What is considered appropriate staffing for grads off of orientation.

Long Term Care Columnist / Guide · Oct 11, 2003

Alas, this is a fairly typical assignment.....once you're off orientation, you're no longer considered a beginner and you're just as likely to draw a heavy team as the nurse who's been there for years. Is this right? No. Is it safe? NO! So what you do is march yourself right down to the supervisor/charge nurse's office and let them know you need help. What you've described here is a patient load that's unsafe at any speed, and unless nurses protest such assignments, they will continue and we will be the first blamed when something goes wrong.

I look at it this way: My primary obligation as a nurse is to serve as an advocate for my patients, regardless of whether it makes me unpopular with a physician or causes inconvenience to the nursing supervisor who must find extra staffing when patient acuity makes my load unsafe. Besides, I waited a long time and worked really hard for my RN license, and I'd like to keep it. I don't call the management on staffing issues very often, but when I do, they almost always find more help because when *I* say something is unsafe, it's NOT because I don't want to take an admission or absorb a couple of confused, incontinent patients.

I sense from the tone of your post that you're not afraid of hard work, which helps in the credibility department........managers just hate it when the nurses who holler the loudest about short staffing are the ones who can always be found hanging out around the water cooler! (These few are the ones who make it harder on everyone else, because the managers think they're crying "Wolf!" and will refuse to call in additional staff when it really does get crazy.)

New grad or not, never be afraid to protect your patients; their lives (as well as your license) may depend on your having the intestinal fortitude to stand up and demand safe staffing.

Good luck to you.

k-eet10 · Oct 11, 2003

Do you happen to work in Louisiana? Our ratio is a disney land dream made up by non nursing personnel for corporate numbers. Do not allow them to give you more than you can safely do. I understand because you are new you don't want to sound lazy,whining ect.. But remember patient care and safety NUMBER ONE PRIORITY. Our hospital has no stepdown, telemetry or intermediate unit that is separated. Patient is either in ICU or Medsurg. They will get pushed to med surg if they need a bed in ICU. The only criteria that does not allow a patient no matter how acute to medsurg is if they are on a drip that needs titration. Period.!!Acuity levels should determine as well as staff mix ratio the number of patients to take. Hopefully we will get there soon. Good Luck but make sure you follow the correct chain of command when you no longer feel you can handle another patient safely. The reason is only you can keep your license if you adhere to the standards and if revoked only you can get it back.

stella123 rn · Oct 11, 2003

At our hospital when the new nurses come off orientation, they are given slightly easier assignments if the staffing allows. When the charge nurses really feel that they are confident and can handle regular assignments they stop doing this. They always say that in this nursing shortage they do not want them to quit.

It is good for them but can be bad for us. We are typically overloaded so they do not have full assignments. I understand what the managers are saying about quiting but we are always thinking "What about keeping the ones that are already there?"

I think that it is a hard balance to achieve. I am still relatively new to nursing (I think!!). Not yet two years and feel overwhelmed all the time. I sure hope that it gets better.

Tweety, BSN, RN · Oct 11, 2003

I wish there were some guidelines and extra staffing we could get for new grads. But unfortunately when the orientation is over, it's sink or swim, same assignements as everyone else. Spread your wings and fly and die.

Orientation shouldn't necessarily have "easy" assignments, by the end of orientation you assignments should be realistic as to what you're going to get on the floor, while you have the back up.

Still, a new grad needs lots of support and consideration when making assignments after orientation is over. Too often that doesn't happen. Discuss it with your charge nurse or manager.

However, remember that feelings of being overwhelmed and not being hable to handle it are completely and entirely normal and expected. Happens to every good nurse. And you are a good nurse. Keep hanging on. You'll be fabulous!

Hellllllo Nurse, BSN, RN · Oct 11, 2003

Originally posted by stella123 rn
I am still relatively new to nursing (I think!!). Not yet two years and feel overwhelmed all the time. I sure hope that it gets better.

I have been a nurse for ten years, and no, it doesn't get better with time. It gets worse, imo!

melbnurse · Oct 11, 2003

This post has opened a big window for me ! Here in OZ we used to have " Hospital trained " Nurses , ie they did their 3 years on the job, and studied as well, but in the end , had time management , and priorties sorted . It was extremely hard , but we got there .

I feel very sorry for the " university " traind nurses , who after a meger oriantation, are expected to handle case loads, which are daunting to them, and given the shoratage of staffing, leaves them vunerable, because everyone else is stressed with their case load , and may not have time to help them

kimmicoobug · Oct 11, 2003

Well, thanks for the replies. I did talk to the charge on another hellish day and told her that with the front load and a load of seven that day, that if I had this group the following day that I would have to at least trade one of my higher acuity patients for a lesser acuity patients. She then went to the director and pleaded the case of staffing (we have enough staff in med-surg..no nursing shortage here) with us newer nurses. On my unit and on nights we are newer nurses. Only two of the nurses have 5 years of exp. The rest are new grads and nurses with one year exp. Also, this was mentioned at the last union meeting, as well. Now, will anything happen. Time will only tell.

