Very Frustrated - does this sound safe?

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Maybe I'm over-reacting, but here's the scenario for the last two days:

I work on a surgical floor (we get some med overflow, but mostly surgical - lots of Roux-en-Y, hysterectomies, abdominal type stuff). Anyway, we've had 5 patients per nurse, one aid (for 25 patients) for about 1/2 the shift and a unit secretary for about 1/2 the 12-hour shift. We do not have a charge nurse because we've been told that "relation-ship based care" practice entails each nurse taking all of their own orders and rounding with each doctor (which doesn't happen - we're too busy). We have many patients getting blood, tons of diabetics, tons of iv abx and pain meds - very very busy. Is this normal? I bring up my concerns to my supervisor, who just shrugs her shoulders and says essentially that it's just the way it is and nothing will ever change and if I don't like it, I can quit. Anyway, back to my original questions: is this normal? does this sound safe?

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Specializes in Travel Nursing, ICU, tele, etc.

That sounds like it is a pretty normal patient load for a surgical floor. Do you have phlebotomy support, does someone do your EKG's, is there a Rapid Response Team at your hospital? Any of those support structures will certainly make it more doable. Without a Charge Nurse, do you have a House Supervisor or someone you can run difficult issues by so that you have another opinion and possibly someone to back you up if you need it?

Surgical and medical units are notoriously busy. Do you feel that you are able to meet most of your patient's needs within a reasonable time frame? I remember being a surgical patient twice and seeing the nurses seldom. Luckily I was able to fend for myself for the most part, except for when I needed pain meds.

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That sounds like it is a pretty normal patient load for a surgical floor. Do you have phlebotomy support, does someone do your EKG's, is there a Rapid Response Team at your hospital? Any of those support structures will certainly make it more doable. Without a Charge Nurse, do you have a House Supervisor or someone you can run difficult issues by so that you have another opinion and possibly someone to back you up if you need it?

Surgical and medical units are notoriously busy. Do you feel that you are able to meet most of your patient's needs within a reasonable time frame? I remember being a surgical patient twice and seeing the nurses seldom. Luckily I was able to fend for myself for the most part, except for when I needed pain meds.

Yes we have a rapid response and a house sup. (who covers two buildings). The house supervisors pretty much just come through and check census to send people home. The main problem doesn't so much stem from the number of patients per se so much as not having a unit secretary (so we have to try to answer the phone and enter orders, arrange follow-up visits, etc. on our own) or a CNA. The gastric bypass patients especially are so labor-intensive that it gets very frustrating.

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Does this sound normal on a med surg floor? Yes it does actually. When I worked med surg, it was 5-6 on days, 6-8 eve and 8 or more on 11-7. One time I had 12 on 11-7. Is this safe? Heck no. But this is what hospitals do to new nurses that they can push around and work for entry level pay. Sure they don't care if you leave, they will just get another new grad to use and abuse. If you can stick it out a year, you will gain alot of experience that will benefit you alot in nursing.Kind of look at it that you are using them, it will help you deal with the stress easier.Best of luck.

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Specializes in Travel Nursing, ICU, tele, etc.

Very good point! There are actually bariatric specialty units that have extra staff etc to service the needs of the larger patients.

That you have to answer the phones and somehow act as secretaries is totally unreasonable! Do you all regularly have to stay late to get all your charting done? It all comes down to money, if you are getting a lot of overtime, maybe some things would change.

God, that would be sooooooooo frustrating, to have to answer the phone in the middle of patient care.

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on our unit at times we have this kind of scenario....it's frustrating especially when patient's condition changes that calls for more attention and care...we would have and aide...then one nurse who's charge capable but still assign to 4-5 patients...we would do our own orders on top of assessing and medicating this patients..Some people think that post surgery is a lot lighter, but really they're more demanding and you have to make sure that you give them a good care to minimize post surgical complications...so is this safe? To us IT'S NOT! and we always raise our concern and in good days admin actually listens and gives us extra help (secretary)...on bad days, answering the phone is on the bottom of my priority list...PATIENT FIRST!

