My unit is 1/2 sub acute/rehab and 1/2 ltc. There were previously 2 nurses for about 24 pts, which was manageable but still a little hectic considering the acuity of the pt load. We've had a TON of admissions in the last week and I now have 16 sub acute pts and my partner has 22 ltc now mixed with subacutes. It is INSANE. Nearly every pt has a wound of some sort that needs a dressing change, some that are very complex. Every pt on the floor has at least one area of skin that must be assessed every shift. I have wound vacs, dialysis, trachs, g tubes, the entire spectrum of patients on top of the confused pts who need to be redirected 1,000 times a day. On average I send 1 pt back to the hospital for worsening of their condition (chronic uti resulting in sepsis, end stage renal or heart disease, etc.) One patient generally dies an expected death.
In the last week my pt load has increased beyond my ability to complete everything. Nurses on my shift are responsible for taking phone orders, taking off orders, calling the MD to report lab results, setting follow up appointments and arranging transportation, restocking all supplies, answering the phone (no receptionist and the phone rings CONSTANTLY but only nurses can answer ) giving meds, all dressing changes, treatments of every kind not to mention the charting (holy cow the charting!) Plus as an RN I am responsible for every IV and antibiotic that needs to be hung on the unit and. Wednesday I stayed until 4:30pm (I get off at 2:30) and didn't finish, but could only stay until 3pm Thurs and Fri because if I don't pick up my kids the school gets annoyed . At the suggestion of my mentor, I spoke with my unit manager (again) today and told her straight out I was leaving a lot of things not completed. There just isn't time in the day for it all! She suggested if we get 2 more pts they may hire another nurse. I gave her many suggestions such as someone to answer the phone and take off orders, etc. and she said she'd try to get us a charge nurse. While those things may or may not happen, the admissions keep coming.
Anyway, when I flat out CANNOT do what is expected of me, what should I do? I make sure my pts get their meds, are fully assessed, and call in the more critical values to get new orders. I also make sure I take off orders that are important. But skin assessments and dressing changes are totally lost. I have a wound vac that should have been changed yesterday. I needed to be trained on it since I've never even seen a wound vac unattached but no one was able the last 2 days. I don't even want to think about picc line dressing changes, etc on the other half of the unit! I feel like I'm leaving my pts and myself at risk. Finding a new job isn't an option, I'm a new grad and have a better chance of winning the lottery than finding a new job. Do I sign and circle treatments and make a note I was unable to complete them? Do I not sign? I'm at a loss here, please help. My facility is big on making sure we don't talk about or admit we are short staffed to families or pts so I can only imagine what they'd say if I charted I didn't do something due to not having time.. I haven't charted unless it's an exception in days either. No one has charted in days, we're all too busy!
) giving meds, all dressing changes, treatments of every kind not to mention the charting (holy cow the charting!) Plus as an RN I am responsible for every IV and antibiotic that needs to be hung on the unit and. Wednesday I stayed until 4:30pm (I get off at 2:30) and didn't finish, but could only stay until 3pm Thurs and Fri because if I don't pick up my kids the school gets annoyed 
. At the suggestion of my mentor, I spoke with my unit manager (again) today and told her straight out I was leaving a lot of things not completed. There just isn't time in the day for it all! She suggested if we get 2 more pts they may hire another nurse. I gave her many suggestions such as someone to answer the phone and take off orders, etc. and she said she'd try to get us a charge nurse. While those things may or may not happen, the admissions keep coming.