Honestly, I do think our ratios are pretty good for the most part. I only wish they would also look into acuity as well as the numbers. For example, if we had 24 patients that is only three nurses, regardless of acuity. Well, we have several night shift staff (me included) who tell the house sups to call if they become short staffed. So, why not have that fourth nurse on and have six patients per nurse. I do alot of thinking about this kind of stuff.

Actually, it is kind of a relief to hear that my hospital is not unique in staffing us grads off orientation. I do like my co-workers and caring for the patients, especially when I get to do primary care. I feel as if I am learning tons (especially what not to do...usually after doing what not to do). In nursing school, they warned us of reality shock of nursing....Yeah, it slapped me upside the head a few times. My mantra for the past three weeks has been "the first year is the hardest...nine more months to go"

barefootlady, ADN, RN · Oct 12, 2003

Hello Kimmi;

You sound like a dedicated, caring, knowledge thirsty new grad. I applaud your wonderful outlook. It does seem like even after a 3 month orientation new grads would have a buddy to fall back on, no matter what the shift. Alass, this is not so in the real world of hospital nursing today. Please continue to speak up and declare yourself "in need of help" whenever you feel like patient safety and your knowledge base is in danger. Call the supervisor if the other staff members are busy, don't take "I'm too busy" for an answer. Tell the supervisor you are requesting her/his help and you will file an incident report if you do not get the help you need. I know this sounds drastic, but it is in the best interest of the patient and your license if you are overwhelmed. I hope you keep us posted on how it is going in the future. I wish you all of the best in this year of learning .

floater · Oct 30, 2003

I agree with the others...SPEAK UP AND SPEAK LOUDLY! I agree that my #1 priority is my patients. I worked at a large teaching hospital as a travel nurse and there were plenty of nights when our M/S unit was staffed my ALL travelers...the supervisor had to be in charge and she was covering the whole hospital.....one night I came in and had 9 pts....I promptly called the supervisor BEFORE I took report and told her that this was unsafe and that she either sends another nurse or I go home...miracuously another nurse appears....I am now working in the float pool at a different hospital and last night was assigned 7 pts with an open room for an admit on a surgical floor...I told the charge nurse that I would only take 6 pts..no more. The nurses on the floor were not happy with me...but again NOT MY PROBLEM...I worked to hard to get my degree and I am not going to lose over short staffing. Filling out the papers that state you don't "agree with your assignment" does not help you at all...so what if it is on your record, if you take the assignment anyway and something happens it is still your responsibility...the hospital will cover their ass..not yours....YOU NEED TO DO WHATEVER IT TAKES TO PROTECT YOUR PATIENTS AND YOURSELF....to many of us complain but are afraid to do anything about it...so they keep giving us more to do! Hopefully all states will follow in CA footsteps and mandate RN/patient ratios! Good luck! You sound like you really care! Don't give up!

nursemary9, BSN, RN · Oct 30, 2003

Hi,

I work in a large city--this is a larger hospital with a large trauma population. I work nights on a Med/Surg/Onc. unit.

Once a new nurse is off orientation, our nurses get the same assignment anyone else might get. We get up to 7 patients each. There have been times when we have had more, but the staffing grid calls for up to 7 apiece on our unit. They are really quite good about not going over the 7 unless there is something major--like a late call-in.

Our units are not all staffed the same--for instance in the telemetry unit it is no more then 5 apiece.

We have charge nurses on each shift; if for instance you felt like your assignment was too much for you or what ever, you cou ld speak with her or him or there could be an assignment change.

It's not all ways great, but it seems to work.

Tonite, for instance, we are full & there are 6 RN's and 2 CNA's.

Usually there are only 5 RN's.

I hope things get better for you . It sounds like this is something you want to do, so Good Luck!!

mattsmom81 · Oct 30, 2003

We try not to do this. We try very hard not to overwhelm the new grads. But...staffing as it is, it is not always possible. All nurses eventually get caught in a scenario where they're given more than they can handle, and we learn when to deal with it and when to say NO.

I always advise new nurses to negotiate longer orientations if possible because once it's over, there are no promises we can protect you. A good charge nurse makes assignments according to the strengths of the staff on duty. We TRY to assign less complex patients. But that doesn't always work either when we're short...

Best wishes...please communicate your feelings to your charge nurses and director. More than likely they will work with you and adjust your assignment a while longer, if you are looking honestly at your strengths, weaknesses, and have a plan to eventually get to the point of full duty.

Good luck..it's hard making the transition. I remember well. :kiss