Hospital Nurses ? - What is your patient/nurse ratio?

[princesspumpkin]

I think we need a thread for nurses to vent on, lol.

Lol, and I have inadvertently (not by trying, but being too busy to eat) lost 30 pounds in the last year and a half of this job, which is a good thing. Changing and positioning 300-500 pound people has probably also helped out with that.

I agree with the need for a nurse's venting thread, but I remember there being one sometime ago, and the lay people had a fit! It's funny how people can complain about their kids, their parents, the teachers, the president, their neighbors, their doctors (and nurses), but nurses can't complain about their job (especially the patients).

 

[froglady]

I haven't "worked" in over 20 years, but am well aware of the staffing problems, and of the increase in short-term/outpatient procedures, so agree that the hospitalized patients are much sicker than they were when I worked.

I HAVE spent hours in the hospital with my aging parents, especially my dad before his death. I was fortunate in that the nurses on all his units (especially the SIC) allowed me to stay with him as much as possible. I suspect they were happy to have a little extra help; I would bathe him, feed him(once he could eat), make the bed, etc. and generally keep an eye on things.

I would carry a 4-6 patient load on general med-surg, less on intensive care units, but at least one was a patient who was ready for discharge or transfer, so required less care. (Although I did have a "discharge" patient code on me once!)

 

[firstmickey]

I float to different ICU's and the ER. In ICU, we have 1:2 and rarely 1:1. In ED...three rooms assigned but they just throw patient's in the hall on a stretcher when they get filled.

They are now doing a nasal swab in/swab out study in most of the ICU's to check for MRSA. It seems like we have greatly increased numbers of isolation patients.



off the nosocomial topic.....


do all of you get mandated to stay alot? It's getting ridiculous how much we get mandated. You never know if they will let you go home every time you go to work.



and I remember that nurse venting thread....it got pretty brutal!

 

[princesspumpkin]

I float to different ICU's and the ER. In ICU, we have 1:2 and rarely 1:1. In ED...three rooms assigned but they just throw patient's in the hall on a stretcher when they get filled.

They are now doing a nasal swab in/swab out study in most of the ICU's to check for MRSA. It seems like we have greatly increased numbers of isolation patients.



off the nosocomial topic.....


do all of you get mandated to stay alot? It's getting ridiculous how much we get mandated. You never know if they will let you go home every time you go to work.



and I remember that nurse venting thread....it got pretty brutal!

I am very blessed that my unit does not mandate you to stay. We will run short, taking a patient load of 5-8 couplets, though.

 

[Disney Doll]

We have not practiced mandatory overtime on our unit. Generally, there is usually someone who wants to pick up a little OT, or we just work short. The upper administration tends to say "well, if you don't fill the slots, then your co-workers suffer" as a way of guilting folks into it...sometimes it works and sometimes it doesn't. Of ocurse, my response is usually "Well, why don't you hire enough bodies so we can fill the slots?" but then I get told I have a bad attitude. There's a part of me that always feels bad when I know my colleagues are working short, but then there's the other part of me that feels that if we keep jumping in and doing the job, then the adminstration will never get the idea that we are short-staffed, because the job gets odne. Nurses are notorious for not taking breaks or lunch if patient care warrants it...as a matter-of-fact, it's almost expected, which I find absolutely amazing, because that is not the expectation of most other professions. I guess administration and the general public assume that since we are "angels of mercy" that we don't need to eat or go to the bathroom for an 8 or 12 hour shift, even if they tend to s-t-r-e-t-c-h to 10-14 hour shifts.

As far as a nurse venting thread...they tend to not be well-received. The general public likes to think all nurses are thrilled to cater to their every whim. Hospital administrators like to think that their nurses are superhuman, and don't need the normal things that other humans do, such as food, water or praise...we're just supposed to be thrilled to get crapped on and smile as it happens!!!

But, the one thing that keeps most of us coming back is the patients. There are moments when you know you are doing the right thing. And there's no feeling in the world like that!