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Specializes in Nursing Education.
Maybe I'm over-reacting, but here's the scenario for the last two days:

I work on a surgical floor (we get some med overflow, but mostly surgical - lots of Roux-en-Y, hysterectomies, abdominal type stuff). Anyway, we've had 5 patients per nurse, one aid (for 25 patients) for about 1/2 the shift and a unit secretary for about 1/2 the 12-hour shift. We do not have a charge nurse because we've been told that "relation-ship based care" practice entails each nurse taking all of their own orders and rounding with each doctor (which doesn't happen - we're too busy). We have many patients getting blood, tons of diabetics, tons of iv abx and pain meds - very very busy. Is this normal? I bring up my concerns to my supervisor, who just shrugs her shoulders and says essentially that it's just the way it is and nothing will ever change and if I don't like it, I can quit. Anyway, back to my original questions: is this normal? does this sound safe?

I think on a med-surg unit - this is rather typical nurse to patient staffing. The problem I see is the lack of ancillary support (CNA and Secretary). I am always amazed when a hospital does not provide clerical support, yet they are concerned when it takes to long for the phone to get answered or the "flow" of care is hampered because orders were not entered into the system timely. I am not sure how administration expects nurses to answer the phone, manage order entry and also take care of their patients. Something suffers when there is not enough help and I am sorry to say that the one that suffers is the patient, while the nurse is filled with frustration and at times - despair!

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Just DO NOT answer the phone. It's the only way you'll get a secretary. Unless you have paged an MD and are waiting for a call back, don't answer it.

The nurse/patient ratio sounds about right (downright good for some places) but you need more techs and a secretary. Especially with bariatric patients. Somebody will get hurt (staff wise) without enough help dealing with bariatrics.

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Specializes in orthopaedics.

sorry to hear about your frustration. i am on a very busy orthopaedic joint replacement floor with rarely spinal/ortho (other) overflow and this is our senerio: 4-6 patients per nurse 1 charge nurse with her own load of patients. 1 nurse tech/aide for 33 patients sometimes 2 during 7a to 7p.lately we have not had a tech/aide from 7p to 11p which is crazy. a unit secretary from 7a to 11p.

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Specializes in ICU, ER, EP,.

The ratio as others have stated is very good. There were many nights in my facility that the floors (all who would do tele too) would take 10-12 patients if the "extra" nurse could not be found. One aid, one secretary. Now that IS ugly!

You HAVE to prioritize and the phone is not on the list, nor are family and friends who call to check on patients when you can't complete patient care. I agree with the other posters. I only have 2-3 patients but will NOT answer the phone, the locked door, only call lights.

When complaints start rolling in to management.."I was busy providing care, I didn't realize the phone was unanswered. or I had a choice between patient care and the phone, I chose".

Unfortunately your ratio is not your problem, somedays with the lightest of acuity, I run myself into the ground with easy tasks run amuck.

I hope you have better days, good teamwork with the nurses makes this much easier to handle. Consider making the first offer, lets hope it's returned quickly.

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unfortunately you are not alone, this is similar to what happens to me every weekend i normally have at lest 6-7 patients on an ortho floor, doing my own vitals, no cna because they have either been pulled to another floor or one was not scheduled, 16 patients between two nurses,

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Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.

As most people have said the ratio nurse to patient sounds ok, but the lack of ancillary support is what kills. I am the supervisor at my hospital on nights and our surgical unit will take: 3-5 days, 4-6 eve/nights. 1 aid to upto 12 patients. 1 unassigned charge to help out. 1 secretery (will eventually cover 2 units when chemo is up and running on nights). Usually we have a house float to help, and I am always willing to come down - insert foley's, ng, admit, and we have a rapid response team also (me and RT, sometimes the critical care charge).

When I hear "horror" stories of places with staffing I say the same thing - there are too many nursing jobs available to be stuck with one you don't feel safe in.

Hope this helps,

Pat

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