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Discussion

work overload

hi! i've been an RN for a year and a half and recently started a new job at a big short-term acute hospital, and so far i've like it very much. i changed my status from full-time to per diem at the long term acute hospital i started out in. last tuesday, i worked at the LTAC facility after being gone for 3 weeks. they switched from primary care nursing to team nursing, which had us loaded with 10 high acuity patients having 1 RN, 1 LVN and 1 CNA per team. the LVN's job was to pass all oral medications and do accuchecks. i had to do ten assessments, hang IV's, call doctors and do all documentations for the 10 pts. we had 2 patients who were not doing so well and one whom i had to totally take care on my own because she didn't get along with my LVN. on top of that, i had to do discharge and admissions. how can anyone keep track of all these 10 patients and provide nursing care safely? i didn't feel like i gave good nursing care during that day to my patients and i didn't feel safe giving care either. i asked my supervisor why they didn't do a full staffing on all the units and she told me that it's because the census was low. they didn't staff for anticipated admits or transfers so we got overloaded with patients. i found it unfair. they've been trying team nursing for 2 weeks now and so far they haven't followed up for feedbacks if it was indeed efficient and effective. i understand that they could be trying to cut down on costs, but to put patients and nurses at risk? i find that ridiculous. i understand that there are maximum limits for nurse-patient ratio. i was wondering what the nurse-patient ratio is for in an LTAC hospital. most of the patients we get are total care, ventilator patients with tube feedings and telemetry. can anyone give light on this subject?

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What was the LVN doing when she wasn't passing meds? What was your CNA doing? 3 of you for 10 patients is a pretty good ratio. Are you satisfied that the work was delegated well? I worked on a stepdown where we had 10 patients and an LVN to help us. We had to do all the assessments and IVs just as you. The LVN did all the oral meds and also did a substantial share of patient care--she wasn't sitting on her butt when her med pass was completed.

I don't know what the legal nurse-patient ratio is in an LTAC hospital.

I do know that most facilities of all kinds have forms where we can document our objections if we feel we are being given an unsafe load (patients we aren't trained for, too many high acuity patients, etc.). Filing the form with a supervisor gives us a little bit of coverage if the assignment is allowed to stand and that results in a bad outcome. It also puts the facility on notice that their allocations have been legally documented as being considered unsafe. The obvious downside of filing such a form is that it makes management get angry at the nurse submitting one.

On a somewhat related note: I changed units recently, and was amazed to realize that one of the main reasons that some of the other nurses had time to chat, while I was constantly running my tail off, is that I was the only nurse on the floor actually observing our high risk fall protocols. The rest just give a patient on the commode a call light and tell them to push it when they are done. I feel very sure there are other less than ideal short cuts being taken by those who spend most of their time talking or net surfing. Ick.

Yesterday, I was given a fresh transfer patient from the ICU ... 5 minutes before report. I wanted to get him settled in, and vitalled in, before I gave report. Turns out that I had to run around searching room to room to find a replacement for the missing oxygen tree in his new room, AND make another search for the cord that connects the B/P cuff from the patient to the telemetry monitor. Was the next nurse grateful that I'd taken the time to get the patient SAFELY settled in? Nope, instead she was way ticked off that I hadn't been there to give her report on the dot.

Somehow, no matter where we work, if we are committed to giving high quality care, we end up hugely pressed for time. Recent health care budget cuts will only lead to increased pressure to do more with less. Nurses get burnt out from the constant pressure to do 'better than their best', and in response they leave or end up sick ... making the workload go up again.

Its a challenging part of the job, for sure. I definitely feel for you, in trying to do everything when there isn't time for it all.

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