Now, I am quite sure what I have just posted will unleash a barrage of stories about the "worst nurses in the world", since that's what happens every time a nurse "vent" thread starts to take place. So here's my disclaimer...Not every nurse is good, or even mediocre. Some are bad. Some shouldn't be nurses. But they are the exception, not the rule. And every profession has its bad apples. And for every "bad" nurse story you can tell me, I can tell you 10 good nurse stories, where a nurse went WAY above and beyond the call of duty to help the patient, from staying late, to missing meals, to risking the wrath of doctors and hospital administration because a patient wasn't being treated properly. Remember something the next time you're in the hospital...the only person outside of your loved ones who is really going to care if you live or die is your nurse. And the person who is going to be at your bedside busting their butt to make sure you live, when every clinical sign is saying you should be dead, is your nurse. I have heard more than one patient say "I'm going to tell the doctor". #1-the doctor isn't my boss. #2- the doctor isn't at the hospital,waiting for something bad to happen to you, but I am. #3-when I call the doctor, he or she is going to depend on my judgement, since they are not here. #4-I don't get paid anywhere near what the doctor does, and yet I do it anyway. Amazing, huh????

 

[wilderness01]

Very nice post Disney Doll

 

[Viking]

DW works on a mixed ward treating orthopedic patients (Hip-replacements, knees, shoulders) and female oncological patients (Mainly uterine and mammarian cancer). They have 26 beds attended by 4 nurses during the day shift, 2 during the lateshift, and 1 at night.

 

[Viking]

And yes, there should be a nurse-venting thread: They are underpaid, overworked and not sufficiently valued by society!!!

 

[froglady]

DW works on a mixed ward treating orthopedic patients (Hip-replacements, knees, shoulders) and female oncological patients (Mainly uterine and mammarian cancer). They have 26 beds attended by 4 nurses during the day shift, 2 during the lateshift, and 1 at night.

1 nurse for 26 patients!!! Alone, on the night shift? That's so wrong, not only for the patients, but for the nurse! (The other shift coverage is pretty bad, also!)

What if she got sick, had a heart attack, stroke, etc? What if someone got on the unit? What if she started dozing off? (it happens) What if a fire broke out?

I could go on and on, but it's a tragedy waiting to happen!!!

 

[Viking]

1 nurse for 26 patients!!! Alone, on the night shift? That's so wrong, not only for the patients, but for the nurse! (The other shift coverage is pretty bad, also!)

What if she got sick, had a heart attack, stroke, etc? What if someone got on the unit? What if she started dozing off? (it happens) What if a fire broke out?

I could go on and on, but it's a tragedy waiting to happen!!!

That's standard. A disciplined nurse doesn't doze of during night, that's what she gets paid for. There's another ward on the same floor, so if she has a real emergency, i.e. CPR she gets reinforcement. And BTW, she not only takes care of all the patients, she also acts as gynecological ER during nights. They would love to have another nurse during the day, but it's also a money issue. BTW, a doc is on call as well for the night, but he/she is allowed to sleep as they usually work double shifts. DW usually gets along very well during the nights, even has time to read or watch some TV, but she usually never does more than 2 nights in a row, maximum 8 - 10 per year. She mainly works the dayshift, perhaps 4-6 lateshifts per month.
BTW, she's doing it for 18 years now and no tragedies have happened so far

 

[Disney Doll]

And yes, there should be a nurse-venting thread: They are underpaid, overworked and not sufficiently valued by society!!!

Well thanks Viking. That's very sweet of you to say!!!!

 

[catherine]

I think our hospital (and the ones in the area) are beginning to prepare for shortages and possible legislation by importing Phillipinos. Our first batch arrives in May. I am going to hold off on judgement until I see how that works out, though I would be interested in other people's experiences with foreign nurses.

In thew UK we have a lot of foreign nurses, some being from the Phillipines. We do have some communication problems, especially when they communicate with the patients. In addition I have worked with foreign nurses that don't follow basic procedures for infection control and aseptic technique etc. I don't know whether this is a result in the difference in training or whether it's just down to the individual not caring enough to follow evidence based practice.

