Well.. I *was* a cardiac nurse

[TorsadesDePointesRN]

As of 8 weeks ago, I am a cardiac post-op AND neuro nurse. Our hospital shut down the neuroscience unit so now I am responsible for everything from pre/post CABGs (with insulin gtts, amiodarone gtts, etc.), acute MIs, pre and post cardiac caths, being transferred any med surg pt from the hospital who starts going into afib or starts throwing tons of PVCs PACs or a few sweet runs of Vtach.. but at least my nurse to patient ratio was rarely over 5. Now that our floor has added neuro patients (NIH scales, q1 hour neuro checks, feeds, dysphagia assessments, q1 hr vitals, etc etc) they have decided a minimum of 6 patients is what we should be taking care of-- along with a lovely speech about TEAMWORK and how now, more than ever, we have to start helping each other out as much as possible.

I really love being a nurse even though I've only been at it for 1 year, but now I have an appt with a PCP tomorrow because I am cracking emotionally. I always thought of myself as a strong person, but I just can't handle all this anymore without some kind of help. On my days off I only want to sleep and I hate it when my 7 and 10 year olds see me crying.

Anyway, was just curious if anyone else has this particular combination of patient population and if there's any hints you have to offer. It just seems like an odd combination of patients because they are both so high acuity.

[noahsmama]

What's your legally mandated ratio for tele patients?

California is the only state in the country that HAS legally mandated patient/nurse ratios. The OP is a good example of why other states need ratio laws too!

[TorsadesDePointesRN]

Maybe you could change to school nursing and be on your

kids schedule....just a thought.

I can't afford that kind of pay cut right now. (school nurses in my area make about 1/2 what I do)

[HouTx, BSN, MSN, EdD]

The neuro docs are ****** in general, and are known for acting like bizarre bungholes. So, in one corner, we have the suave, top of their class mcdreamylike cardiac surgeons and cardiologists.. then in the other corner, we have the neuro docs who each seem to enjoy sporting horrendous displays of fashion abominations and..to put it mildly.. just plain odd physical attributes.

I actually like neuro much better than cardiac - more interesting and usually not nearly as 'chronic' - so I am definitely biased.I must defend the neuro docs. Cardiac surgeons, and to a lesser extent, interventional and medical cardiologists, have long been considered the 'stars' in any hospital because of all the revenue they used to produce. This is diminishing rapidly under new reimbursement rules so their prestige is beginning to decline. The neuro folks have resented attitudes toward their service line.... requires enormous skill and knowledge, but very little acknowledgement of their expertise.

Let's face it, until the concept of 'stroke centers' emerged, no one got too excited about patients having a "brain attack" but everybody immediately went into overdrive at the mere mention of chest pain or heart block. So the brain team is finally coming into their own. So it's no wonder that a lot of neuro docs have huge chips on their shoulders from being treated like second class citizens for so long. They may also not have the high level of interpersonal skills as other specialties... not much conversation with comatose patients.

Give 'em a break - an maybe some fashion advice??

Note to OP --- make sure you understand and take advantage of your state's 'safe harbor' process. It may not prevent clinical issues from occurring, but it will protect your license.

[azdesertflower]

I would start looking. I work on a medical tele unit. Our ratio just went up as well, 1:6 on days. It is soooo unsafe. In one shift I'll have 3 pts with dementia on bed alarms and hi/low beds with neuro checks q4h, pulling out IVs, getting naked and pooping everywhere, 2 COPD pts with PNA and q2h breathing tx and high glucose from the steroids on top of their diabetes and antibiotics and maybe if I'm lucky one pt in detox that -might- be stable, usually not. Everyone's on IVFs, tele. AND we're usually short staffed. I'm applying elsewhere as I'm fried and I've only been doing this 3 years!

We got the teamwork talk too. Really?! If we're so all about teamwork, why doesn't the manager come in and take a team of pts when we're short staffed!! It's getting old.

Good luck, hang in there.

[TorsadesDePointesRN]

Some great points are being made.. this is very helpful, thank you all.

[highlandlass1592, BSN, RN]

Unfortunately, the idea of safe harbor, in some states, offers no protection for the nurse if something goes wrong. You are still held legally responsible, which is a catch-22 for the nurse. When I was in NC, you could file all you wanted but you weren't offered any protection

[wooh, BSN, RN]

what's your legally mandated ratio for tele patients?

bahaha! "legally mandated ratio"??? really? that exists? other than california?

[wooh, BSN, RN]

I think the hospital knows this and is taking FULL advantage.

Hospitals have known for a while how bad the economy sucks and are taking full advantage of the power they have. They know we can't quit, so they're throwing out every stupid policy they can find now while they can. Then we'll be used to it once we can talk with our feet.

[gigglymo]

Bahaha! "Legally mandated ratio"??? Really? That exists? Other than California?

When I was a tele nurse, we were not allowed to have more than 5 patients, 6 if one was a m/s overflow. I was under the impression that if not "legal" mandates, there were guidelines put in place by JCAHO - incorrect?

Either way - the OP is in a pretty miserable situation right now - clearly the people making the rules are NOT the people who have to follow the rules, which is consistent no matter where you work, unfortunately...

[wooh, BSN, RN]

JC (as they no longer call themselves JCAHO) doesn't make strict "rules." They create "standards" for which the hospital has to create their own rules. Like they don't say, "Check the armband." They say that a hospital should have a policy in place to provide for ensuring the correct identification of the patient. So the hospital tells the people in the trenches, "JC said you have to check armbands." JC doesn't care HOW you ensure the identification. You could take the patient to the roof and check smoke signals sent by their family in the next state. As long as the hospital has a process and can prove they have that process.

So JC may have a standard of something like, "Telemetry patients should be properly monitored" and a hospital may turn that into a policy of a 5 to 1 ratio. But even that's rare. The hospitals aren't going to put anything in writing that will get them in trouble. The policies are all to protect the hospital. I guarantee if it came down to you taking a 6th tele wherever you had that rule or a manager coming in at 3am, you'd be taking a 6th tele patient.

[Otessa, BSN, RN]

Had a similar floor but the pt. load was 4-5 MAX on days or nights.