Worried about too much accountability.......

babalou58 · Jul 30, 2006

Patient Safety?

begalli · Aug 2, 2006

Thank God this does not happen in CA - anymore. I wouldn't be a (working bedside) nurse if it did.

What the OP describes is a HUGE contributing factor to why I took nearly a year off nursing after watching my dad waste away for 3 months and then die on a med/surg floor where his nurses had 10-12 patients for 12-16 hours a day (they worked 6-7 days week) and after the sudden and tragic death of my 16 year old nephew in a accident the nurse was so slammed with patients that my sister-in-law didn't even know she had the dried blood of her son all over her face from giving him mouth to mouth. There wasn't even time for that nurse to hand her a washcloth or alert her to the fact until just before they left the facility. As a matter of fact, the nurse wasn't available to my brother and his wife until they were leaving and she apologized profusely.

I was absolutely ashamed of telling anyone I was a nurse.

When will this kind of stuff stop? What will it take?

OP, your situation is UNACCEPTABLE. It is totally UNSAFE and WRONG.

I personally think that nurses need to STOP accepting these situations. While I realize that it's much easier said than done, I think ENOUGH is ENOUGH. I am absolutely terrified when I hear that a friend or loved one is sick and requiring hospitalization because I can't be everywhere at once.

While I don't have any concrete answers for how to change this, we as nurses and our patients deserve better. It's disgusting.

kstockdaleRN · Aug 2, 2006

I appreciate your response. I guess my problem is - I'm torn between working my butt off trying to make it better, and taking a stand. I feel like, if I DON'T do this - who will? I work a shift where there is only one other part time nurse who is NOT a new grad within the last year. I accepted the job as charge nurse knowing that it would be a real challenge. However, now i'm whining. :) It's hard to know where to draw the line.......how much is TOO much? So far, even though I stay 2 hours over the end of my shift catching up on charts and stuff every night, and I work too many doubles to count........so far, no major incidents. I feel like we provide good patient care, but I also feel overwhelmed. I guess I just wish that once I could feel like a regular person with a regular job who leaves their job AT their job. I worry about things so much that I often call back to work 2 or 3 hours after I'm off - in the middle of the night - making sure that someone has checked this or that. Is it just me?

For example, tonight the entire hospital was full. The units were almost full, two monitored beds left in the entire 800 bed hospital. We couldn't go on divert. I had a patient ON THE NURSING FLOOR on a lidocaine gtt, going into slow VT (rate 105) regularly. The cardiologist would come to the bedside, pace him rapidly to speed up his VT until his AICD fired and shocked him out of VT. This happened 3 times in 8 hours with multiple lido boluses and stuff. Still couldn't get a unit bed for the guy. It seems that a patient not on a vent or a balloon pump can't get a spot in CCU. AND I had 8 other patients. Scary!! But I kind of go into survival mode, we just have to do what we can with what resources we can, because there's nothing better within 200 miles - we are the only level1 trauma center, and we can't divert, and we are full to the brim with not nearly enough staff. What to do? Anyone feel like this?

CrunchRN, ADN, RN · Aug 2, 2006

I think you are great for doing what you are. However, as long as you all accept these dangerous patient loads then it will not change. The hospital could get more nurses if they had an enticing enough package. The nurses are out there. They will never pay the bucks though unless forced to. I think you are doing the right thing, but where do you draw the line? That patient load on any acute care floor is outrageous. A new grad nurse or even an experienced nurse with 8 patients on a cardiac floor? That is just not right. We have GOT to educate the public more so that they can demand changes. Nurses will make med errors under that kind of load. It is inevitable. Just a matter of time. Then they will be hung out to dry.

HappyNurse2005, RN · Aug 5, 2006

8 telemetry patients? that alone is nuts. You may want to "make things better" you say:

I'm torn between working my butt off trying to make it better, and taking a stand. I feel like, if I DON'T do this - who will?

Yeah, thats a great thought,but you could lose your license from such an unsafe environment. Really. Look for another job!

tinderbox · Aug 18, 2006

8 patients, a normal load??? Just curious, what state are you in? Here in Oregon, on the tele stepdown unit that I work on, the max pt load is 4. We do our own vitals but still. Eight patients is a LOT for 1 RN!!! Especially on a tele unit.

TAC50133 · Jul 8, 2008

I am an LPN at a small hospital, we take 6-7 pt's. I give blood, platelets, triage and so assessments and care plans on all my pt's. Our Charge takes 4-5 pt's and is responsible for signing off on our charts, but she doesn't have time to assess the pt to know if the care plan is right or not. That is so unfair to the charge nurse. Pt care suffers because of we do not get a tech or a secretary, sometimes for a half shift. We do all our admits and discharges, it relives the charge nurse some but she still has to acccountable for all the nurses on the floor and anything that goes wrong. Speak of accountability.

LauraTheNurse · Aug 1, 2008

Where I am in NY, its 5 max for tele. I understand what you are going through

Spatialized · Aug 2, 2008

I work on a 31 bed cardiac telemetry unit, but at any given time we do have some respiratory patients and neuro with telemetry. Our unit has recently hired 5 new grads for my 3-11 shift. I am charge nurse. One night last week I had this situation - I was precepting a new grad, so I took report on her team of 8 patients (the normal load) and after following her a little, I didn't feel like she was ready to be left alone for any amount of time. She didn't know her meds yet, very green overall.
At the same time, I had 2 LPN's on the floor, each with 8 patients, and one more experienced RN with 8 patients. As charge, I have to sign off care plans for the LPN's, do all of their IV pushes, administer any blood products, etc. Technically I had 3 other nurses working under my license, with 24 patients. I have to do staffing for the next shift, and sign off all Dr.'s orders. Whew!
Anyone else experienced this? I just felt like that night was the perfect storm - if anyhting had went wrong it all would come crashing down. I was just praying that we wouldn't have a code or something. Oh, and also - we discharged 8 or so patients and admitted about 8 more. Sheesh.

Yipes! That's more than unsafe, that's downright dangerous!

I had a patient ON THE NURSING FLOOR on a lidocaine gtt, going into slow VT (rate 105) regularly. The cardiologist would come to the bedside, pace him rapidly to speed up his VT until his AICD fired and shocked him out of VT. This happened 3 times in 8 hours with multiple lido boluses and stuff. Still couldn't get a unit bed for the guy

And this is even worse. We run our Lido drips on our step-own floor, with a 3:1 ratio - and the nurses don't have to run to another floor to adjust meds. No paycheck is worth someone's life (or your license!) Rn very far away - if you can. In spite of wanting to change, trying to change organizational momentum is well-nigh impossible.

The floor where I work has a step-down unit with a max of 3:1, the progressive care (i.e.medical telemetry) was 4:1, maybe 5:1 if we're way short staffed. THe grass is greener...

Cheers,

Tom

RN1989 · Aug 2, 2008

I hope you are documenting every shift. There will come a point where you will need the documentation - either to CYA or to provide proof of the unsafe conditions and need for a change.

stepaukob · Aug 2, 2008

Can you tell us what state you work in? I plan to travel next year and would like to make a note of this now. It would be greatly appreciated, thanks.