 

[cdrn1]

I just got home, called in by another nurse, when I answered the phone she just said, "HEEEELLLLLLPPP!!!!" so I went in even though I had 8 people coming for easter dinner, instead of ham I planned on serving it's now hamburgers. I was there for a little over three hours and it was a madhouse. I started six IV's, admitted two patients, and cleaned two rooms because we needed them for admits and the lone housekeeper was too busy. Then just before I left I got reamed by a doctor because a patient never got her TED hose. Talk about preaching to the choir. I am a stickler for DVT prevention, I almost lost my sis to a PE. It wasn't my patient, I don't know why she never got her TEDs and I can't answer WHY she never got them. So, the b****** yells at me, "WHY DOESN'T SHE HAVE THEM????" and my answer is I couldn't tell ya, "WELL YOU BETTER HAVE A BETTER ANSWER THAN THAT WHEN I ASK YOUR DON TOMORROW!!!" he says. The answer is the nurses have had nine patients each since Friday and they should only have five and they are doing the best they can. I know of no other profession that is treated so poorly and taken so for granted. Sorry to vent. My company got here and sat in the driveway for twenty minutes waiting for me to get home, and I felt guilty leaving.

 

[PrincessKitty1]

For regular people who are reading this thread just for info, I suggest if you have a loved one in the hospital who is unable to care for themselves, DON'T leave them there by themselves - either stay with them or hire a private nurse.

This is the advice I give to EVERYONE who asks what they can do to ensure a loved one gets good care.

In my last floor-nurse job (almost 2 years ago), the nursing coordinator for our unit purposely shorted our rotation every weekend (but not the opposite weekend's rotation--totally different staff) because he knew the two RNs on our weekend (two guys who had worked there for 15 and 18 years) wouldn't say anything (while the nurses on the opposite weekend would have raised holy heck).

Then he hired me, and I went over his head to the ADON on call for the weekend to complain. It fixed the situation for about 6 months. Then he tried it again, and this time all I did was threaten to go over his head again. He fixed it again. The thing is, when we were short staffed, we were NOT giving good care. I don't understand how nurses can keep their mouths shut when they know they cannot give excellent care based on their staffing! It is our obligation to be squeaky wheels for the sakes of our patients (not to mention our own sanity).

The unit I worked on was a specialty unit (a locked geriatric medical/psychiatric unit) and we generally had 4-5 patients each, which doesn't sound like much, but due to the nature of the patients and the unit (many total-care patients with numerous medical problems, patients in seclusion or restraints who required one-to-one coverage, extremely high fall risks, etc.) an increased patient load could be extremely unsafe for the staff AND the patients.

 

[Antonia]

Disney Doll and cdrn1 - sounds like we could have worked on the same units. The unit I was working on got to where EVERY time I went in, I had 8 - 10 patients and families wanting more care than I could provide. Some days we had one nurse tech (nurses aide) for 30 patients. Nearly no one could get a bath and the basic care that people expect for their families. We were so short staffed that each nurse was so overwhelmed with her own patient load there was no way we could help each other exceppt in a dire emergency. It was a telelmetry unit with a ward secretary watching the monitors. Anything could have happened. She had very little training. We complained, but it did no good. Even most doctors started feeling sorry for us. Many of them went to administration to complain and go to bat for us. Nothing has changed. I luckily found a job at an outpatient surgery center that does all urilogical surgeries. It is well-staffed and I don't have to leave after working feeling like I have given sub-standard care. I was working locally in my own community, but left to drive 20 miles to the next town in order to keep my sanity.

 

[Poohlovr]

I work on a 35 bed "monitored med/surg" unit. Day shift has 7 nurses, 4 NAs; evening shift 7 nurses, 3 NAs, nights 6 nurses, 3 NAs. The nurse totals include the charge nurse, who normally does not take patients,except on night shift (charge is supposed to take 3 pts on nights).

