I am a nurse on a cardiovascular floor. I have been there for a couple of years and can't help but notice the increasing acuity of the patients.
Our nurse/patient ratio is 1:5/6. I know that doesn't sound like a lot to some people, but most of the patients we take care of have a list 20 miles long of medical conditions, which only adds to the work load. Not to mention the fact that people lose all functions when they come through the hospital doors.
Like many other places, we took a hit from the economy. We are down to 1 CNA for 32 patients during the weeknights who stays until 3am. We fend for ourselves on the weekend. We have a secretary until midnight, but only on weeknights.
Day shift is another story. Of course, they are max staffed and didn't take one hit. In fact, they got our best CNA from nights.
I am at my breaking point after this work week. I came in with 3 patients (which is rare), walked out of report only to be called report of a patient transfer that I was unaware of. Now I'm starting off behind. The patient I received is a prisoner with a guard who was post arrest with stent placement and who needed further stents before d/c. The patient was extubated that day, and couldn't yet leave the unit.
Needless to say, this patient went into respiratory distress numerous times throughout the night because he kept pulling his O2 off and getting out of bed (after the guard was told 5 gillion times to keep him in bed).
Patient #2 is the total care patient: dying, contact precautions, foley, rectal tube, recent bka, peg tube, picc line, restraints, lipids, turn q2h, suction, meds every hour and the list goes on.
Patients #3 and #4 - prepare for cath in am (not as heavy). Admission of #5 - C-DIFF rectal bleed (are you serious?) Required changing every 30mins.
I gave meds from 8-2am, tried to sit down and chart, and heated my food three times before I realized that I was going to have chewing gum for dinner. My coworker, who also had five patients, was kind enough to help me all night (it literally took two of us just for my patients).
My patient worksheets did not get updated before report nor did any other thing get done in a timely manner. I ended up leaving at 9:15 that morning, only to do it all over again the next night. I left at 10:30 the following morning of my second night. I was so exhausted, dizzy and nauseous from sleep deprivation that I could hardly finish my charting.
My question is: When does it stop? At what point do they realize that patients (and our licenses) are in jeopardy? It's not good patient care. It seems that they keep putting more and more on us and all we can do is continue to take it. I love what I do and I like the area I work in, but it's getting to the point where I feel like I could walk out and not look back.
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March 24th, 2009 at 5:58 pm
your situation has nothing to do w/ the economy.sadly,staffing is that alot of the times from night and day shifts
March 24th, 2009 at 6:02 pm
Having been in a situation similar to this I would suggest you step back and take some days to yourself…it’s hard but if you keep working like this you may encounter a worse situation, one you can’t get yourself out of without a mistake somewhere.
I always tell my patients to “listen to their bodies” and to take a break when it tells them to…I am now grasping that concept and letting myself take a break when needed.
These are just my 2 cents, hope things get better soon.
March 24th, 2009 at 6:15 pm
We have a similar situation currently in our unit. I work in a 16 bed Surgical Intensive Care unit (1 of 5 ICUs in this hospital). Besides acute surgical patients, we take care of the preliver transplant patients that require CRRT, as well as post kidney, liver, and pancreas transplant patients. Needless to say we are usually full and have multiple 1:1 patients. We are chronically short on staffing with RNs, NAs, and HUCs; especially on nights and weekends. I am scheduled 80 hours per pay period and end up working a lot of overtime. I live in an area that has multiple hospitals and nursing schools so we never really experienced a nursing shortage until now. It is awful. Everyone is in danger of burning out here.
March 24th, 2009 at 6:24 pm
The big reason for the disparity between shifts is because (allegedly) there’s more work to do on days than nights. That may be true on regular med/surg floors, but on critical care units (including stepdown and intermediate care), the tasks and workload don’t stop at 3pm or 7pm.
I’ve worked in a busy inner-city ER on nights where I was amazed I walked out with a valid license. Unfortunately, anecdotal evidence is not on your side- you need to document, document, document everything- acuity, workload, staffing (or lack thereof)- in a manner that can be presented to management. Whatever you document, be sure you keep a copy for yourself, just in case management “loses” theirs.
If your facility has an Unsafe Staffing Situation form, start using it. If they don’t, but have an in-house incident report, use that to document what you perceive as unsafe staffing. Again, make sure you make copies for yourself, and hopefully your facility’s Risks & Claims department or management will eventually do something about it. If you don’t document anything, you know what will get done?
Nothing.
Things will not change unless nurses not only advocate for their patients (whose care suffers when staffing doesn’t match the high acuity), but also self-advocate. If you’re witnessing situations that not only put your patients, but also your license in jeopardy, be the loudest, most obnoxious squeaky wheel you can be. I left my position in the ER for many reasons- one of which was I was being *FORCED* to go on break, and leaving ONE nurse to care for her regular assignment, but also cover my and another nurse’s patients, totaling 13+ patients, including 3 ICU admits, acute problems, and a bunch of non-acute patients that had a lot of task-oriented stuff to do. Sorry, but I am not working in that environment. That was unsafe for the patients and the nurse, and I was written up for “borderline insubordination” for it.
