What does "Stand up for yourselves" really mean?

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I work on a cardiac/telemetry floor where the ratio was supposed to be 4:1. Now it's usually 5:1 and occasionally it's 6:1. This happened so incrementally that it became the norm. We have, at best, one tech and there are 30 beds. Meanwhile, ward clerks quit left and right because of the workload -- so it is impossible (or seems so) to stay abreast of the constant changes in the patient's orders. A few weeks back, a patient (not mine, but it could easily have been) actively infarcting was totally overlooked, for instance. It's crazy. I rarely feel safe and always feel like I am drowning.

So I look on the internet with search terms like "safe staffing" and "nurse-to-patient ratios" and stuff like that, and I constantly read, "Nurses must stand together to resist unsafe staffing," and blah, blah, blah, and I have to ask: what is that, exactly? Everyone complains, but nothing is done. Our supervisor says (if he responds at all), "Oh, everything will be fine." ??? If I refuse a sixth patient, because I already have one too many with probably two cardiac drips, a post-cath and another who is completely confused and pulling out his IVs (and God bless that fifth patient, who is just there for observation and I must totally ignore), that just means a co-worker will get her sixth and she won't refuse -- in other words, nothing works.

I don't know what I am looking for here. Company maybe? Any advice? I want to be a really good nurse. But all I feel like I do is try to just keep my head above water.:crying2:

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You answered your own question when you said your colleague won't refuse another patient. Standing up for yourselves means that all the nurses on the team recognizes unsafe practices, and won't back down or be forced into an unsafe situation.

It may sound like I'm advocating forming a union, but I'm not. Safe nursing practices and ratios are well documented, as you have found. Just make sure that everyone knows and follows them.

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Specializes in Emergency Medicine.

There are many jobs and only one license.

Put up or shut up...

If you think that you can't handle the load safely

you need to say so. If your concerns aren't addressed

then get the hell outta there.

Standing up for yourself is saying what's right

and taking responsibility for your stance EVEN

at the prospect of losing your job.

Do it. How much value do you put on your

license after all...? Seems unsafe to me.

Just a matter of time before there is a bad outcome.

The real question I see:

Will you have a chair when the music stops?

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Specializes in Emergency Department.

When things like the active infarct you mentioned happen, there should be an investigation to find out why it happened and what could have been done to keep it from happening again. If your company does not do that I would suggest finding employment elsewhere because it is not safe practice there. Especially if all it would take to ensure safe practice for nurses and clients is to hire another nurse or tech/aide.

Unfortunately, some facilities will not do anything until someone dies and they are forced to.

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

I've done crazy shifts where I've had 7 or 8 patients, 5 or 6 are post op and the amount of work and paperwork kept me busy the whole shifts. These are the very worse shifts. But somehow I got through it. You constantly hear complaints re staffing ratios but nobody does anything about it all. NMs don't care or are powerless. But as far as a I know you can refuse a patient due to being overloaded, though I've never heard of anyone doing this. I think nurses don't refuse extra patients because they would be seen as 'letting their collegues down' or 'not coping'.

Can you talk to someone higher up? Also if you can't safely look after a patient, document this and then take it from there.

I often think about this problem. I can't think of anything else you could do at this point, but sometimes you have to quit the battle, and maybe look for another position.

I'm lucky cos my hospital calls in extra staff (me!) to help the nurses out when it is too busy.

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Specializes in cadiac-thoracic post sx.

Wow, that is very sad for your patients and you. I too work on a tele floor post cath, MI, CHF, AMS, you name it and everything in between because internal medicine wants to put everyone on our floor, some who don't even have a cardiac history. For one thing, I have NEVER taken care of more than 5 people at night. If it gets that busy charge will take patients. Now when I worked nights and we were short staffed it wasn't uncommon for us to have 5 and charge take up to 3. But that is if we can't anyone to come in. Now I work days and we never have over 4. Seven or eight patients, my GOD, how can you keep up with all that? Nobody can do that safely. Does your charge nurse take patients to help with the staff? And one tech for 30 patients?? When I worked step down CVICU we had 2 techs on at night and 3 during the day for 18 beds. Now on just Tele same thing but we have I think 23 beds. I agree with several of the other girls. 1) if you aren't getting any results from your nurse manager, go up the chain of command. 2) if that doesn't work or you don't feel like you can do it, then sadly I too would look for another job (for your own sake, license, sanity, health). There has to be somewhere else you can get a job. I just don't think it would be worth risking your license esp if someone could infart and no one notice or was able to do anything about it. If that patient died the family could throw a lawsuit so quick, and of course all the courts have to look at is the charting. And when you (or whoever) goes to court, do you think the court is going to ask, how many patients did you have that night, what was going on that day to where you couldn't treat this patient? No, the charting is soley going to reflect what was done that day. I think that is just a very very scary situation. Like I said I do the same thing everyday and I just could not imagine taking on more than 5 patients. The only way you would know someone is alive is by the moniter but then they could always go PEA. I'm really sorry you (and your patients) are in this situation. You are right it is NOT SAFE!! Maybe even call your board of nursing and see if they can give you suggestions on how to handle that. does your state have a law on patient nurse ratios. Legally can you get in trouble for refuing a patient under unsafe ratios. There is so much at stake here. I wish you the best of luck.