We also have 2 monitor techs on days and evenings (one to watch the monitors and one to put patients on/back on monitors--those leads are always popping off) and one on nights. Day and evening shift are supposed to have 1 1/2 unit secretaries (we never do--we're lucky to have 1 on days now, because the full time secretary quit 3 weeks ago and hasn't been replaced; usually a nurse takes the desk--the 1/2 works 11a-7p, so covers 1/2 of each shift, altho we usually don't have that one, either).

We are short staffed on every shift, so we frequently work extra shifts or work short. Luckily, we get a 10.00/hr bonus for working extra shifts, so that helps motivate people to sign up to work extra.

The sad part of this story is that when I started working here, we were a PCU and our staffing was 5 nurses for 22 patients. We were bought by a different health care organization and our floor was expanded by 15 patients and we got 2 whole nurses added. Nothing else changed. Our acuities are still the same (we do multiple drips, chest tubes, we hold patients for the unit, we get patients who have gone bad on a true med/surg and need a higher level of care--the whole nine yards)--we just have to do it with more patients and fewer nurses.

Now, we've gone to a new computer system for charting and it takes a lot longer to chart than with the old system (I feel as if I spend more time with the computer than I do with my patients).

Our hospital has stopped hiring LPNs, so we go short-staffed longer than when we could hire them (we still have LPNs, we just don't hire them any longer).

We have had Phillipino nurses for 2 yrs--most are good.
Now, we are getting Indian nurses--thus far, I am not impressed, but, none are off of orientation, yet, so I guess I have to reserve judgement.

The language barrier seems to be more of a problem with the Indian nurses than with the Phillipino nurses.

Our organization is spending a fortune to recruit the international nurses and move them and their families here. Then, their rent (for a furnished apartment in a very nice complex) is paid for 2 yrs (the term of their contract).

Some of the Phillipino nurses quit as soon as their 2 yrs were up. I expect to see the same with the Indian nurses.

Seems a real waste of money that could be better used.

 

[maps]

12 yrs ago I was a new nurse on a surgical unit at a VA hospital.

This is not an exageration!

We had 32 patients (all postops) and it was:
Me (new nurse)
1 LPN
2 NAs

Talk about stress!! Hopefully things have changed for the better.

 

[Judy from Boise]

How how does a hospital "mandate" that you stay ? Do they threaten to report you to the BON if you leave ? How does this work if managament is at home? When I am on call (as someone always should be) you'd better believe my charge nurse calls me in if they are short!

 

[MEG&MINNIE]

I too have not worked as an R.N. for almost 20 years now,and like the other poster said ..Who will be there to take of us when we get old.... It's nice knowing that many of my friends are still practicing R.N.'s ,so hopefully when we all get older and sicker ...we'll be there as advocates for eachother and keep a close eye on eachother. I must say that the nurses up here in Mass. are getting paid well for their long hours and stressfull working conditions...finally!!!

 

[Disney Doll]

I think there are several reasons for the shortage, none of which are going to disappear in the next few years!!!

1. Women have more and different careers availablke to them than they did 25 years ago. Realizstically, there was a time when teacher, nurse, secretary were your 3 choices if you were a woman. These days, women can really be anything.

2. Though it is slowly changing (thank God!!!!), there is still somewhat of a "stigma" to being a man and a nurse.

3. The pay, while it is decent, is not all that great when you think of the amount of responsibility you have and the working conditions (shifts, holidays, weekends, short-staffing, lawsuits which are threatened at every turn...to name a few).

4. There is an overall lack of respect for nurses. Many people still see us as the doctors handmaidens.

5. Administrators in general have very little respect for staff nurses, despite what they always say.

6. I don't think young people today are as willing to do "dirty" work. Let's face it...there are some aspects of nursing that are dirty and kind of disgusting in and of themselves. I am not the type of person that stuff like that bothers, but it is dirty work sometimes. Even my mother, who is very proud that I am a nurse, will sometimes say "I wish you had gotten a nice clean job" if I am telling her a story about work where there are some gory details.