In the meantime, update your resume, and see what the job market has to offer. Til then, like I said, document, document, document.
March 24th, 2009 at 6:29 pm
There is no easy answer to the workload you are enduring. It has been many years since I worked floor nursing, and I can tell you I would not choose to do it now.
That said it sounds like you need to take care of you –for your patients.
Have you considered moving to a critical care unit where the ratio might improve?
I worked as a critical care float for more than 10 yrs. Usually 2-3 patients, but a more reasonable workload. Have you looked at the long term? Where do you see yourself in a year or two or three under your current stress level?
Over the 10 years I was working on an advanced degree that moved me from the bedside to outpatient. There are so many opportunities in Nursing- wound care specialist, subacute, occupational health, case mangement, midwife……..
Try picturing the future – your future. I could not picture my own future, but I knew that I wanted to prepare myself for doing something new.
It can be very comfortable (and uncomfortable)to stay where you are. I have been downsized twice, but I have stayed resilient. In the next few weeks I will be starting a new job. Post your resume on Monster, check out local hospitals, outpatient centers, and find there are many ways to feel good about and be challenged in nursing. It is a wonderful profession —
Good Luck!!
Ann–more than 30 years in Nursing.
March 24th, 2009 at 6:29 pm
Your situation sounds very much like the floor I worked on for a couple of years. Many nurses were getting burned out – calling in sick. I loved the work and all the things I got to see and do, but enough was enough. I left that floor and went to the endoscopy suite in the hospital. Still get lots of patient care and very fulfilling, though I must say I miss the mixture of things I saw on the floor. Anyway, what I’m getting at is, maybe it’s time for a change!
March 24th, 2009 at 7:31 pm
I also work on a cardiovascular unit and your day sounds like a typical day for me. I would have to add a few more things. The countless minutes spent looking for IV pumps or vital sign machines that work. Fighting with the pharmacy on what “STAT” means. Consoling, reassuring and managing the complaints of family members. Having to page the doctors over and over to clarify their orders or to get something for my patient the doctor should have already done. Having unstable patients admitted, only to have to whisk them to ICU. Patients being returned from procedures and the transporters didn’t bother to tell me they were back. The list of aggravations goes on and on.
What keeps me coming back is when a patient says, “You have been the best nurse I have ever had.” Or, “Thank you for taking care of my mom today, I had no worries while I was at work since you were here.” Or my gentleman last week, who I transport to a hospice room. He told me, “Wait, your not staying with me? No one said I would loose you for a nurse if I moved rooms. You have to promise you will visit me.” And then his wife pulled me aside and said with tears in her eyes. “If I never see you again, thank you for taking care of my husband. You have been a comfort to us all.” It’s those moments that I remember and they keep me coming back.
March 24th, 2009 at 7:53 pm
I totally understand. I have been a rn for almost 30 years. Times have changed. pt load and complexity has changed. I work on a large cv – telemetry/cardiac/med-surg, whatever floor. We don’t even know what a good day is anymore. It’s always very busy and then the horrible days. the race to discharge and admit is crazy. Rarely do you feel like you did all you needed to do. some days you just want to cry. Breaks are rare. administration doesn’t get it. anyone who has been off the floors for 5 years doesn’t understand the change in pt acutity.
When are the nursing organizations going to pay attention and help?
March 24th, 2009 at 8:46 pm
It seems that most hospital floors are now full with
total care patients with extensive histories and of course whatever their acute problem happens to be.I work on a ortho floor/med surg.Our biggest issue is not enough unlicensed help.I am not above giving a bed bath,changing a diaper or emptying a foley. I have a problem with being expected to give total care to 5/6 patients and call the doc and pass meds and chart and be a waitress and deal with families and auctually need to critically think in between.The attitude of administration is that 5-6 patients is manageable.As every nurse knows,there is always a patient or two whom are very needy(psych pts also need surgery)and it can make your day impossible.I sometimes wonder why I put myself through tough schooling,consider myself somewhat intelligent and put up with all that gets thrown our way.I am constantly searching the sites for other opps,the search continues.Good luck and move before burn out or a unavoidable tragedy happens.
March 24th, 2009 at 8:50 pm
I have been a nurse for two and a half years, and I can see a difference in the acuity of my patients from when I started until now. I have days when I feel like you do. I work on the Med Surg floor, and our hospital is getting rid of different departments. We no longer have an IV team, admission nurses, our transportation employees have been cut, they are getting ready to cut the phlebotimists…. and guess who picks up the slack, from all of these cuts? Our ratio varies, 1 to 5, 6, or 7. You just never know. Hang in there. I had chosen to work 12 and 16 hour days in the beginning, and recently went down to 8’s and 12’s. 16’s are just too much when you have a bad day! Good luck!
March 24th, 2009 at 9:35 pm
I am a new grad ( 7 months on the job). I work in a rehab facility that is a SNF. I have 12-13 pts, we don’t have a unit secretary to input our orders, we have to re-order the meds, do blood draws, IV’s, all medications, all wound care, plus 6-7 diabetics, plus charting and skin and hydration assessments. I am getting quickly exhausted.