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Specializes in medical surgical.

Sadly this will become even more normal in the future. Do you think that once the so called recession ends that staffing better will happen. It is all about the almighty dollar and the ceo at the top doesn't give a squat about your license. After all, it will be you who will be on the outside looking in. It doesn't appear that nurses will ever stand together. Someone is always there ready to take that extra patient and it will continue. The only hope may be unions and state mandated staffing ratios. As of now, California is the only state where ratios are mandated and nurses are flocking there!

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Sadly this will become even more normal in the future. Do you think that once the so called recession ends that staffing better will happen. It is all about the almighty dollar and the ceo at the top doesn't give a squat about your license. After all, it will be you who will be on the outside looking in. It doesn't appear that nurses will ever stand together. Someone is always there ready to take that extra patient and it will continue. The only hope may be unions and state mandated staffing ratios. As of now, California is the only state where ratios are mandated and nurses are flocking there!

I'm afraid I have to agree.

If you stand up for yourself, you will be standing alone. Too many nurses are women who "need the job." This includes NMs.

Unions, as far as I can tell, are only good for taking your money and bugging the hell out of you when election time is near. Otherwise they may as well not exist. (Okay, they did bring me a keychain during Nurses's Week.)

I wish I could say I have the answer, but it is a very comlex issue that is not going to be resolved anytime soon.

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Specializes in Cath Lab/ ICU.

Wanna know what standing up for yourself means? Really means?

It means you will fight for your license. You will be labeled a troublemaker.

It means you will fight for your patient. You will be labeled as someone who cant be a part of a team.

I've found that fighting for what's right has gotten me in a load of trouble. Loads!

I don't know how to advise. I'd say, choose your battles wisely. Fight honorably. And when the time comes, know when to walk away.

Because once you're labeled, you're done. And you don't want to wonder if you can make your mortgage payment, or car payment, or groceries, because you made a stand.

Because as much as we know we are right, and as much as we wish others will rush to our aid-they won't.

You will be alone so make it worth it.

But remember, we can get another job. But it's sure hard to get another license...

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Specializes in Med-Surg, Cardiac.

I work on a similar floor. On daylight 5 pts is normal though often have only 4. If we have a call-off we may get up to 6 and I think I may have had 7 once briefly. A lot of it depends on who's doing the assignments. For example there are days when I have 5 post cath patients who are up and about and stable and planned for AM discharge. Those days it would be better for me to take one or two additional admits so the person with the two confused or unstable patients can concentrate on them. I notice some of our charge nurses are very good at recognizing the differences in patient acuity and some not so.

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Specializes in ER.

CCL RN has it right. But if you still choose to fight...

They took away your ward clerk. If you don't have time to answer the phone, let it ring.

Leave orders to be put in unless they need to be carried out during your shift. The day staff probably have a ward clerk...so they can be put in on days.

BASIC charting, each piece of information in one place only.

Adding papers to charts, creating order from disorder, weeding out extra paper...no more.

Snacks, cots, blankets for visitors...when you finish patient care you will do your best. At this point though sounds like you are never "done" with patient care.

Restocking, going through expiry dates, that can all be done by someone else.

As you do this you should never be just sitting around chatting. Take the breaks you are entitled to, but make sure you are truly working during the entire shift. Be courteous when asked to do extra stuff, say "I'll add it to my list." But if you don't have time don't stay over, don't apologize, just say there is too much to get through.

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I've done crazy shifts where I've had 7 or 8 patients, 5 or 6 are post op and the amount of work and paperwork kept me busy the whole shifts. These are the very worse shifts. But somehow I got through it. You constantly hear complaints re staffing ratios but nobody does anything about it all. NMs don't care or are powerless. But as far as a I know you can refuse a patient due to being overloaded, though I've never heard of anyone doing this. I think nurses don't refuse extra patients because they would be seen as 'letting their collegues down' or 'not coping'.

Can you talk to someone higher up? Also if you can't safely look after a patient, document this and then take it from there.

I often think about this problem. I can't think of anything else you could do at this point, but sometimes you have to quit the battle, and maybe look for another position.

I'm lucky cos my hospital calls in extra staff (me!) to help the nurses out when it is too busy.

"I think nurses don't refuse extra patients because they would be seen as "letting thier colleages down" or not "coping".

And just how sick and self-defeating is THIS attitude?"

How long would you like to continue this martyrdom? When will you forget about your OWN fears and think about the pt.s? And when will you FINALLY recognize that your pt's lives and your career is being harmed because of your employers greed? Not having that extra nurse in 270 hospitals daily adds up to MILLIONS per year that the greedcats get to pay out to themselves! You suffer, and your pt.s suffer, because you fear you are "not coping"?

Your "coping" expectations have been arbitrarily set by a company who doesn't care about you, your pt.s or good outcomes. They are about profits offset by the occassional bad outcome (read: lawsuit). As long as the pay in exceeds the payout, they could not care less about your working conditions or stress.

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