxin. AXOx 4 can’t ambulate due to poor endurance.

 

So I really feel that 1,4 and 6 do not belong on a med-surg unit. That their conditions warrant a 4 to 1 ratio and closer monitoring. Trying to decide if I am going to be able to cut it in led Surg if this kind of patient load is the norm. Yes I had an aid, but she had 15 patients so I was pretty much 1 to 1 except for vitals. I feel like running but I’ve tried all sorts of nursing, there is no where to go.

Why aren't providers stepping in? They see the nurse is overwhelmed, this poses a risk to the patient. Why do they sit back and let their patients be subjected to this?

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Specializes in Medsurg.

Number 6 alone gave me hives. Glad you left and reported them fools.

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Specializes in Emergency.
On 7/26/2021 at 5:15 PM, caffeinatednurse said:

This could easily be a snapshot of the typical patient load on my med-surg unit. Seriously.

It wasn't always like this on my unit, which is why I've been there for so long. We used to have decent ratios and a dedicated charge nurse (which we haven't had in over a year). But COVID definitely made it worse. ICU and progressive care units are easily overwhelmed with the influx of COVID patients requiring ventilators and intensive care, so they send the "less acute" patients (meaning they're not on a ventilator) to med-surg. Med-surg is also forced to take every non-ICU patient that enters the ER, including all of the confused patients, psych patients, overdoses, detoxes, and falls. We also take care of chemo and oncology patients on my floor, so that's an interesting mix to add-in. It has gotten considerably worse in the last month, and I'm not sure if it's because of an uptick of COVID patients in my area or something else. 1:6 is the goal but lately bed coordinators have been pushing us to 1:7 and even 1:8 "when there's no other choice." That quickly becomes a daily ratio.

So yeah, things are bad. It's not just that unit. It's probably most med-surg units. And staff are leaving in droves, including myself.

I left the MS unit over a year ago because of this. We were still 5:1 with an occasional 6:1. A month or so ago I ran into one of my coworkers from MS in the hallway and she described the unit as LTC with so many dumped patients with multiple psych, drug, and behavior problems.  SO VERY GLAD I LEFT!

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Specializes in Med-surg, telemetry, oncology, rehab, LTC, ALF.
2 hours ago, CKPM2RN said:

I left the MS unit over a year ago because of this. We were still 5:1 with an occasional 6:1. A month or so ago I ran into one of my coworkers from MS in the hallway and she described the unit as LTC with so many dumped patients with multiple psych, drug, and behavior problems.  SO VERY GLAD I LEFT!

I hear you. I quit that job last month. I just couldn't take it anymore. I used to work LTC and I swear I took care of less LTC patients in that setting, compared to your typical med-surg unit now. Confused people wandering out through the fire escapes, our drug ODs trying to leave with their IV intact and having to call security on them, and then one of your non-ICU but still sick-as-you-know-what patients coding in the middle of it all...yeah, I was done. I would have put in for a transfer elsewhere if I thought it was better, but the whole hospital was dealing with the same issues. ✌️ 

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Specializes in Med-surg, telemetry, oncology, rehab, LTC, ALF.
On 8/11/2021 at 4:54 PM, Hopeful RN said:

So unsafe and scary! I just ended up passing a job on a med-surg unit. I honestly never saw myself in that unit, especially now with Covid. ? I fear for my mental health and patients' safety. 

It's definitely not worth it!

 

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Specializes in Progressive Care, Sub-Acute, Hospice, Geriatrics.

And here I am trying to get into Med-Surg ?

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