The good part is that we have a CNA for q 7 patients.
March 24th, 2009 at 10:37 pm
Maybe a change is what you need. One of the great things abour becoming a nurse is that there are so many different options out there. Don’t let the “job” ruin the career. Look out there and see what’s available. It would be a shame if an obviously caring nurse like you lets the system beat them down and turns into another warm body that passes meds.
March 25th, 2009 at 6:27 pm
I have been an RN for 1 year and 8 months now, and I can totally see your frustration. I feel that everything that I was taught in nursing school is a far truth from the reality of what really goes on in hospital nursing. I am currently looking into a total career change because I feel so appaled, guilty, and disgusted that I cannot give the nursing care that I want/need/should be giving due to “the politics” of staffing issues. I feel that the healthcare system has really let ourselves and our patients down, by giving us no option to provide less than average care due to staffing/budget reasons.
June 21st, 2010 at 2:10 pm
I can see I am not the only new nurse that is feeling completely frustrated. I have 5 to 7 patients on an oncology floor, and most of our patients are really sick and needy. It is impossible to ever get in front on the game. I I feel as though I only have time to do a quick assessment, pass meds, play maid and waitress… and charting has to come after my 12 hour shift is over. I was hired to work three 12 hour nights (back to back); but instead of our original deal, I am working nights here and there and days on weekends. This past week (6 days), I worked over 70 hours. This is totally absurd. I went to college for four years at age 45 for this? I wanted to spend time with patients and use critical thinking skills (you know all those things we talk about in college). If they taught reality nursing in college, no one would enter the program.
June 22nd, 2010 at 9:50 am
As another said, the economy is not the biggest cause of this, because what you described was going on already long before the economy went in the tank.
Welcome to the world of a nursing shortage!
It’s just so unfair sometimes that so much is expected of so few, with an almost “I don’t care” mentality it seems, for people that are supposed to be caring all the time. It is a paradox. How can there be a shortage of nurses when there’s a waiting list a mile long to get into nursing schools? Some of that is because of lack of faculty as well, but still it is ridiculous.
Every year 80-100 nurses graduate from a ton of nursing schools, but yet nothing changes. Some can’t find jobs (which is economy driven unfortunately), some never actually do this, some give up 6 months in, some go on to get advanced degrees, it’s not hard to figure out why there is a shortage, just hard to understand why it keeps being allowed to go on when there are obvious safety issues.
In all honesty, all it would take is The Joint Commission pulling a hospital’s accreditation, or a nursing school’s, because of safety issues related to staffing and patient care and that paradigm would shift immediately in every organization across the country. But would The Joint Commission ever do that? In all honesty, I don’t know.
But something monumental will have to happen to ever change the course, because as I see it, if issues like that mentioned above are still perceived as “routine” trials of the job, it’s never going to change.
April 23rd, 2012 at 9:07 pm
I’m a new grad on a Med/Surg unit on the day shift where I always have 7 patients, 1 CNA if we’re lucky (for 30 patients), and half the time we don’t have a unit secretary. I’m so overwhelmed ALL THE TIME that I don’t know how to handle the stress anymore. The worst part is that I’m locked into a 3yr contract with this company. I’m trying to switch to nights with the hopes that it will be more manageable.
I’m so wound up from work that I don’t sleep the nights I work (or I wake up throughout the night, so tense that I get headaches constantly). I’m single, just moved to a new city and state that I don’t know anyone in, so I don’t even have a support system to help me get my mind off things.
I really don’t know how to deal with my situation at work, and it’s changed me into a different person. Does anyone have any advice? Thank you!!
May 2nd, 2012 at 9:28 am
Burnout happens fast. You don’t have to have 20 years in this profession to feel “burned out”. I have seen it happen in 1 years time so don’t feel alone out there. The problem is that there is only 1 solution…….get out of nursing. As far as “good” nursing jobs go I would say if you can find a Mon-fri office job, where you are closed holidays and weekends, close for lunch, and get out on time, I think that is the only “good” job out there, but those jobs are coveted and tough to find.Don’t waste any mpore time on nursing if you can’t stand it because it really does not get better over time. I’m sorry if this is harsh but if schools were more realistic in the way nursing is portrayed there truely would be a “shortage”…..
December 4th, 2012 at 5:31 pm
Thank you so much for your story. I am still a new nurse (1 year in) and I’m realizing what nursing really is. Nothing at all what they made it seem like in nursing school. I am expected to do soo much with little to no help from any other team member. I get it done, with no breaks or food or even unable to use the bathroom in 8 hours (which usually ends up being 10-12hrs), but I feel bad for the care my patients could be receiving and what they really are sometimes…it’s sad. Nurses need to speak out and demand more help. Everyone knows patients have many more health problems now with a dozen different treatments they need but it’s still only one nurse taking care of those 5-10 patients…safety, quality and care is compromised… Anyway, I will try to find an ‘office job’ as rondodondo said lol Good luck to everyone, let’s hope it turns around.