4 yrs, Low experience, Hospital

[LexxNervous]

Hello all, I am new to this forum. I was a stay at home mother, I went back to school and got my RN in a rural area of Western Massachusetts. My first job was at a SNF/subacute facility where I did not receive training, just orientation. I was frightened that I had 15+ patients in the subacute (and more in the SNF area) so I left and went to work at a For Profit Drug and Alcohol Detox. I left there because they were not in compliance with state requirements regarding medication storage, narcotic storage, etc. I went to another SNF/Subacute where again I feel the nurse to patient ratio is unsafe. I am interviewing with a hospital, and their HR assures me that their nurses have a ratio of 1 nurse to 5 to 6 patients on med/surg. HR states I can be trained and oriented for months, as long as I am progressing and until I am comfortable in my role.

Does this sound like a good opportunity, and can I believe HR as to ratios? I know we are all impacted by COVID, but my fear is that I will be attempting to manage as many as 8 patients (given admissions from ER, etc.) I am also afraid because, by erring and choosing to start at SNFs, I have never had proper hospital training. I have had my license for 5 years but feel that I am nowhere near hospital nurse experience and knowledge. I was not ever educated as to Scope of Practice (in college or on the job), or to reporting Neglect or Abuse to the state, merely that I was a "mandatory reporter." I am educating myself as no one has ever had the time or inclination to train me or educate me properly. I just want to be the best nurse possible, take great care of patients, and know what to do in cases of abuse/neglect/bad staffing/etc.

Thank you for all your input.

[Mrs.D., BSN]

On 8/6/2022 at 11:17 AM, LexxNervous said:

Hello all, I am new to this forum. I was a stay at home mother, I went back to school and got my RN in a rural area of Western Massachusetts. My first job was at a SNF/subacute facility where I did not receive training, just orientation. I was frightened that I had 15+ patients in the subacute (and more in the SNF area) so I left and went to work at a For Profit Drug and Alcohol Detox. I left there because they were not in compliance with state requirements regarding medication storage, narcotic storage, etc. I went to another SNF/Subacute where again I feel the nurse to patient ratio is unsafe. I am interviewing with a hospital, and their HR assures me that their nurses have a ratio of 1 nurse to 5 to 6 patients on med/surg. HR states I can be trained and oriented for months, as long as I am progressing and until I am comfortable in my role.

Does this sound like a good opportunity, and can I believe HR as to ratios? I know we are all impacted by COVID, but my fear is that I will be attempting to manage as many as 8 patients (given admissions from ER, etc.) I am also afraid because, by erring and choosing to start at SNFs, I have never had proper hospital training. I have had my license for 5 years but feel that I am nowhere near hospital nurse experience and knowledge. I was not ever educated as to Scope of Practice (in college or on the job), or to reporting Neglect or Abuse to the state, merely that I was a "mandatory reporter." I am educating myself as no one has ever had the time or inclination to train me or educate me properly. I just want to be the best nurse possible, take great care of patients, and know what to do in cases of abuse/neglect/bad staffing/etc.

Thank you for all your input.

Well I can only speak to my eastern MA acute care hospital that has a union… but ratios aren’t not in the contract. Our tele floor can take up to 5 patients 7a-11p, and up to 6 patients 11-7a. Most of the time it is actually 4 patients if we’re not in a surge from the ED. Management knows this and our unit census caps attest to this. 
 

They have never tried to pass these established ratios in my four years, but if they did ask me to take a 6th patient on days I would laugh and say, try again. It just wouldn’t happen. It’s not safe. 
 

So hopefully they’re saying those ratios because they know the limits and are proud of them to attract a nurse. As opposed to lying to gain a nurse that will be quickly overwhelmed and leave. 
 

Good luck!

[scribblz, BSN, CNA, LPN]

Hello and welcome to our forum @LexxNervous ☺️

Those ratios are fairly consistent across many med surg units in MA. I will say more than four patients on 7:00 to 3:00 and 3:00 to 11:00 is hard. Especially 3:00 to 11:00 where you get hit with admissions and discharges. But as long as they agree to not exceed five until 11:00 p.m. it's doable.

 Of course if you have an emergency, it doesn't matter how many patients you have you are focusing on the emergent patient. In a well-run unit the rest of the nurses look out for your other people, the supervisor pauses admissions and hopefully you have a good orientation so you're prepared. Depending on your hospital they may even have a code team and/or nurse educators to provide support.

I worked LTC and SNF for 10 years before I went from LPN to RN, and it was pretty brutal in terms of patient ratios. I found my hospital experience to be much better in terms of length of orientation and in having more resources and staff. 

I commend you for being motivated with your own education and to continue to look up things that you experience that you don't understand. There are some amazing nurse educators on Youtube. I highly recommend the YouTuber "ICU advantage" even though he is explaining concepts that are more common to the ICU and critical care he also explains a lot of things that carry over to med surg, and is a delightful human being to learn from.   

I wish you the best of luck and hope that your hospital experience is a good one. Please feel free to reach out for help if you need it and let us know how you're doing!